Author Topic: Canadian Healthcare Future Proofing  (Read 19166 times)

aloevera1

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Canadian Healthcare Future Proofing
« on: January 08, 2024, 09:53:28 AM »
Hello my fellow Canadians what are your thoughts on the subject?

Lately issues with Canadian healthcare have been making all the headlines (surgery wait times, overfilled ERs, lack of family doctors, etc.etc). And while I am aware that the quality of care we are receiving is still significantly better than some areas in the world... I do wonder what the future holds from the financial perspective and quality of life perspective.

I don't really want to start a discussion on political climate & how we got here. There is a lot of bitterness and a lot of intellectual debate on this around the Internet.. I am more interested in your thoughts on your personal planning. Are you hoping that "things will get themselves sorted"? Are you perfectly happy with everything? Are you including extra margins for the pessimistic situation of having to pay for everything and/or medical tourism? Any other creative approaches to planning for future healthcare needs?

Obviously, the advice to simply stay healthy is great, it's just we are all adults enough to know that during our lifetimes we or our our loved ones would need health care.

Sooo where are you at?

treffpunkt

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Re: Canadian Healthcare Future Proofing
« Reply #1 on: January 08, 2024, 11:00:53 AM »
Are you including extra margins for the pessimistic situation of having to pay for everything and/or medical tourism?

This is my plan. Most people I know have chosen to pay privately at some point in their lives for accelerated surgery, diagnostics, or procedures. The system has been declining for decades so nothing short of a miracle will result in "things will get themselves sorted". 

okits

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Re: Canadian Healthcare Future Proofing
« Reply #2 on: January 09, 2024, 10:38:04 PM »
I am more interested in your thoughts on your personal planning. Are you hoping that "things will get themselves sorted"? Are you perfectly happy with everything? Are you including extra margins for the pessimistic situation of having to pay for everything and/or medical tourism? Any other creative approaches to planning for future healthcare needs?

Perspective of someone living in Ontario.

I think you can help yourself a little by living someplace where you have a better supply of medical care (I'll generalize this into urban vs. rural).  Knowing how to advocate for yourself or a loved one in a medical situation is also helpful, as are connections to people working within the medical system (who can advise you on what you should ask for or put you in touch with a helpful contact).

Saving extra money so private pay is an option is a definite yes.

c-kat

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Re: Canadian Healthcare Future Proofing
« Reply #3 on: January 10, 2024, 09:46:18 AM »
Thanks for bringing this up, as it is something that I've been thinking about quite a bit lately.  I do think we're going to add extra to the retirement budget in case we need to pay for private tests etc.  I recently had to have an MRI and my doctor even offered to give me a requisition for a private one in Gatineau for $1300. I decided to wait but if it had taken too long I would have gone back and asked for the private requisition.


Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #4 on: January 10, 2024, 10:22:07 AM »
I plan to have a second residence in Mexico, that's how I'm solving the problem.

ETA: a big element of being able to get good care in places like Mexico is having a network that can help you navigate the system. Medical tourism is unfathomably dangerous and inconsistent. I have enormous extended family in Mexico and plan to live there half time so that I can safely navigate the healthcare system.
« Last Edit: January 10, 2024, 10:23:59 AM by Metalcat »

aloevera1

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Re: Canadian Healthcare Future Proofing
« Reply #5 on: January 10, 2024, 10:46:41 AM »
Thank you for responses @treffpunkt, @okits, @c-kat, @Metalcat. I'll respond below. This is also just thinking out loud. :)

Most people I know have chosen to pay privately at some point in their lives for accelerated surgery, diagnostics, or procedures.

I also think about this. The problem with the margins approach is our inability to semi-accurately predict the cost. Like a small discrepancy is somewhat manageable over the long term. Being wrong by 100x times has huge applications both for health AND budget. Going over crazy with conservative margin means no FI and essentially working for your hypothetical budget...

Say, I would be a lot more comfortable budgeting for future dental in Canada because at least there are some ballpark numbers right now.

Given that we don't have a private system as of yet (in Canada) there are no estimates. I wonder if the US or some other country could serve as a source of data and then have that country as a backstop for future medical trips.



Perspective of someone living in Ontario.

I think you can help yourself a little by living someplace where you have a better supply of medical care (I'll generalize this into urban vs. rural).  Knowing how to advocate for yourself or a loved one in a medical situation is also helpful, as are connections to people working within the medical system (who can advise you on what you should ask for or put you in touch with a helpful contact).

Saving extra money so private pay is an option is a definite yes.

Agree with all items. I do find that there is a huge medical discrepancy in access to medical services in the country. This trend will probably exacerbate as we go forward. Politics, cost of life, infrastructure, etc, really determine where doctors/nurses/etc go. It's not a uniform distribution :D

Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.


Thanks for bringing this up, as it is something that I've been thinking about quite a bit lately.  I do think we're going to add extra to the retirement budget in case we need to pay for private tests etc.  I recently had to have an MRI and my doctor even offered to give me a requisition for a private one in Gatineau for $1300. I decided to wait but if it had taken too long I would have gone back and asked for the private requisition.

Glad the MRI worked out! Where I am the wait times for MRIs are huge. Did you still need a requisition for a private MRI? Wow.


I plan to have a second residence in Mexico, that's how I'm solving the problem.

