Health Services are in the news right now. I’m frankly astonished at the antipathy shown by some to me it’s a no brainer. Healthcare should be equitable and available to all regardless of the ability to pay.
I’m British, brought up in a background of socialised heathcare. I’ve seen the good and bad aspects of the NHS. I now live in Canada and can see the good and bad in the Canadian system too. Both systems were based on compassion and brought in by altruistic people who wanted to improve the lives of many.
Britons are generally very insulting and unappreciative of their NHS. Maybe that’s a national characteristic, we tend to be a glass half full people but at least it means we try to make things better and rail against what we feel is wrong.
Canadians are very proud of their healthcare system. They are a glass half full people who see the good side of things. I’ve just benefitted from the Canadian Healthcare System to the tune of one cochlear implant.
Anyway, here’s an overview, hopefully accurate, of the health systems of the two countries. It would be interesting if others would add information about what happens in their country.
National Health Services of England, Wales, Scotland and Northern Ireland.
The NHS was founded in 1948 and brought in by Minister for State Aneurin Bevan. The NHS was intended to provide health care for all from “the cradle to the grave” and “free at the point of service”. Prior to this health care depended on ability to pay or charity. Doctors were self employed, a profession in the old sense of the word. They mostly resented the idea of becoming employees but Bevan negotiated with them so that they could maintain their private work and be paid well by the NHS too. He called it “stuffing their mouths with gold”
The collective principle asserts that… no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.
—Aneurin Bevan, In Place of Fear.
The NHS is funded by taxation but one does not have to be a tax payer to be eligible for NHS services. Eligibility is based on residency within the UK, that your main home is in the UK and you spend more than half the year there. There is no waiting period. Some services are free to anyone;
Treatment given in an accident and emergency department
Treatment for some infectious diseases i.e. TB. ( HIV/AIDS is excluded)
Compulsory psychiatric treatment.
Family planning services
Services are prioritised, triaged on clinical need and so some people have a much longer wait than others. Some people have private health insurance and can chose to be treated at a private hospital. Private hospitals do not provide Accident and Emergency services.
Each country within the UK administers its own NHS, but they are largely similar.
Audiology services are provided as outpatients in hospitals. Hearing aids are provided free of charge, as are batteries, repairs, replacements. There is generally no choice in the type of instrument provided. People can also buy their hearing aids privately if they prefer. Cochlear implants are available, batteries and repairs are free of charge.
The principle of free at the point of service has been eroded over time as governments have found that other demands on the public purse are too great. In 1951 prescription charges were introduced, for drugs and ophthalmic services. The prescription charge is now £7.20 per item but various groups of people are exempt from this; under 16, pregnant, over 60, people on benefits, those with certain long term illnesses. Dental treatment is subject to a minimal charge otherwise free if you are under 18, pregnant, over 60. Many people chose to use a private dentist as NHS dentists are hard to find. Eye tests are free if you are under 16, over 60, have glaucoma, are at risk for glaucoma, need complex lenses etc, otherwise it is £19.
Canadian Health Care
This is often known as Medicare.
Canada has had universal health care since 1966 when the Medical Care act was introduced. The Medicare system was eventually set up in 1984. It took a long while to come to fruition starting in 1947 when the Saskatchewan Government, led by leader Tommy Douglas,(Keifer Sutherland’s grandfather) introduced a provincial program for free hospital care. Doctors opposed publicly funded health care and went on strike for 3 weeks in 1962.
Each province or territory administers its own health service. Federal law under the Canada Health Act sets out the minimum standards for the provision of health services. Edit: The province decide on what services they will provide above that mininum level. Eligibility depends on residency, most provinces have a waiting period of 3 months.
The minimum standards say that the services not covered are those that are not medically necessary.
In Ontario this includes
Sight tests unless under 18 or over 65, or have a medical condition that needs annual eye tests. A sight test cost around $80
Prescriptions drugs as an out patient.
Out patient physiotherapy unless under 18, over 65, or after hospitalization
Hearing aid services are provided privately but each HA purchaser can claim $500 towards the cost of the aid from Medicare. Cochlear Implants are provided free, the user must pay for replacement batteries and repairs once the warranty has run out.
There are various welfare programmes that will provide help for those on low wages but it’s not rare to see fundraisers for an individual’s healthcare.
Many people have health insurance as part of their salary. This is usually only for full time staff, and sometimes after a qualifying period of a year. This will pay varying amounts towards dental work, prescription drugs, private and semi private rooms, the difference between a plaster cast or a fibreglass cast for a broken limb.
The hospitals are publicly funded but doctors are self employed and paid on a fee for service basis, billing the Health Ministry for their services. There is currently a huge shortage of family doctors in Canada. Some people have been without a doctor for several years, the options available to them are to visit walk in clinics or the Emergency Department. Outpatient services are often provided away from the hospital in clinics or doctors’ offices.
It’s illegal to charge for a service that is provided under the Canada Health Act, so private hospitals as understood in the UK do not exist. Though there are some, and this principle is constantly being debated.