March 17, 2014

Canadian Healthcare

I thought I'd give a little overview of our healthcare system and experience, since many of my readers are not Canadian. Also, even if you are Canadian, there are a lot of differences between provinces.
While we do have Health Canada and there are certain standards all provinces as supposed to comply with, healthcare falls under provincial jurisdiction. In other words, each province pretty much does their own thing and if you were to compare the services between them, it might look like we're all in different countries.

For example, when people quote our maternity and parental leave benefits, they often quote Quebec's allowance, which is the highest in Canada. While QC actually has a law saying a woman is not allowed to return to work before six weeks post-partum without a doctor's note, in Ontario, you can get up and head back to work right after labour if you want to.

On the downside, our seasonal flu shots are only (technically) free to those considered part of the vulnerable population (under 23 months or 65 and older or immunocompromised, or in contact with any of those people). I say technically because while I've always just walked in and gotten it when I wanted it, no questions asked, it's not always that way - it seems to depend on the nurse's mood that day. If they wanted to charge me (and they could!) it would also not be covered by my private insurance, so if I didn't have the money, I would have a problem.

So if you want to get an idea of Canadian healthcare, you need to ask a person from each province and territory to go over the good, bad and ugly bits. Ask anyone who has lived in more than one province and how confusing it can be. Or take for instance, the fact that PEI doesn't have even ONE abortion provider. That's not right.

I'm going to concentrate on QC, because that's where I live, so it's what I know best.

Basic healthcare in QC is free. So if I want to see a doctor every day of the week for any reason whatsoever, I can walk into any clinic or hospital, show my card and see one.
Then the system forces every single employer to provide a private insurance policy for prescription medications and other sundry things like life insurance. The plans are all pretty much the same, and cost somewhere around $80 a month at most to cover a family. Some workplaces cover that cost, making it free (yay!) but I don't think that's too common. The plan usually covers 80% of the cost of your prescription medications and things like massage, OT, speech therapy, naturopathy, acupuncture, psychological counseling and those sorts of services. They also cover eye exams and dental appointments. You are allowed to be covered by more than one plan, so for example, my husband and I are both employed, so we both have our own policies. We claim our 80% on our own first, then the 20% that is left is covered by the spouses' plan, making everything FREE! The Little Man is covered under both of us, so we claim on both our plans and all his stuff is free. Dental care for children is free up until a certain age (have to look it up).

So starting from the beginning of Little Man's life, my pregnancy was followed part public and part private. Blood work and check ups were all public. Scans and specialists were private. It didn't have to be that way, but it's what I chose for myself. I preferred the specialists at the private clinics.
I gave birth at a hospital (public) and my delivery and two-night stay in a private room was free. After being sent home, about five days later a nurse came to check on us at home to make sure we were ok.

All his vaccinations were free. Before vaccinations, a nurse does a quick check up of mom and baby. They check weight, ask about how you're coping, answer any concerns you may have.

Fast forward to when things started to get complicated - I brought up my suspicions that something was wrong with the Little Man's pediatrician. I switched doctors three times because they were blaming me for his issues initially and not listening to me. He was sent for a hearing test (private, so $$), and an allergy test (public, so free). Eventually someone listened to me and we were referred to OT. OT was free through the local children's hospital. There we also had an assessment by a physiotherapist and a psychologist. I wasn't satisfied with just that, so I took him to a private psychologist, who finally assessed him for autism. If I hadn't gone private for that, we'd still be waiting for a diagnosis. Last I heard, the waiting list for public-system autism diagnosis is 3 years long. Ain't nobody got time for that.
I should note that even though insurance covers us, it covers to a max of $500 per service annually. So that's only $500 of psychological testing/services, $500 of (private) OT or speech therapy etc. If you know anything about the hourly rates of these things, you know that doesn't cover much. And even if you double our maxes to $1000, that still may not cover everything you need.

Obviously, when it comes to certain things, it's because we were privileged enough to afford private testing that we got our services quickly. That is not the case for everyone in this province though and that's a big problem.

After finally having a diagnosis in hand, then there's the waiting list for public services. QC provides free ABA therapy for any autistic child for 20 hours a week, up until the age of 6. Or at least that's what they say they provide or would like to provide. Does that actually happen? Probably not as much as one would expect. Also, ABA wasn't exactly on our top choices of things we wanted to subject our child to, but we put him on the waiting list in our area anyway. We received a letter over a year later telling us we would probably get services in the next two years. So, he would be six by then, which would have been useless anyway.

However, things can also be different by borough, because the city is divided up into boroughs and each borough has it's own health services. When we moved to a different borough, our file transferred and suddenly the waiting list became shorter. It also offered more services. Honestly, I'm happy we moved to a richer borough because the differences are so stark.

Now we get a special educator who comes to the house to help us with the Little Man, about an hour every three weeks or so. She pretty much just acts as an assistant to us. She gives us pointers on things, and she makes our picto boards and social story books for us. She has really helped us be better parents, by giving us different strategies. Pretty much whatever we ask her to do, she does the grunt work for us. We just send her what words/pics we want and she does all the printing, plastification and velcro work. This might not sound like much, but it helps us a lot.

One other detail, with official diagnosis, you are assigned a social worker. Well, kinda. You see a social worker, then you're on a list for a dedicated one. We had one, but she went on mat leave and we moved, so we no longer have one. Kinda annoying. What comes out of the meeting with the social worker is down to luck - if they're not knowledgeable about grants and services specific to autism (and a lot aren't, or not in English, since French is predominant here) you will miss out on certain things. Again, the experiences of different parents I have spoken to have been so vastly different (and that's within the same city!), it's absolutely ridiculous. However, I can't really complain about my experience. We receive two subsidies for the Little Man and that is through the work of the social worker helping us fill out applications. From speaking with other parents, social workers here spend an awful amount of time trying to get us to talk about our marriage/relationship to make sure everyone is ok, but I really don't care to speak to a social worker about those things. If I need relationship help, I'll see a psychologist. I use our social worker solely for access to services/funding. However, I do see the value in family support and counseling, so if we didn't have money for a psychologist, at least some part of mental health would be looked after.
And this is an important point, because I know if I were depressed or overwhelmed, I would be taken care of promptly and for free.

So there is what I had hoped would be a short overview of our experience with our public health system. If you have questions or want more detail, feel free to ask! 

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