ETA: a big element of being able to get good care in places like Mexico is having a network that can help you navigate the system. Medical tourism is unfathomably dangerous and inconsistent. I have enormous extended family in Mexico and plan to live there half time so that I can safely navigate the healthcare system.

Oh that is interesting. I heard very conflicting things about health care in Mexico.. But yea, it makes lots of sense if you have people around familiar with the system. Do you also speak the language?

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #6 on: January 10, 2024, 11:13:52 AM »
Medical care in Mexico can be fantastic if you know how to navigate the system and you speak fluent Spanish.

My family is in Cuernavaca, which is close to Mexico City, where my access to specialty care would be INFINITELY superior to my access here since it can take a year or two to even get an appointment with a specialist, and I often have ZERO option for a second opinion. With premium insurance down there, I could basically see whatever kind of specialist I need very quickly, especially if I'm well networked within the professional class in the area.

As someone with a complex systemic health condition, I require a lot of specialists, so more access would be a huge improvement.

The other benefit for me medically in Mexico is actually supportive care. It's quite normal for working/middle class folks there to have domestic help, it's extremely affordable. For me, that's a huge element moving forward.


FLBiker

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Re: Canadian Healthcare Future Proofing
« Reply #7 on: January 11, 2024, 12:25:33 PM »
Just to add another perspective -- we're US citizens, soon-to-be Canadian citizens, who have been living in rural Nova Scotia (but near a hospital) for about 3.5 years.  Our hospital is decent, and we've used the ER for small issues over the years (especially because it took us 3+ years to get a family doctor).  That said, the doctor we eventually got is great (and very accessible) so it's all good, for now.  I'm definitely budgeting for (and open to) adding some sort of private health care in the future.  Plus, once we hit 65, both DW and I will qualify for medicare in the US, so we could potentially use that as well.  I'm also open to medical tourism, but I'd have to do a lot more research before I pursued it.

Fundamentally, I'm fairly pessimistic about the next several decades.  Thus, I'm not quitting my job despite having hit our FI number -- I want a significant margin of error.  Honestly, getting an additional citizenship was part of that as well.

okits

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Re: Canadian Healthcare Future Proofing
« Reply #8 on: January 11, 2024, 03:30:14 PM »
Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.

I learned by doing but also by speaking with other regular people who were more knowledgeable about the conditions or situations I was in, and had information and experience to share.

A general observation I've had is that medical professionals are university educated, upper middle class specialists, and they are most comfortable interacting with (and taking seriously) people who speak their language (the actual language itself as well as medical lingo) and resemble (or reflect) the mores and conventions of that socioeconomic class.  And they don't know you from Adam.  So you're helping yourself if you present a certain way and let them know your goals, knowledge level, and what resources you have to devote to treatment.  (Obviously there's variation in situations and practitioners, but I think this is generally useful advice.)

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #9 on: January 11, 2024, 04:20:10 PM »
Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.

I learned by doing but also by speaking with other regular people who were more knowledgeable about the conditions or situations I was in, and had information and experience to share.

A general observation I've had is that medical professionals are university educated, upper middle class specialists, and they are most comfortable interacting with (and taking seriously) people who speak their language (the actual language itself as well as medical lingo) and resemble (or reflect) the mores and conventions of that socioeconomic class.  And they don't know you from Adam.  So you're helping yourself if you present a certain way and let them know your goals, knowledge level, and what resources you have to devote to treatment.  (Obviously there's variation in situations and practitioners, but I think this is generally useful advice.)

With an overworked, burnt out MD, which is most in Canada, it's hard no matter who you are. I speak MD fluently and even then, it can be incredibly hard for me to advocate for myself. I just had a HORRIBLE experience with an ophthamologist who didn't read the referral that was sent to him, and simply refused to allow me to explain why I was there. Had he given me as little as 30 seconds I could have said "the optometrist saw a lump on my retina that was not able to be captured on imaging." Instead, he looked at the images, said "there's no lump" and then got vicious when I tried to say anything otherwise and ranted at me about his credentials.

This was after he first said how impressive it is that I'm double licensed in Ontario. So I had his professional respect, but he still wouldn't listen to a fucking word I said.

RetiredAt63

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Re: Canadian Healthcare Future Proofing
« Reply #10 on: January 12, 2024, 06:17:48 AM »
At the clinic I go to I have 15 minutes with the doctor.  I go in with paperwork.  I have a chart that shows all my important blood values over the last 3 years so she can easily see how they are tracking.  I go in with a list of topics to be discussed, listed in order of importance so the most critical things get addressed first.

I also let a new doctor know I taught physiology at the College level for years and am a retired University instructor.  That helps offset the old woman just getting old image.


But that just helps me.


Provincial Conservative governments seem to be trending to financially support more private health care, when the funding needs to go into public health care.  That is a political issue.  We've seen in the US that if doctors are really unhappy with working conditions they will leave.  The same can happen here.  Our governments needs to be supporting doctors and nurses and all the medical technical support people instead of trying to minimise things like pay and working conditions.



techwiz

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Re: Canadian Healthcare Future Proofing
« Reply #11 on: January 12, 2024, 07:32:33 AM »
I am optimistic on the future of digital health. New technology will help lift some of the burden on our health care system and provide faster and better care.  Sure there is no magic bullet and we need our elected officials to start addressing things from a longer term vision instead of just sound bites and short sighted solutions to boost polls.

