I want to start things off by saying that I come to the table not only bringing a problem, but also the solution. Most of us are skeptics and are concerned that the money recently handed out will not be used to improve the patient care in our healthcare system. Even with the best intentions, the money may get diverted to areas, which may have little impact on the real systemic healthcare problems. As you read this article, you will discover there is a way to ensure that the changes and investments of the dollars have the desired outcome on healthcare. It only requires passion and a solid strategic plan for implementation.
Over the last few weeks, there has been a great deal of press and conversation about Canadian Healthcare. The politicians are dividing up a pot of newly found money for healthcare and the public is wondering why the waiting lists for many of the critical care areas are so long. It appears the healthcare system is broken down.
Growing up in Canada, the one differentiator between Canada and the rest of the world was our fantastic healthcare, which served all Canadians. We were the envy of all countries. Today, the envy has turned to smirks and sometimes laughter created by the dissatisfaction and frustration of the present healthcare service that is received.
Canadian Healthcare Facts
I caught the end of a talk show the other day and within the span of 20 minutes I heard some astounding healthcare facts:
Canadians in the Ottawa and Regina area can wait between 50 and 70 weeks for an MRI
Doctors who work in hospitals make on average only $95, 000 per year
Midwives make 4 times as much as Obstetricians when delivering a baby
A cook in a hospital makes approximately 50% more than a cook in the private industry
The number of healthcare administrators making more than $100,000 per year has tripled since 1996
» There are 55,000 administrators in healthcare – more than the number of actual healthcare providers
Lean Healthcare Potential Solutions
If these facts are even partially correct then I must agree the ‘system’ is either broke or on the verge of breaking.
As with any problem there are several options:
Do nothing – doing nothing is just not an option for any of us
Privatize parts or all of the system – privatization may be the answer if the current environment can’t be fixed or parts can’t be fixed. This option brings in emotional as well as practical issues and challenges. Most Canadians expect equal access to all levels of medical treatment and the amount of money in your bank account should not be the main factor in determining who gets treatment and who doesn’t.
Pour a ton of money into all areas to compensate for the present problems – point improvements – pouring money into parts of a broken system without a proper understanding of the entire system and the interconnectivity of each part will only sub-optimize the results and more than likely hide the problems. And while we are hiding the problems they will of course get worse and be tougher to solve down the road when they surface again (which will definitely happen). Initially, everyone will feel good that they are fixing the concerns and improving the service but this feeling of accomplishment will soon start to turn to frustration again and the money will be used up.
The ‘Right’ Choice – Focus our energies on understanding the current ‘systems’ and determining how to implement a proper plan that will create better service to the patient while making it faster and less costly – understand the potential of the current system and transform it to maximize it’s effectiveness so we don’t buy unnecessary equipment and assets. We need to remove the existing ‘waste’ by following a Plan that gives’ system’ improvements that will impact the patient/client.
Lean Healthcare The Method
If we don’t do this, then ‘how do we know how much more equipment we need, how much more space and people we need?’ By understanding our Current State and removing the ‘waste’ to create the desired or Future State, we will be able to make very effective decisions on doing what is right. We won’t waste our time on doing ‘point’ improvements (we call it ‘Exciting Chaos’) that do little or nothing to improve the service to the patient and has little impact on improving the quality and costs.
Map the current state of the entire ‘system’ (end to end including information/communication through the actual hands-on activities), identify all the value and non-value activities, determine the present Turnaround Times TAT, determine the present costs and quality issues. Once that is complete (takes normally a day), then design a Future State (6 months out) which removes the pure waste in the system (takes a day or two), develop and detailed Implementation Plan (two days max) that outlines the tools, the people and the sequence of events to remove the waste for the entire system.
Lean Healthcare Results
This Plan will tell us where we need to spend the $$ and effort and will maximize the impact to the patient and the budgets of the organizations. Then, and only then, will we be able to accurately determine what equipment purchases and building requirements are needed. Then execute the Implementation Plan and get immediate results. Without an Implementation Plan the moneys will be wasted and just mask the problems so that we have to go after even more $$ n the coming years. The results we have experienced are greater than 50% improvement (within 6 months) using the existing assets.
Note: We are working with a world-renowned healthcare provider and hospital in the U.S. and their waiting list for an MRI is 2 to 5 days and they want to get better.
It is a simple process. The politicians have done their job of dividing up the money, so let’s not waste this opportunity to make everyone of those dollars have the desired impact and result in ‘doing more with less and doing it faster and better’!
