why I'm here

[bunnie]

and if she were to pay it would cost her ....$US5,000 ... for a course of antibiotics that here would cost $AU15 (about $US10)!

Wow! that is shocking!

Someone told her that there was a nearby medical service for homeless people

But why should there need to be? I mean I understand why there is one, but in Britain anyway, it doesn't matter if you are on the streets, or not registered with a GP, everybody is seen at their local hospital, or wherever one happens to be.
It's hard to get one's head round it really. How was it Lg that you finally saw your derm regarding payment. Did your GP know ways round it so you got her services free? Do you pay for anything at all?
Are there clinics in America that people can go to if they are ill and have no money? Would they be admitted to hospital if necessary, even though the docs know they cannot pay?
Bunnie

[LIGA girl]

in Britain anyway, it doesn't matter if you are on the streets, or not registered with a GP, everybody is seen at their local hospital, or wherever one happens to be.

It is the same here, Bunnie ...

How was it Lg that you finally saw your derm regarding payment. Did your GP know ways round it so you got her services free? Do you pay for anything at all?

I have to pay a % of the fee, about 30%, then once I reach a "safety net" of $500 for the year I pay virtually nothing, that happens round June usually. I pay $4.90 for prescription drugs and for some of them I get months' supply for that amount.

Are there clinics in America that people can go to if they are ill and have no money? Would they be admitted to hospital if necessary, even though the docs know they cannot pay?

If one is to believe what is in "Sicko", patients are literally dumped on the streets if they are unable to pay. It is an aptly named movie .....
LG

[CalamityJane]

Hi all:

Briefly an answer to Blue's question,

Quote
In Canada, Province of BC we seem to be caught in the middle, and many services, like podiatry, eye exams have been taken away.  Particularly hard for seniors on a fixed income.

 Is the health care system changing in Canada? It sounds like it.
Was this recent and what do you think of the health care system in Canada, in general?

I'm in BC, and Itchy is in a different province, and that in itself makes a huge difference. The services that disappeared from BC did so in 2002 I believe when the latest Government was elected. They tore up Collective Agreements w/many of the unions, including the Hospital Workers and Auxiliary services. Along w/others, Podiatry, eye examinations have to be paid for. It gets complicated. Physio you have to pay for. I have a "Plan", but the 'plan' only pays $7.00 per visit to the physio. Physio's charge $65.00 approx. for initial visit and about $35.00 thereafter. My plan has a deductible of $250.00 each calendar year. I think if I reach $1,000 (copay), then all the coverage is free, or nearly so. All of the Canadian provinces are different. However, I believe all the Provinces get many $$$ from the Federal Government, and we in BC believe, (or some believe) that the East is favoured. Our current problems come entirely from the current provincial government. Is that the same for you LG?

BC residents pay premiums for their medical coverage on a sliding scale. Prescriptions they have to pay for. Regarding hospital visits, through Emergency, by Ambulance, there is firstly triage, which is a good thing. If you drive yourself as Itchy notes, you will have a wait. In BC, some folk have waited many, many hours, including the elderly in hallways, office space, wherever they can be put. Our wait lists are horrendous, despite the governments claims. People waiting for hip/knee replacements for example, will often die while waiting. The government calls this "keeping up". The wait for specialists is sometimes very long indeed. The last Derm I saw (who did really nothing, and was not the slightest bit interested), I'd waited a year to see.

There is access though for everybody, if you are on the streets, there is help available. That's a huge plus IMO. I think our system is more like Oz, and if pushed I'd say more like UK, rather than USA. I have an acquaintence who is a US citizen, living here in Canada. Has a US passport. She can't go back to live in the USA simply because they cannot afford the medical insurance. They are in their 70's and can't risk it. In BC they feel secure and I do believe there is some security here. I also believe at times you need to be desperately ill, or nearly dead for it to kick in.

People come in droves across the border here from the US to have prescriptions filled. (Is it the same where you are Itchy?) They do that because it saves them hundreds of $$$. There was a huge debate about it, and I don't know the resolution, if any. 0T0H, Canadians flock across the border to buy US gas I'm not surprised at LG's story re her daughter. In BC, she would have had to pay upfront I believe, but would have been able to claim on her travel insurance upon her return.

Very interesting post Itchy, gives me an idea what it's like in your Province.

Jane

[bunnie]

Hi Ladies
LG

I pay $4.90 for prescription drugs

I think ours are 2 1/2x more than that, but we don't pay another penny to the doctors or for services, except of course the Nat.Ins.Cont. which is deducted from the wage packet. I get everything free except my specs, but I do get a reduction.
I would really like to see that film!
I just wondered if anybody could leave advice on the thread that moeim has started, as to ways and means people in America (and other countries) can get treatment. There must be other ways, so that people, as moeim said, do not have to make a choice between health care and other necessities.
Bunnie

[itchychick]

Jane, Toronto isn't really a border city, as it's quite a drive from the nearest bridge crossing over Lake Ontario, so I don't know how much "cross border shopping" there is for medical care.  I do remember several months back, there was a lot of press over Americans getting their prescriptions filled on-line by Canadian pharmacies, but I don't remember the reasons (it must have been cost related)

As far as prescription coverage goes, here in Ontario seniors (over age 65) and people of Social Assistance have to pay $6.11 for every prescription, regardless of whether the prescription costs $10 or $200.  There are also some drugs which are not covered - for example, Protopic is not covered, so if a senior wanted it, they would have to pay out of pocket.  Which drugs are covered is decided on the basis of efficacy and cost.  If there are cheaper drugs which have similar effects, those will be covered before the less proven, more expensive ones.