Missy B

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Re: Canadian Healthcare Future Proofing
« Reply #12 on: January 13, 2024, 03:40:59 PM »
Am I including extra margins/planning for medical tourism?

I hadn't originally, but in the last year  I've really started to think about where else in the world I can get timely, quality care.
I hadn't considered ever wanting to retire outside Canada, but now I'm thinking about the health impacts of things like weather and surrounding culture and availability of health care.
I live in BC, which is particularly bad for cancer treatment times. I experienced just how bad in 2022 when my mother died of metatstatic melanoma.
 
The reason it was discovered so late is that her GP refused to follow up on her multi-year, worsening symptoms properly. 
Many GP's here refuse to book X-rays or other types of scans if there is another possible explanation for symptoms, since it is 'a waste of MSP dollars'.

That wasn't the end of his failures in her care. Nor was he the only part of the system to completely fail, by which I mean that there are metrics the system sets for taking steps in a certain period of time in cancer care and they missed all of them, by a huge margin. And no apology, no explanation.
Ironically, the only part of her medical care that was timely and connected was the non-cancer part of her treatment.


So, yes. I have a plan to grow extra savings to earmark for health that wasn't in my original plan, and I'm also thinking that I should probably start learning Spanish because that is the language in so many of the countries that welcome retirees and have accessible, well-priced private health care.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #13 on: January 13, 2024, 06:51:02 PM »
Am I including extra margins/planning for medical tourism?

I hadn't originally, but in the last year  I've really started to think about where else in the world I can get timely, quality care.
I hadn't considered ever wanting to retire outside Canada, but now I'm thinking about the health impacts of things like weather and surrounding culture and availability of health care.
I live in BC, which is particularly bad for cancer treatment times. I experienced just how bad in 2022 when my mother died of metatstatic melanoma.
 
The reason it was discovered so late is that her GP refused to follow up on her multi-year, worsening symptoms properly. 
Many GP's here refuse to book X-rays or other types of scans if there is another possible explanation for symptoms, since it is 'a waste of MSP dollars'.

That wasn't the end of his failures in her care. Nor was he the only part of the system to completely fail, by which I mean that there are metrics the system sets for taking steps in a certain period of time in cancer care and they missed all of them, by a huge margin. And no apology, no explanation.
Ironically, the only part of her medical care that was timely and connected was the non-cancer part of her treatment.


So, yes. I have a plan to grow extra savings to earmark for health that wasn't in my original plan, and I'm also thinking that I should probably start learning Spanish because that is the language in so many of the countries that welcome retirees and have accessible, well-priced private health care.

Yep.

I'm suddenly very happy that I seriously dated a Colombian guy back in my 20s and got a pretty decent foundational level of Spanish. Once I finish grad school in a few months, that will become my next learning project.

DH also has Irish citizenship, so that opens some doors for us because I can get Irish citizenship if we live there for just 3 years. And Irish healthcare is currently rated pretty well. I can also get my naturalization citizenship in Denmark after 2 or 3 years because of my family, and since DH is already EU, that could work out.

However, that would mean budgeting for living in Ireland or Denmark. And I really don't actually want to move away. Our ideal would be to live in Canada half the year and live in Mexico the other half.
« Last Edit: January 13, 2024, 06:59:24 PM by Metalcat »

okits

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Re: Canadian Healthcare Future Proofing
« Reply #14 on: January 13, 2024, 08:34:45 PM »
Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.

I learned by doing but also by speaking with other regular people who were more knowledgeable about the conditions or situations I was in, and had information and experience to share.

A general observation I've had is that medical professionals are university educated, upper middle class specialists, and they are most comfortable interacting with (and taking seriously) people who speak their language (the actual language itself as well as medical lingo) and resemble (or reflect) the mores and conventions of that socioeconomic class.  And they don't know you from Adam.  So you're helping yourself if you present a certain way and let them know your goals, knowledge level, and what resources you have to devote to treatment.  (Obviously there's variation in situations and practitioners, but I think this is generally useful advice.)

With an overworked, burnt out MD, which is most in Canada, it's hard no matter who you are. I speak MD fluently and even then, it can be incredibly hard for me to advocate for myself. I just had a HORRIBLE experience with an ophthamologist who didn't read the referral that was sent to him, and simply refused to allow me to explain why I was there. Had he given me as little as 30 seconds I could have said "the optometrist saw a lump on my retina that was not able to be captured on imaging." Instead, he looked at the images, said "there's no lump" and then got vicious when I tried to say anything otherwise and ranted at me about his credentials.

This was after he first said how impressive it is that I'm double licensed in Ontario. So I had his professional respect, but he still wouldn't listen to a fucking word I said.

I'm appalled you were treated this way and am so sorry you experienced this.  Unsure if the doctor was just a raging asshole or having a mental breakdown right in front of you.  Both simultaneously is also an option I guess.

OP: good self-advocacy won't work in every situation, but on balance I think it's extremely beneficial.  Thanks for starting this thread, I've found it informative.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #15 on: January 14, 2024, 05:41:10 AM »
Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.

I learned by doing but also by speaking with other regular people who were more knowledgeable about the conditions or situations I was in, and had information and experience to share.

