Health Care Takes a Holiday: A Comparison

Yesterday I saw a new side of the much-hailed Canadian health care system. People in Canada (at least those in my population sample, which consists mostly of women at the gym and at church) are quite proud of their healthcare system, even as they complain about being on waiting lists.

Many of my American friends say they envy me because I am living in this country with this "fabulous healthcare system." Others are horrified because I have to live in a country with this socialized medicine, which "everybody knows" results in inferior care.

I've written a few times about the healthcare system. Fortunately, I haven't had much reason to. I am healthy (knock wood) and have little need of the system. Which is good because I don't have a family physician. I go to the walk-in clinic when I get sinus infections. I've been maybe three or four times in my going-on-four years here.

Yesterday, I was just along for the ride. My husband had a minor skin irritation that became infected and suddenly swelled, and he obviously needed an antibiotic. His family physician recently retired, leaving him an "orphan," and in any case, it was something best treated at a walk-in clinic. And thus began a bit of an odyssey.

We had at least thought to check which walk-in clinics are open on Friday afternoons. However, as we drove around town from clinic to clinic while the afternoon waned, we discovered that all the walk-in clinics were closed. Why? March break.

I understand that physicians are people too. They have kids. They want to take holidays. But closing ALL the "open on Friday" walk-in clinics really does NOT seem like a good public health policy.

Our last option was the Emergency department at the hospital. It was a perfectly fine experience. I would have felt a little foolish for bringing such an obvious non-emergency to the hospital, but apparently none of the staff showed impatience.

When my husband was called to the inner sanctum to see the doctor, he explained the nature of his "illness," finishing with, "...and all the walk-in clinics are closed."

"Don't I know it," the doctor replied.

Apparently we were not the only ones surprised.

Still, it was only a three-hour adventure, including waiting around for the prescription and all the driving hither and yon.

I've been trying to imagine how this would have played out if I'd been the sick one at 4 on a Friday back when I lived in the U.S.

One option would have been phoning my family practice physician's office to see if (a) he could see me quickly to prescribe the antibiotic or (b) if he'd believe me over the phone and prescribe for me. Option A is more likely, but truthfully not likely at all. If I'd seen him, I'd have had a copayment of $15 to $25.

The next option would have been a walk-in-clinic equivalent--an Urgent Care Center, known as a "doc-in-the-box." The cost for this visit would be more than the co-pay for the family doc. Although the clinic might bill my insurance company first and bill me for the remainder, it's equally possible that I'd have had to pay and request reimbursement. Plus, my insurance would pay something like 80%, but only if I'd met a deductible (which was I think $500). So this option would be more expensive than the first.

The last option would have been the Emergency department at the hospital, which would have been the last resort. The costs there, too, would probably be covered (after meeting the deductible) at 80%. But an ER visit would have run into some money--probably hundreds out of my pocket.

And of course I'd have been paying monthly premiums for an insurance policy. If I had an employer other than myself, my employer would be contributing, too. So for a relatively healthy person, I'd have been paying what now seems like a lot.

Because up here, a swipe of the health card and you're done. The antibiotics cost only $13 because we do have a drug insurance plan with monthly premiums.

As healthcare goes, the whole experience was fine. As I've said before, healthcare systems are systems, which means that they are designed by one group of fallible people and run by another group of equally fallible people, and therefore they don't function perfectly. Each system has pros and cons.

I choose to live here and I can handle the system here. In fact, in thinking back over my options in the U.S. vs. what happened yesterday, I'm pretty glad to be here.