Ah, I replied to the wrong comment. "Canada is that it's basically the only country in the world wherein it's illegal to pay a doctor to help you" - this is factually untrue. There are private medical clinics in Canada. Doctors are not allowed to bill both provincial health systems as well as the patient at the same time.
The Canadian system is a mix of private and public, with a mix of national and provincial funding, some national standards (tied to funding), and provincial jurisdiction.
For procedures covered by provincial health programs, doctors in private practice (GPs, at least some surgeons) give the service to the patient and then bill the government for that amount. For services that aren't covered by provincial health programs, GPs/surgeons bill the patient.
Provincial health care programs cover anything medically necessary. My general understanding is that you cannot pay to have a service done which is covered by a provincial health program. The intent is to prevent the establishment of a two-tier health care system.
It's probably less complicated than the US system, but it's still complicated.
More or less correct, healthcare in Canada is mostly “private” with a single public payer on a provincial level. One other difference is that hospitals are owned and run by the government (with slight variation between provinces) so they don’t bill the government and are instead given large annual budgets with some incentive based payments.
Imagine the US system with Medicare as a single payer setting rates and HHS owning all of the hospitals.
Physicians (for the most part) bill the government on a fee for service basis and most do so through a medical professional corporation that only physicians and certain family members are allowed to be shareholders in.
It is illegal to charge for services insured by the government. It is not illegal to charge for uninsured services (for example some knee arthritis injections) or those not insured (e.g. visiting Americans).
I knew Dr. Day professionally, he has run an ambulatory surgical center (different from a private clinic, all freestanding clinics are “private” in Canada) for several years now and the issue with his practice is they are providing insured services (like joint replacements) charged directly to the patients. Although technically illegal, the BC government has let this happen due to long wait times and lack of political will in their voter base but this recently gone to the legal system.
There are some rules hobbling the private system in Canada that don’t exist in every country with universal healthcare. As I understand it, if a doctor participates in the public system they’re limited in their ability to accept private-pay patients. Happy to take correction here from Canadians who know better.
First, understand that there isn't really a Canadian federal health care system. The Canadian government (federal) transfers funds to the provinces, which operate health plans for provincial residents. The provincial health plans control the number of available specialists. A health care provider can only bill the provincial plan if they have a billing number, and the provincial plans manage billing numbers to limit/encourage specialists and to make sure doctors provide services in less populous areas. I don't know if it's still the case, but historically there was no private alternative available (so doctors couldn't operate a private practice that didn't need a billing number from the provincial plan). If provinces chose to allow private practices, the federal government threatened to withhold funds from the plan.
As with most western democracies, Canadian doctors are well compensated in comparison to the rest of society. But it is generally understood that they can make more money in the US if they qualify for immigration (and many can because of rules allowing people with specialist skills to get immigrant visas). This also contributes to reduced supply of specialists, and longer waiting times.
To get to see one of the available specialists in Canada, you have to have a referral from a primary care provider. Here in the US (in my experience) a referral is as simple as saying to your GP, "I want to see a cardiologist." Then your GP says "Oh, sure, this one's very good. I'll refer you." In Canada, your GP has to follow plan guidelines for referrals, and confirm that it is warranted. Then you get on the waiting list for the specialist. You'll wait for a consultation. At the consultation the specialist will determine whether or not you need treatment, and the urgency. Then you go on the waiting list for treatment.
Of course, Canadians with the financial resources are free to travel to other countries to obtain medical treatment more quickly. The provincial medical plans do not pay for treatments obtained outside of Canada. Medical "tourism" is not that unusual, including travel to the US and other countries.
Incorrect about Canada. Doctors are prohibited from practicing in both the public and private hospitals. There is almost no private surgery - people just go to the US.
I am in Quebec and here the state sets the rate for every single reimbursed act. Doctors can opt out of the public system, but then they can't take any reimbursement from it at all. It's all or nothing. Needless to say that the overwhelming majority of doctors opt to stay in the public system.
I assume it's similar in other provinces and therefore your premise is mostly wrong.
Private insurance in Canada barely exists, and primarily covers prescription coverage and paramedial (acupuncture, chiropracty, TCM, etc.) Inpatient prescriptions are covered by provincial health. Doctor's visits are covered by provincial health. Dental may or may not be covered. Hospital stays, urgent care, ER visits, routine checkups, mental health are covered by provincial health. Health hotlines (call a nurse) are literally free. There's no such thing as "pre-existing". There's no such thing as medical billing.
Of course not. Canada's healthcare system is not, at the point-of-care, a business. Whatever business arrangement that exists is between the government and providers, not me and my doctor, so the latter relationship is not directly constrained by economic concerns, as is the case here in the US. If that appointment had taken place in Canada - and let's be clear first that it would not have, as I would have been insured unconditionally since birth and able to deal with each issue as it arose - the doctor would have either helped set up a treatment plan then and there, or she would have let me know that it would require another visit or two to go over everything, as here.
The difference is that I would not personally be out 1-3 weeks worth of food money for each visit, just establishing my baseline. In neither case would what happened be a "matter of billing" because I would never receive a bill.
Yes, it is absolutely true. Literally from the Canada Health Act: "Private health insurance plans are prohibited from duplicating coverage for health services provided in Canada which are insured under the Canada Health Act."
If you start to provide services normally covered by the government, you will be shut down, or you'll have to take your case to the Supreme Court where this law is still being tested.
There are places that provide parallel services, they operate in a grey area. For example, the Supreme Court of Quebec ruled that private services can be provided for treatments wherein the government does not provide 'timely service' i.e. 'wait times are too long'. But exactly the parameters of those 'wait times' nobody knows, and the only way to find out is to go to the Supreme Court. So not a good business plan.
I'm not an expert, but my understanding is that it is common in single-payer system to outlaw at least some forms of private practice, see for example:
> In addition to public health care providers such as primary care doctors and hospitals, many private clinics offering specialized services also operate in Canada. Under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act.
One of the EconTalk links I posted above has an interview with someone who started a hospital that takes no insurance, and the total payment for a procedure is less than the co-pay for a procedure at hospitals that take insurance (or at least, that's their claim), and their cited cost was much more than 13% less than the study claims can be done. In that interview, he discussed how people had problems getting basic procedures done in a timely and affordable fashion at other hospitals.
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