A general observation I've had is that medical professionals are university educated, upper middle class specialists, and they are most comfortable interacting with (and taking seriously) people who speak their language (the actual language itself as well as medical lingo) and resemble (or reflect) the mores and conventions of that socioeconomic class.  And they don't know you from Adam.  So you're helping yourself if you present a certain way and let them know your goals, knowledge level, and what resources you have to devote to treatment.  (Obviously there's variation in situations and practitioners, but I think this is generally useful advice.)

With an overworked, burnt out MD, which is most in Canada, it's hard no matter who you are. I speak MD fluently and even then, it can be incredibly hard for me to advocate for myself. I just had a HORRIBLE experience with an ophthamologist who didn't read the referral that was sent to him, and simply refused to allow me to explain why I was there. Had he given me as little as 30 seconds I could have said "the optometrist saw a lump on my retina that was not able to be captured on imaging." Instead, he looked at the images, said "there's no lump" and then got vicious when I tried to say anything otherwise and ranted at me about his credentials.

This was after he first said how impressive it is that I'm double licensed in Ontario. So I had his professional respect, but he still wouldn't listen to a fucking word I said.

I'm appalled you were treated this way and am so sorry you experienced this.  Unsure if the doctor was just a raging asshole or having a mental breakdown right in front of you.  Both simultaneously is also an option I guess.

OP: good self-advocacy won't work in every situation, but on balance I think it's extremely beneficial.  Thanks for starting this thread, I've found it informative.

Yes, absolutely, in no way am I saying that self advocacy isn't important.

I'm sharing my concern that as the system falls apart, self advocacy is going to be less and less effective.

okits

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Re: Canadian Healthcare Future Proofing
« Reply #16 on: January 14, 2024, 10:55:16 AM »
Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.

I learned by doing but also by speaking with other regular people who were more knowledgeable about the conditions or situations I was in, and had information and experience to share.

A general observation I've had is that medical professionals are university educated, upper middle class specialists, and they are most comfortable interacting with (and taking seriously) people who speak their language (the actual language itself as well as medical lingo) and resemble (or reflect) the mores and conventions of that socioeconomic class.  And they don't know you from Adam.  So you're helping yourself if you present a certain way and let them know your goals, knowledge level, and what resources you have to devote to treatment.  (Obviously there's variation in situations and practitioners, but I think this is generally useful advice.)

With an overworked, burnt out MD, which is most in Canada, it's hard no matter who you are. I speak MD fluently and even then, it can be incredibly hard for me to advocate for myself. I just had a HORRIBLE experience with an ophthamologist who didn't read the referral that was sent to him, and simply refused to allow me to explain why I was there. Had he given me as little as 30 seconds I could have said "the optometrist saw a lump on my retina that was not able to be captured on imaging." Instead, he looked at the images, said "there's no lump" and then got vicious when I tried to say anything otherwise and ranted at me about his credentials.

This was after he first said how impressive it is that I'm double licensed in Ontario. So I had his professional respect, but he still wouldn't listen to a fucking word I said.

I'm appalled you were treated this way and am so sorry you experienced this.  Unsure if the doctor was just a raging asshole or having a mental breakdown right in front of you.  Both simultaneously is also an option I guess.

OP: good self-advocacy won't work in every situation, but on balance I think it's extremely beneficial.  Thanks for starting this thread, I've found it informative.

Yes, absolutely, in no way am I saying that self advocacy isn't important.

I'm sharing my concern that as the system falls apart, self advocacy is going to be less and less effective.

I suspect it will deteriorate more, to the point where all patients are fighting for the 10% of good function burned out healthcare workers have, and that will largely go to the patients who are VIPs or well-connected in some way.  Which is an appalling level of inequality within a system meant to serve, well, the entire population, but where scarce resources leave more and more vulnerable and regular people behind.

I guess this is a further vote for saving more money towards medical tourism, OP.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #17 on: January 14, 2024, 10:56:56 AM »
Do you have any idea where to learn more about advocating for yourself? I find that there is A LOT of protocol that partially prevents that advocacy (e.g. you can only do this test/referral after you spend half a year doing this medicine). Sure, there are lots of reasons to have protocols in place but to me a lot of things don't really look like any type of negotiation.

I learned by doing but also by speaking with other regular people who were more knowledgeable about the conditions or situations I was in, and had information and experience to share.

A general observation I've had is that medical professionals are university educated, upper middle class specialists, and they are most comfortable interacting with (and taking seriously) people who speak their language (the actual language itself as well as medical lingo) and resemble (or reflect) the mores and conventions of that socioeconomic class.  And they don't know you from Adam.  So you're helping yourself if you present a certain way and let them know your goals, knowledge level, and what resources you have to devote to treatment.  (Obviously there's variation in situations and practitioners, but I think this is generally useful advice.)

With an overworked, burnt out MD, which is most in Canada, it's hard no matter who you are. I speak MD fluently and even then, it can be incredibly hard for me to advocate for myself. I just had a HORRIBLE experience with an ophthamologist who didn't read the referral that was sent to him, and simply refused to allow me to explain why I was there. Had he given me as little as 30 seconds I could have said "the optometrist saw a lump on my retina that was not able to be captured on imaging." Instead, he looked at the images, said "there's no lump" and then got vicious when I tried to say anything otherwise and ranted at me about his credentials.

This was after he first said how impressive it is that I'm double licensed in Ontario. So I had his professional respect, but he still wouldn't listen to a fucking word I said.

