Q: I am a bit confused about the health care system, having just come here a few months ago. Can you explain the system to me?
A: As a newcomer, it will take 90 days or three months for you to get medical coverage through several provinces, including Ontario and B.C., so private coverage is critical during this period. Check in your yellow pages or online for companies that offer private health care coverage.
Most Canadians have a family doctor or “GP” (general practitioner), so once you have coverage, you will want to get a GP. Your GP (or primary care physician), will be your first contact with the formal health care system. Here are some tips on finding a GP.
- Ask a friend or family member if their doctor is accepting new patients.
- Check with the province’s College of Physicians and Surgeons. They may have a list of doctors accepting patients.
- Look in the Yellow Pages of your local telephone book under “Physicians & Surgeons” and cold call to see if they are accepting patients.
Doctors generally control or direct their patients’ access to most health care specialists, as well as to hospital beds. It is also your doctor who decides which diagnostic tests you will need and generally makes the appointments for these tests. Your doctor will also prescribe any necessary medications, which you will then pick up at a pharmacy of your choice.
In other words, with the exception of a medical emergency — in which case you head for the emergency room at your nearest hospital — you will need to visit your primary care physician to obtain treatment or a referral for treatment for any kind of illness or medical problem.
Q: I’m unclear on what is free in Canada’s health care system and what isn’t. I recently had to pay a big ambulance bill, which surprised me. Can you explain what the different costs are?
A: Under Canada’s health care system, all medically necessary hospital stays, including those needed for treatment of an illness or surgical and maternity services (such as childbirth, prenatal, post-natal and newborn care, and treatment of complications surrounding a pregnancy) are covered, as are the prescription drugs while in hospital.
You will also not be asked to pay the clinic, hospital or physician directly, and there are no deductibles or fees levied on any specific insured service. However, there are some services that are only partially covered, depending on the province, and therefore require a fee for service from the patient. And there are some “uninsured” services, meaning they are not covered at all.
Services not covered by any plan in Canada include: medical examinations requested by third parties (such as for employment, insurance or driver’s licence), cosmetic surgery that is not medically necessary and preparation of medical testimony reports for legal purposes. Depending on the province, circumcisions may or may not be covered.
Also not covered by is dental care, vision care, limb prostheses, wheelchairs, prescription medication, podiatry and chiropractics. With the exception of the Yukon Territory, ambulance service in Canada is generally not fully covered by the health insurance plans of any province or territory. The only exceptions are when it is necessary to transfer a patient from one hospital to another. Some provinces have capped the costs of an ambulance ride, but in other provinces ambulance service can be very expensive.
Certain groups of the population, however, such as seniors, children and those on social assistance, may be able to obtain these extended health services through a Pharmacare program provided by their province.
Canadians in every province, however, can purchase private extended health insurance to cover some of these uninsured health services not included in the national health care plan. Some employers also provide extended health care benefits to their employees that cover some of these costs.