Having said that, most employers have drug plans that employees are covered by.  We, for example only pay 10% of a prescription fee, so my $100 script for Protopic costs us $10.  These private plans vary, naturally.

As far as other types of health care, in Onatario we are not covered for massage therapy, physio (unless it's in a hospital setting for rehab purposes after, say, a stroke...), optometry, dentistry,  etc.  A few years ago, however, they reintroduced free eye (optometry) exams for children.  And I recall that when I was little, there was free dentistry for kids as well... but I think that may have changed.

The thing to know about Canada is that there are really 14 different health care systems, as every province is slightly different, and the military has it's own system as well.  What is constant is that there is some form of universal coverage everywhere.

Unfortunately, I can't offer any advice to Americans who are without insurance - my dh who works in the industry and worked in the States for a few years knows of nothing to suggest either. 

If you all are interested, I'll see if Tim can put up a link to his company's website, which details the specifics of each provinces health coverage.

[CalamityJane]

Hi Itchy, no, you are not a border city! Just because I can see the US, I think everybody else in Canada can as well.

Having said that, most employers have drug plans that employees are covered by.  We, for example only pay 10% of a prescription fee, so my $100 script for Protopic costs us $10.  These private plans vary, naturally.

My plan pay 80% after I have met my deductible of $250.00.

Yes, every province is different. Our is similar to yours in many ways, and all the diagnostic tests are "free", if you don't die before you get in! We are much better off than US. For me it would be very unnerving if I couldn't get to a doctor for even a small thing w/o paying a huge sum.

do not have to make a choice between health care and other necessities.

I don't know of anything here, but then again, we are not in that situation. Everybody has access and there are social agencies that will pay for prescriptions.

[LIGA girl]

Hi ladies

to answer some of your questions, ours is a national system as far as the drugs and the rebate for doctors' visits go, but the hospitals are managed by the states here. So the rebate for your fee to see a doctor is standard nationally (though docs can charge what they want and some will bulk bill Medicare for patients such as me who are on benefits, which means I dont have to pay anything). Specialists are different as I said, I have to pay for most of mine but some are attached to the hospital and are free. The waiting to see a specialist can be very long (6-8 months) here too but if you are an urgent case the GP can hurry things up and that is what has happened to me with my illness I have never had long wait since getting it. When I needed to see my derm in Sydney I didnt even need to have the GP pull those strings for me, I easily got an appt and I think it is because she specialises in bullous diseases so there arent that many patients around with what we have and she is keen to see as many as possible. I have to say that now I am in this category of patient that the system has really been good to me, whereas before I was just a normal person who went to the docs occasionally and had to pay for everything (but it still came to a lot less than I pay now as I only went once or twice a year for fairly minor things).

Regarding the costs of our drugs, the ones that are $4.90 are ones that are on  a national list, everything else is much more and my HRT is like that. There is also a scheme where you get 5 repeats for the price of one for certain drugs if you have certain chronic diseases and I get my cortisone cream and scalp lotion and my erythromycin under that scheme. The new drug I am going to be having, Rituximab, is a very expensive one and an application has to be made to a hospital committee to approve it for patients and they do so on the basis of the severity of the disease and the other number of drugs that have been used on that patient without good outcomes. The drug Mycophenylate mofetil that I am on now is also in that category. I get it for $4.90 even though its full cost is $600 per month.

LG

[bunnie]

Rituximab, is a very expensive one and an application has to be made to a hospital committee to approve it for patients and they do so on the basis of the severity of the disease

Exactly the same here, but I wouldn't have to pay anything. This is the card my derm has up his sleeve for me LG should it break down again. As I have had the disease many years now he is hoping it is finally slowly burning itself out. My worst problem now is if these cells change yet again into cancerous ones. I am very anaemic even though i am only on 50mg of dapsone now, but  my bloods are low as if I was on Interferon or something, due to the treatments I have had in the past. I do know for certain that here in Britain the cost of IV rituximab is £20,000. We were discussing it at my last appointment, end of January.
Bunnie

[LIGA girl]

I would get the rituximab for free too Bunnie and he is confident it will be approved for me as he is on the approval committee and I have tried so many things. I didnt know it was that much, L20,00 would be about $50,000 here .... he said the treatment was valued at higher than $10,000 and I didn't ask how much higher ....

I am lucky that my bloods are still in the normal range, it must be a miracle after what I have been through, tho I know you have had many more drugs and bad reactions to them too.

LG