I'm appalled you were treated this way and am so sorry you experienced this.  Unsure if the doctor was just a raging asshole or having a mental breakdown right in front of you.  Both simultaneously is also an option I guess.

OP: good self-advocacy won't work in every situation, but on balance I think it's extremely beneficial.  Thanks for starting this thread, I've found it informative.

Yes, absolutely, in no way am I saying that self advocacy isn't important.

I'm sharing my concern that as the system falls apart, self advocacy is going to be less and less effective.

I suspect it will deteriorate more, to the point where all patients are fighting for the 10% of good function burned out healthcare workers have, and that will largely go to the patients who are VIPs or well-connected in some way.  Which is an appalling level of inequality within a system meant to serve, well, the entire population, but where scarce resources leave more and more vulnerable and regular people behind.

I guess this is a further vote for saving more money towards medical tourism, OP.

I am actually *not* a fan of medical tourism at all. It's extremely hard to navigate foreign healthcare systems safely.

rocketpj

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Re: Canadian Healthcare Future Proofing
« Reply #18 on: March 07, 2024, 01:06:10 PM »
I don't specifically budget for things like medical tourism, because my experience with the BC health system has been pretty good overall.

I do have some general 'shit happens' budget, which I suppose would include medical tourism if that was appropriate.

General rule of thumb for Canadian Health Care is that the higher the proportion of the last 30 years a province has had a Conservative government, the worse the health care will be.  Right now in BC we are still trying to pick up the pieces after a decade of right wing hostility to the idea of public health care. 

The poor bastards in Ontario and Alberta are stuck with governments that think the solution to a shortage of medical professionals is to underfund medical schools and cut doctor and nurse pay.  You get what you vote for.

elaine amj

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Re: Canadian Healthcare Future Proofing
« Reply #19 on: March 29, 2024, 09:32:12 AM »
DH battled cancer for 7 years here in Ontario before he died last year. By and large, I was pretty happy with the Ontario healthcare system - although of course, we ran into some issues along the way.

He was also American and in the first couple of years, kept up health insurance in the US so we could have the option of going there for treatment. We did go to the US for a second opinion and they recommended the same thing our Ontario doctors did. So he chose to get treated in Ontario (wayyyy cheaper with no co-pays!).

I will agree it is good to save some extra money. As his disease grew more complex, we had to travel 2-4hours away to bigger cities for treatment. We even had to stay for a six week span for daily radiation once. At another point, we were doing an 8hr roundtrip every week. And so I learned some of the benefits of urban life. We claimed an average of $3-5k/yr in medical travel alone.

In Ontario, it helps that there are heavy subsidies available for medical equipment. The Assistive Devices Program paid for 75% of the cost of major equipment and his insurance covered most of the rest. So a $6500 wheelchair cost us $400 out of pocket (good thing as he only got to use it for 2 weeks!).

At one point, there was the strong possibility that Ontario would not pay for his immunotherapy treatments as his was a more rare cancer and there hasnít been enough patients to run enough clinical trials (since we have a small population to start with). We were getting to the point of being willing to pay $10k/mo privately. But the doctor worded the application carefully enough that the govt shocked us all by agreeing to fund it (Side note: it didnít work for him).

As for scans, Ontario doctors are generally reluctant to order tests. Like many others, doctors spent months brushing off his symptoms as allergies or stress so he had to be persistent and pushy to finally get his diagnosis (I donít know if it would have been more than a little faster in the US as his initial symptoms were really mild).

Most countries order PET scans constantly, but doctors here said it wasnít necessary for him. Sometimes we didnít like it, sometimes we did (DH worried about the exposure to extra radiation, etc). But more or less followed similar standards to the rest of the world (we were part of various FB support groups for his cancer).

And yes, itís hard to get appointments for CT scans and MRIs (we dealt with hospitals in 2 cities). We soon discovered calling constantly for last minute openings usually got him a scan in a timely manner.

Weíve also sat many, many, many hours in ERs (which seems to be a systemic issue that really deserves attention). The one time it was really serious (but not hair on fire urgent), we sent DH by ambulance and he got the necessary scans a few hours later.

Advocating for medical care for us meant constantly following up on doctor orders. A lot of things often got lost in translation. For example, after chemo treatments in the hospital, DH was referred to homecare for IV fluids at home. Sometimes the homecare org didnít get the order. Sometimes it was the pharmacy not getting the order to send the supplies. Another example is sometimes the MRI department would get the order for a scan that didnít include all the parts needed (even though DH always got the same scan for the same parts lol). So we learned to follow up to make sure they got the correct order from the doctorís office.

I donít know if it would have been any better in the US as a lot of the problems were the various departments talking to each other correctly.

E-health doesnít always help either. One time a nurse didnít key in his medications correctly (apparently there are some steps involved and she missed one). All the oncology nurses just gave him the meds seen on the screen and didnít notice his nausea meds were not there. It was a day or two before I questioned it as I remembered the doctor explaining the schedule of meds to me.

The majority of health care professionals we met were caring although like others said, it probably helped greatly that we spoke their lingo. I will say that when DH was in the hospital for a week and couldnít advocate for himself, I was never completely satisfied with the care he received when I wasnít present. The understaffing was obvious then and they werenít able to attend to him as frequently as I felt he needed (which left me concerned about inequity for patients without someone at their bedside all the time. At least I was able to be there from morning to night).

