Canada's Health System Draws Mixed Reviews From Psychiatrists

Suppose you awakened one morning and discovered that you could care for your psychiatric patients in whatever manner you deemed best—even by providing lengthy psychoanalysis—and that you would be reimbursed for your efforts by simply submitting a bill. No managedcare exclusions or precertification hassles.

You might think that you had died and gone to heaven, but what's more likely is that you simply relocated to Canada where such seemingly luxurious perks of the government-run universal health insurance program are routine.

The name of the program is “medicare,” although it differs dramatically from the U.S. program with the same name (see A Tale of Two Medicares).

The Canadian health system covers all citizens and works well in some areas in which the U.S. system has problems.

“I hear stories of patients being turned away from hospitals in the United States or being afraid to go to the emergency room because they can't afford the care,” Padraic Carr, M.D., an associate clinical professor of psychiatry at the University of Alberta, said in an interview. “In Canada that really doesn't happen. When people come to the emergency room, or for an appointment, or to be assessed, no one is refused treatment because of inability to pay.”

“Even if psychiatric patients start off rich in their lives, many drift down to a low socioeconomic level because of their illness,” Dhanapal Natarajan, M.D., a Saskatchewan psychiatrist who also practiced in Great Britain, reported. “So for them, a universal health care system is extremely important. Even after they are discharged from the hospital, they are looked after.”

“Another thing I like about the Canadian system,” Carr said,“ is that the doctor decides what treatment is appropriate, and it does not have to be approved by any insurance company or third party.”

Jacques Bouchard, M.D., a psychiatrist in St. Lambert, Quebec, concurred.“ I don't have to justify anything I do. I can treat patients as much as they need.”

Outpatient drug coverage mandated by Canadian provinces is also a plus, Arlie Fawcett, M.D., an associated professor of psychiatry at the University of Calgary, stated. “I have patients whose medication costs would be $1,000 or $1,500 a month [if the costs weren't covered by Alberta's mandated drug-coverage plan],” she said.

Still another positive feature of Canada's universal health insurance program, Bouchard reported, is he bills “a single payer, and it is always paid.”

Robert Notkin, M.D., a Toronto psychiatrist in private practice who also lectures at the University of Montreal, had good things to say about the health care billing system in Canada. “I have a cousin, a gastroenterologist, in the United States, and I remember being in his practice and seeing four different staff members collecting money from insurers. Most Canadian physicians operate with one staff member or even no staff. Billing is straightforward. You just submit a bill, and generally a month or so later you are paid for the vast majority of claims.”

And if that isn't enticing enough, “[r]eimbursement for doctors is based on an honor system,” Carr noted.