health services in gt britain and canada

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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
Dental work
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.

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10 responses »

  1. Very interesting! I think part of the reason Canadians are so proud of their medical-care system is because, while imperfect, it looks pretty good compared to that of our neighbours to the south.
    However, it's very much a Provincial system rather than a National system. When it comes to non-basic care, the level of coverage varies a lot across the country. e.g. Hearing Aids are largely paid for in the more populous provinces but not in the smaller ones such as New Brunswick. See http://www.chha.ca/documents/Hearing_Aid_Subsidies_Across_Canada.pdf for some more details on this.

    Steve P.

  2. Hi Steve, good to see you on here.
    You are of course right about it being Provincial System and I have edited my post to clarify this.
    Thanks too for the link re hearing aid provision, that will interest a few of us. I think it's shocking that HOH in New Brunswick and other Provinces have no help towards HAs. The cost to the Province for benefits when people can't work because they cant hear etc has to be included. Of course there may be schemes where welfare will pay for HAs but it's wrong not to consider being able to see and hear as part of essential health care. BTW the $1000 Ontario gives towards aids isn't much when the aids cost $7,000. Hearing services in the UK aren't much better when you have no choice in the type of aid you get.

    Manitoba doesnt have any Cochlear implant services and sends patients to Ottawa for treatment. A 4 year waiting list! How on earth do they manage with their followup appointments?

  3. Quite an interesting comparison

    I think the British have it in there blood to complain about the nhs

    My dad has literally just ( today) been diagnosed with prostate cancer

    Whatever people might say about the nhs at least I know that he'll be seen by a urologist within a fortnight ( two week referral) and that wahtever treatment he needs won't bankrupt him!

    I shake my head in despair at the Americans in the news protesting against healthcare reforms. I really don't get it

    Z

  4. Shake your head if you must Z, but if you have not read the bill that is being presented to us, then how would you know what is being protested? I have read it and I protest. Don't believe everything you hear or see in the media.

  5. Very interesting Leigh. There are slight differences in the NHS in Scotland – one of which that prescription charges are £4 at the moment, with plans to abolish them by 2011. I do feel that the NHS is very stretched to provide all services free at the point of care but the majority of staff are very committed to carrying out this ethos. However funding is always finite and, particularly with the recession, it gets harder to manage.
    I feel that we really have a good Health Service all things considered – maybe I'm biased! Yes, there are failings but these are in the minority – nothing is perfect!

  6. Glenice, I think Z means people such as the senator who was saying people in Canada died because they were considered too old to be treated. The bill is rightly being contested, that's what democracy is about and the duty of any opposition party.

    The idea of eugenics and being killed off because we are old or disabled is anathema to me, and I have no doubt to many too. However there are those that equate socialised medicine, equality of access to heathcare and bad medicine as the same thing. This patently isn't true. Britain and Canada have many world class medical centres. Plus both countries have a higher average life expectancy than the USA.

  7. Sorry if I misunderstood Z's intended meaning. There are so many things wrong with the bill they are pushing in the US, it is quite upsetting. It is nothing like the medical care you described above.

  8. Interesting post, Mog.

    It is amazing the crap floating around US websites.

    Dental care is only covered if you are on welfare, and then it is inadequate. There was a huge article in The Star about that.

    I write a lot about Ontario Health Care and seniors (http://ontarioseniors.blogspot.com/) and have seen all the bizarre stories posted on US sites. They are crazy! Like they will kill those they deem palliative since they are using up too much funding. OMG they are crazy.

  9. To,
    The Incharge Of Audiology Department,

    Subject- Appeal For Help.

    Sir, Most respectfully, it is stated that i am SOHAIL SAJJAD GILL . I am in suffering from complete deafness due to a chronic disease since some months (last 6 months).
    Docters have suggested cochlear implant of both ears, but this is not possible in pakistan.
    i belong to a poor family i can not afford it plz help me. i want need ur help and kindness, so can spend my life normally.
    i send u docter,s reports
    Patient/Name… SOHAIL SAJJAD GILL
    from PAKISTAN

    i am waiting ur answer

    • I’m sorry to hear of your predicament but I am not in a position to help you. I don’t work in audiology nor do I have $$$$ to spare

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