Anyway, there were some issues with his healthcare. But although we had the option (and the funds) to move to the US for care anytime through those 7 years, we chose to stay in Ontario and were content with our decision. And actually, I am grateful for the care we received. I do come from a country with just ok public healthcare and private healthcare is expensive (although wow is it an eye-opener when an oncologist is available by text to answer questions )

From a purely money perspective, it really didnít cost more than an extra $5-10k/yr, which we were able to manage in our FIRE budget. Of course, everyoneís illness (and the expenses involved) is different and we were fortunate that he had very good extended health insurance from his work.

For me, I am paying almost $4000 a year for my extended health plan premiums. Mostly because it feels safer to keep it. I might change my mind ( it really is $$!) but it is a nice safety net. If I ever have major needs, this would make a big difference (as it did for DH).


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PoutineLover

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Re: Canadian Healthcare Future Proofing
« Reply #20 on: March 29, 2024, 10:34:50 AM »
I've had mixed results so far and am slightly nervous about future care but not terribly. I had to fight for a referral for a suspected skin cancer, but once I got it, it moved very quickly and it was removed with no issues and good follow up care.

My infant daughter was seen very quickly for all of the referrals she received in the first few months of life, and luckily all of them were minor and treated promptly or cleared upon closer examination.

I have some connections to the health care system which has helped a ton, even in just knowing what to expect or ask. I don't have much faith that health care will be a priority for many of the governments in power and access to primary care is really limited but for urgent issues I do think it works for now.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #21 on: March 29, 2024, 11:07:22 AM »
Yes, our system still moves reasonably fast for cancer and clearly life threatening conditions.

But I'm on year 4 of waiting for treatment for my left leg, which I can barely walk on. ALL of our resources are going towards keeping people from dying, and everything below highly urgent issues is where you see the biggest impact.

snacky

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Re: Canadian Healthcare Future Proofing
« Reply #22 on: March 29, 2024, 08:43:00 PM »
I've flirted with the idea of living elsewhere in the world, but have concluded that I have to remain a resident of Canada to keep access to the healthcare system. My specialists prescribe things that are rare or illegal elsewhere, and I'm currently connected to the specialists I most need. It took a long time to get into this position and I'm keeping it. More importantly I want to reserve the right to choose a medically assisted death.

As for private care/ access to tests/ medical tourism, my medical crap budget is big and I expect it to keep growing. These kinds of things are built in. Living in my body costs a lot of money and it doesn't matter to my chequing account if that money goes to a Canadian or Mexican care provider.

Anyone who isn't planning to have money for medical care and home assistance as they age is probably going to have a problem at some point.

ricelife

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Re: Canadian Healthcare Future Proofing
« Reply #23 on: March 29, 2024, 09:53:46 PM »
For me personally I will stay living in the big city (Ontario) as I have access to the big hospitals in case me or someone in my family has a serious diagnosis. Also, best to not move too often because people are now having a hard time finding a family physician. Last time I had to switch family physicians (mine retired in his late 70s), it was like the hunger games to get a new one. In the meantime I was always stressed going into walk in clinics and dreading the day I needed to go to the ER.

Private care - I will probably pay for private health insurance while I can still be underwritten cheaply. When you FIRE and leave your workplace, there is usually a 30 day period where you can convert to individual insurance without underwriting and you are usually given a discount.

As for medical tourism - I am from a country where medical care is private but due to foreign exchange with CAD it would be pretty cheap for me to go and get some stuff done there. I will use this as last resort

I'm actually more concerned about advanced age and needing help with day to day stuff. Like say if I'm 80-something, generally healthy but physically weak. I would need to budget more money for services like landscaping or snow shoveling. Or maybe I will need a day nurse or PSW to come visit me etc etc. The scary time is when I can't live on my own anymore and need long term care. Lots of people end up in the hospital and eventually hospital tries to kick you out. I think the future looks bleak for places the elderly will live.

Retire-Canada

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Re: Canadian Healthcare Future Proofing
« Reply #24 on: March 30, 2024, 07:52:56 AM »
Sooo where are you at?

I've got a great hospital down the road. When I have needed the ER the wait time was short and the service was great. I needed a family doctor as we moved here a couple years ago. I put my name on a provincial wait list and got a decent doctor in about a year. When I needed a doctor in the intervening time I've used the various virtual doc telemedicine services and had positive results. I needed several minor surgeries last year. I got to see a surgeon in a couple months and booked everything fairly quickly. Service was great. My GF has had the same type of experiences. My friends as well with issues ranging from cancer to major surgeries.

So firstly I am not freaking out about healthcare in Canada. Secondly no I am not putting any specific money aside to deal with healthcare issues. That said I have a healthy portfolio so in theory I could pay out of pocket for some healthcare services if I needed to.

totoro

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Re: Canadian Healthcare Future Proofing
« Reply #25 on: April 04, 2024, 03:33:56 AM »
I already pay privately for a np.  Well worth the enhanced access and care- I finally got a gp but he is not great and it is near to impossible to find another.We will also go to Malaysia for preventative health screening.  Weíve budgeted a significant amount for health going forward, including treatment abroad.  Health care here is often ok for serious stuff but way too rationed and slow for stuff that wonít kill you right away or could have been caught earlier.

aloevera1

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Re: Canadian Healthcare Future Proofing
« Reply #26 on: April 04, 2024, 01:38:06 PM »
I already pay privately for a np.  Well worth the enhanced access and care- I finally got a gp but he is not great and it is near to impossible to find another.We will also go to Malaysia for preventative health screening.  Weíve budgeted a significant amount for health going forward, including treatment abroad.  Health care here is often ok for serious stuff but way too rationed and slow for stuff that wonít kill you right away or could have been caught earlier.

