Health Care in Newfoundland

Believe it or not it is a coincidence that this will publish during the COVID-19 outbreak. I've been keeping an eye on the Canadian government's response to date and have every confidence that Canada will get its citizens the best care available as well as take care of their financial needs during this uncertain time.

The pictures I'm including are from a hike I took on The Bordeaux Trail in Arnold's Cove this summer.

Much of the Bordeaux trail looks like this

Let's start with what I thought I knew before we moved from the U.S. to Canada, mostly from observation of how my relatives' health care issues seemed to be handled over the years and from their comments.
1. Coverage automatic upon residency. Level of care seemed "fine".  Care seemed up to date and adequate.
2. Sometimes you would have to wait for surgery/care if it wasn't an emergency due to doctor shortages on the island.  For serious situations this would be in hospital, some routine care might be lengthy wait.
3. Prescription medication costs much lower. This I knew from having to buy antibiotics 20 years ago. What that looked like now I wasn't sure.
4. Insurance premiums and co-pays obsolete. Everyone covered, everything covered. Sales taxes higher but overall cost of care much less with no worries.

View of Arnold's Cove from the trail

Level of Care
In our experience, the level of care has been BETTER than what we received in Wisconsin.

• MCP (Medical Care Plan) coverage is automatic. We arrived in Newfoundland, went down to our local Services Canada and filled out the 1 page application. We had coverage within days.
•  There are no premiums, no copays, no explanation of benefits sent to you in the mail because everything is covered.
• Coverage does not include ambulance, dental (unless surgically necessary), vision, prescription, cosmetic surgery, in vitro, acupuncturists, chiropractors and other alternative medicine practices. It was the same with our coverage in the U.S.

Let me interject here that Cory was covered under Medicaid due to his mental health issues in Wisconsin. We tried FOR A YEAR to get him dental extractions. With his autism spectrum and mental health issues/medications his teeth had gone to the point where infection was inevitable and we were having teeth extracted TWO AT A TIME by a dentist because there was ONLY ONE oral surgeon for the southern half of Wisconsin that accepted Medicaid and it would take months to be seen. The first thing we did when we got here was have him seen by a dentist who referred him to an oral surgeon and by August he was in the hospital and had them all removed.  It was 100% covered by his MCP and his suffering was over.

• You have to see your doctor every 3 months and undergo bloodwork in order to refill your medications. Doctors are obviously properly trained and ask all the right questions. In the U.S. we had to see the doctor once a year to get medications.  I'm impressed by this 3 month requirement, obviously more chance for doctor to discover problems and treat them early.
• If you have the flu or just have questions you can get seen in a day or two. Waiting room times are no longer than in the U.S. and often less. This may vary by town, but I doubt it since we live in a rural area. St. John's may be a little different with its higher population.
• Medical records are electronically shared across all platforms. If you see your doctor, then get testing done in St. John's or get anything done anywhere they all have access to your information. In the U.S. this was only true for us if we saw doctors within the same hospital network.
• Couseling is available at our rural location every other week on a walk-in basis. Free. Yeah, let that one roll around in your head for a minute. You don't even show your MCP card, just sign in or call ahead and book a time if you prefer.
• Since arriving I have had a tetanus shot and been seen for medication refills. Wayne has been seen for breathing issues and has had testing done related to that. Cory has obviously been seen the most for his mental health care and it has been REMARKABLE. I will get to that in another post rather than try to cover it here. 

Plenty of berries for snacking along the way

Waiting for Care

This one is a bit tricky. It is not completely untrue that you may have to wait for surgery/specialists in some situations. We live on an island. Doctors don't want to come and live here. I have heard from relatives living elsewhere in Canada that they do not really have this issue. Obviously we didn't have to wait long for Cory's dental surgery, and he was seen by a psychiatrist within 2 months as well I believe.  Again, we had problems with psychiatrist shortages in Wisconsin so not something we felt was unreasonable.  I have been waiting a few months to find out when I will be scheduled for a routine endoscopy which is certainly something I'm in no hurry for.

However, I do have a relative that has been waiting up to a year to see a neurologist. This is unusual, and due to extreme shortage of neurologists on the island right now. I am guessing his primary care doctor is consulting on medications to prescribe to control symptoms and that if they thought the need was urgent he would be seen. Why? I have another relative have a stroke just days after we arrived this spring. She was obviously cared for immediately and actually STAYED IN HOSPITAL for weeks before being transferred directly to a rehabilitative center.  She underwent all her rehabilitation as an inpatient for at least another month. When my father had a stroke in the U.S. I guarantee you he did not receive full time inpatient rehabilitative care. This is not her first stroke, and her recovery has been miraculous in my opinion due to that extensive rehabilitation process.

When I was searching for a psychiatrist for Cory in Wisconsin there wasn't a single one in 3 counties who was taking new patients UNLESS YOU WERE HOSPITALIZED and that was how he got his care initially. When we wanted to switch we ended up having to drive an hour to the Milwaukee area to get seen by someone. So this happens in the U.S. as well. Private insurance is no guarantee of services, not to mention of coverage.

When Wayne needed a CT scan and a lung function test the orders were sent in by his doctor and we received a letter in the mail of his appointment dates in St. John's. The scan was a 2 month wait, the lung function test was 4 month wait. From this I deducted they didn't really think he had a lung tumor or he would have been moved up the list, but the tests still need to be done to rule everything out. In other words, not everything is an emergency and if it was there would be no delays. 

Exploring a bit off the trail is always the best part

Prescription Costs

Look, I don't even know where to begin. So I'll start with the fact that I got 90 day refills on our medications with our flex spending money before we left the U.S. The only precription medications I take is an inhaler for occasional mild asthma flare-ups and one for arthritis.  I was spreading out the arthritis medication usage (something no one would think of doing here to my knowledge) and getting by on Tylenol and Advil when I could to make it last. I had a flare up and it finally ran out. Right before I left for this work trip I got it refilled and was told that I also had low iron.  I picked up my prescriptions for Fosamax and Meloxicam and laughed out loud when they told me $34 CAD for the both of them total. Without insurance. I pay more for a haircut or lunch for two. I probably would have paid more WITH insurance copays in the U.S. considering the equivalent is $25 USD.  Wayne's inhalers for his pulmonary issues have been similarly priced.

I even spotted currants growing wild under some trees

Taxes

I don't know what "Medicare for All" would look like in the United States or how it would be paid for.  Yes, sales tax is higher here.  Before moving I did the math.  We were paying about $1,000.00 a month average for Wayne and I in premiums, copays and deductibles. I computed our average monthly spending of taxable items here and maybe you are looking at an extra $100 month. What about big ticket items like furniture or a TV? If you were really concerned they have "save the tax" sales here all the time, buy your big items then. And otherwise our cost of living has been the same. Groceries, utilities, internet, cell phone, cable, all the same after exchange rate differences.  Our property taxes are lower, but our heating cost may be slightly higher. Only noticeable price increase is fuel cost, but we drive a lot less so it's still a decrease in spenditure. One hundred dollars a month versus one thousand dollars a month? For the same or better care? For coverage no one can take away?

Happy and healthy Canadian!

The take away - we are beyond delighted with our care here. The fact is that we have no intention of ever moving back to the United States.  Even if Medicare for All were to become a reality there is no way it would be as straightforward as it should be once it got passed and no way it would be as cost effective as it is in Canada.  Now if we could only convince our daughter and her fiance to move here, right? Unlikely, but I'll keep dreaming.

I'll go over Cory's mental health care experiences in more detail at a later date.