I'm curious, what type of services do you receive from NP? Obviously, will understand if you'd rather not answer. I am just trying to see where NPs fit in the healthcare picture...

totoro

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Re: Canadian Healthcare Future Proofing
« Reply #27 on: April 07, 2024, 01:38:17 PM »
I already pay privately for a np.  Well worth the enhanced access and care- I finally got a gp but he is not great and it is near to impossible to find another.We will also go to Malaysia for preventative health screening.  Weíve budgeted a significant amount for health going forward, including treatment abroad.  Health care here is often ok for serious stuff but way too rationed and slow for stuff that wonít kill you right away or could have been caught earlier.

I'm curious, what type of services do you receive from NP? Obviously, will understand if you'd rather not answer. I am just trying to see where NPs fit in the healthcare picture...

Almost the same as a family doctor but better imo because I pay for it so get appointments asap and testing as needed.  There are some things a NP cannot prescribe - like opioids of some kind.  I don't take drugs like that but they have a relationship with a GP for clients who need them.

sasha520

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Re: Canadian Healthcare Future Proofing
« Reply #28 on: April 15, 2024, 09:23:35 AM »
I am planning to have extra money so that I can either pay privately in the states or Mexico. If I have to, it will be in Canada, which I'm sure within the next 10-15 years will have a more extensive and well run two tiered system.

Our system is broken. If you are young you get healthcare. If you aren't, they triage you and unfortunately you're bottom of the barrel.

Anecdotally, my father had an intestinal blockage, severe chrons disease, was hospitalized etc. and they had scheduled him for a colonoscopy ONE YEAR LATER. Suffice to say, plan to pay for private treatment.

sasha520

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Re: Canadian Healthcare Future Proofing
« Reply #29 on: April 15, 2024, 09:25:14 AM »
I am more interested in your thoughts on your personal planning. Are you hoping that "things will get themselves sorted"? Are you perfectly happy with everything? Are you including extra margins for the pessimistic situation of having to pay for everything and/or medical tourism? Any other creative approaches to planning for future healthcare needs?

Perspective of someone living in Ontario.

I think you can help yourself a little by living someplace where you have a better supply of medical care (I'll generalize this into urban vs. rural).  Knowing how to advocate for yourself or a loved one in a medical situation is also helpful, as are connections to people working within the medical system (who can advise you on what you should ask for or put you in touch with a helpful contact).

Saving extra money so private pay is an option is a definite yes.

100% this. You HAVE to advocate. Be the squeaky wheel, make the calls, ask the questions, check EVERYTHING. And.... know someone in healthcare, because line jumping happens.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #30 on: April 15, 2024, 10:04:46 AM »
I already pay privately for a np.  Well worth the enhanced access and care- I finally got a gp but he is not great and it is near to impossible to find another.We will also go to Malaysia for preventative health screening.  Weíve budgeted a significant amount for health going forward, including treatment abroad.  Health care here is often ok for serious stuff but way too rationed and slow for stuff that wonít kill you right away or could have been caught earlier.

I'm curious, what type of services do you receive from NP? Obviously, will understand if you'd rather not answer. I am just trying to see where NPs fit in the healthcare picture...

Almost the same as a family doctor but better imo because I pay for it so get appointments asap and testing as needed.  There are some things a NP cannot prescribe - like opioids of some kind.  I don't take drugs like that but they have a relationship with a GP for clients who need them.

"Better" until you have complex health issues and you're well outside their scope of practice.

NPs won't touch most of my family members because the liability is too high for them when complex systemic issues come into play and every prescription comes with major systemic risk.

I intend to use a private NP in Newfoundland, but just to get referrals to specialists. They won't even touch my prescriptions because they require advanced knowledge and monitoring.

totoro

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Re: Canadian Healthcare Future Proofing
« Reply #31 on: May 19, 2024, 11:40:40 AM »
I already pay privately for a np.  Well worth the enhanced access and care- I finally got a gp but he is not great and it is near to impossible to find another.We will also go to Malaysia for preventative health screening.  Weíve budgeted a significant amount for health going forward, including treatment abroad.  Health care here is often ok for serious stuff but way too rationed and slow for stuff that wonít kill you right away or could have been caught earlier.

I'm curious, what type of services do you receive from NP? Obviously, will understand if you'd rather not answer. I am just trying to see where NPs fit in the healthcare picture...

Almost the same as a family doctor but better imo because I pay for it so get appointments asap and testing as needed.  There are some things a NP cannot prescribe - like opioids of some kind.  I don't take drugs like that but they have a relationship with a GP for clients who need them.

"Better" until you have complex health issues and you're well outside their scope of practice.

NPs won't touch most of my family members because the liability is too high for them when complex systemic issues come into play and every prescription comes with major systemic risk.

I intend to use a private NP in Newfoundland, but just to get referrals to specialists. They won't even touch my prescriptions because they require advanced knowledge and monitoring.

The scope of practice for NPs varies widely between provinces.  In BC where I am NPs have almost the same scope as GPs except for some prescriptions ex. opioids.  Here NPs have full hospital privileges, consult with and refer to specialists, and conduct advanced health care diagnostics.  I don't take opioids but I know my NP has an agreement with a local GP to refer for this.  In the case of someone with complex care needs with prescription interactions in BC you can have free med review by a pharmacist plus, in these cases, there are often specialist referrals who are recommending or prescribing the medications.  In BC so many people don't even have a GP and if you do have one they may or may not be great but you have no way to change.  My NP has been a godsend.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #32 on: May 19, 2024, 12:20:55 PM »
I already pay privately for a np.  Well worth the enhanced access and care- I finally got a gp but he is not great and it is near to impossible to find another.We will also go to Malaysia for preventative health screening.  Weíve budgeted a significant amount for health going forward, including treatment abroad.  Health care here is often ok for serious stuff but way too rationed and slow for stuff that wonít kill you right away or could have been caught earlier.

I'm curious, what type of services do you receive from NP? Obviously, will understand if you'd rather not answer. I am just trying to see where NPs fit in the healthcare picture...

Almost the same as a family doctor but better imo because I pay for it so get appointments asap and testing as needed.  There are some things a NP cannot prescribe - like opioids of some kind.  I don't take drugs like that but they have a relationship with a GP for clients who need them.

"Better" until you have complex health issues and you're well outside their scope of practice.

NPs won't touch most of my family members because the liability is too high for them when complex systemic issues come into play and every prescription comes with major systemic risk.

I intend to use a private NP in Newfoundland, but just to get referrals to specialists. They won't even touch my prescriptions because they require advanced knowledge and monitoring.

The scope of practice for NPs varies widely between provinces.  In BC where I am NPs have almost the same scope as GPs except for some prescriptions ex. opioids.  Here NPs have full hospital privileges, consult with and refer to specialists, and conduct advanced health care diagnostics.  I don't take opioids but I know my NP has an agreement with a local GP to refer for this.  In the case of someone with complex care needs with prescription interactions in BC you can have free med review by a pharmacist plus, in these cases, there are often specialist referrals who are recommending or prescribing the medications.  In BC so many people don't even have a GP and if you do have one they may or may not be great but you have no way to change.  My NP has been a godsend.

Yeah, NPs are great and I fully support them having expanded privileges in all provinces. My point was that NPs won't touch *my* family members because their education doesn't cover really complex, rare, multiple intersecting condition case management.

It's hard enough for us to find MDs who can handle our cases. The second an MD hears my diagnosis, about 50% of them won't even see me.

Metalcat

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Re: Canadian Healthcare Future Proofing
« Reply #33 on: May 19, 2024, 12:30:39 PM »
Update on my disdain for this system:

I have a hemorrhagic ovarian cyst that appears to be causing some torsion and a truly horrific amount of pain. This started in late 2023, I likely need surgery. I live in Ottawa, which is not one of the largest, but a city of over 1M people.

My consultation appointment isn't until September.

Considering I've waited over a year for a surgical date to get this very painful rod out of my leg and didn't get called for a date until last week, I'm doubtful that I'll get a non-emergent surgical date within a reasonable timeline after that September consult for an ovary that has been stable for many months, just really, really fucking painful. So I could be looking at a solid 2 years of ovarian pain unless it bursts in its own or torsions enough to become life threatening. Neither of which seem to want to happen.

I honestly keep hoping for it to become emergent because then I could maybe get some care.

If I wasn't in an extremely time-controlled period of grad school right now, I would be traveling to get this taken care of, but I can't.

So I just live with two extremely painful, extremely treatable problems.

Let's not even talk about the 4 other surgeries I'm supposed to have with absolutely no timeline other than "maybe in 2025."

Fucking infuriating.
« Last Edit: May 19, 2024, 12:32:55 PM by Metalcat »

aloevera1

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Re: Canadian Healthcare Future Proofing
« Reply #34 on: June 03, 2024, 10:21:29 AM »
Update on my disdain for this system:

I have a hemorrhagic ovarian cyst that appears to be causing some torsion and a truly horrific amount of pain. This started in late 2023, I likely need surgery. I live in Ottawa, which is not one of the largest, but a city of over 1M people.

My consultation appointment isn't until September.

Considering I've waited over a year for a surgical date to get this very painful rod out of my leg and didn't get called for a date until last week, I'm doubtful that I'll get a non-emergent surgical date within a reasonable timeline after that September consult for an ovary that has been stable for many months, just really, really fucking painful. So I could be looking at a solid 2 years of ovarian pain unless it bursts in its own or torsions enough to become life threatening. Neither of which seem to want to happen.

I honestly keep hoping for it to become emergent because then I could maybe get some care.

If I wasn't in an extremely time-controlled period of grad school right now, I would be traveling to get this taken care of, but I can't.

So I just live with two extremely painful, extremely treatable problems.

Let's not even talk about the 4 other surgeries I'm supposed to have with absolutely no timeline other than "maybe in 2025."

Fucking infuriating.

Wow this really sucks. Hoping you get care you need soon (but whom am I kidding.....).