Let’s choose the best option and become the envy of the world again and more importantly start saving more lives! It’s our choice to make, let’s not throw the opportunity away.
Remember in order to get a better result; we have to stop doing the same things we did that got us in this predicament in the first place!
Larry Coté is well known for his penetrating analysis and creative energy. He was with the Lean Enterprise Institute in Boston for almost two years as C.O.O./E.V.P. He was the Founder and President of the Lean Enterprise Institute Canada.
Over the years, Larry has worked with 100’s of companies at various stages of their Lean journey in many different business sectors. Larry has expertise in Toyota Production System concepts, diagnostics and assessment of Lean readiness. He works with the corporate leaders to develop effective plans for transforming organizations using Lean and adapting it to their particular culture.
Canada inspires lakhs of people from throughout the world with India being no exception. A recent study suggests that most of the 18,000 individuals polled across the globe (from as many as 24 different nations) would reside in the Maple Country, in case they got an opportunity.
Perhaps, this is because the said country proffers several benefits to its people. Indeed, the Maple Country provides many opportunities, and Canada immigration comes with numerous benefits for all, including the Indian migrants.
Actually, a flood of benefits greets Indian immigrants to Canada. From safe & secure environment to terrific business/investment opportunities, from life time free healthcare to a variety of social assistance schemes, the overseas nation provides numerous benefits to those who shift to it, and become its nationals. No wonder, the country occupies a high place on the immigration map of the world not only for the Indian migrants but also for the migrants from other areas of the world.
Benefits of Canada immigration for Indian migrants
Here under are given some of the many benefits which greet the Indians, who shift to the dream land called Canada.
Life time free healthcare
The nation boasts of one of the globe’s best healthcare arrangements. Each and every national and permanent resident of the nation is duly sheltered with insurance plan of his specific province. The given health plan is funded by tax measures even as it proffers the globe’s best possible essential health services, along with hospital’s and doctors’ charges. Every resident of the nation enjoy free access to world-class healthcare. A significant section of the individuals above 65, along with the social aid receivers, get most of their drugs & tablets/pills absolutely free. Each and every citizen of the Maple Country gets complete healthcare protection. It covers not only hospitalization but also doctor visits. The many benefits are normally available inside just 3 months of acquiring the prized citizenship, and at certain times, earlier.
Free first-rate education till 12th grade
Ottawa gives free primary & secondary education. The nation also gives financial support for post-secondary studies. Each and every kid ought to be present at school till they turn 16-17 even as 95% of the kids go to such public schools, which receive funds and are free. The nation spends comparatively more on education, vis-à-vis any other developed country. Significantly, the Canadian educational arrangement differs from one province to another.
Till they turn 17 years, every child receives monthly payments from Ottawa on the basis of his parents’ earnings. The said fund is proffered to every child in the country for a better life & education.
Safety & security
As compared to most other nations, Canada is safe and one can feel so at any given time even across the downtown regions of the key Canadian cities of Calgary, Ottawa, Vancouver, Toronto, etc. Across almost every class, the Maple Country has lower crime rates vis-à-vis other nations, including its immediate neighbor, the US.
Durham Region covers an area of over 2,500 square kilometres and is conveniently located to the East of Downtown Toronto. Another Region with a diverse landscape, Durham has everything from the large lakeshore communities of Pickering and Oshawa to the farmlands and recreational areas in the north. Durham Region has a well educated population of over 570,000 that are employed by a wide variety of Businesses. These employers range from the High Tech like Siemens and Corning controls through agriculture and automotive manufacturing – GM Motors, Volkswagen Canada and BMW Canada all have facilities in the Region.
Durham Region administers its Healthcare and Education following the Provincial guidelines. The responsibility for the day to day operations of the education belongs to the Durham District School Board and the Durham Catholic District School Board – all the schools in the area are governed by these boards.
One essential piece of research you need to do BEFORE you purchase/rent a house is to find the school(s) you want your child(ren) to attend. This is vital as the schools are dedicated to particular residential area’s so where you live decides where they go to school.
The Region has excellent transportation links including Pearson International airport, Oshawa airport and the Harbour at Oshawa which give tremendous access to North America. This is coupled with easy access to recreational opportunities in the outdoors and everything that a Major metropolitan area like the GTA has to offer!
Each section below is only an overview so please use the links to the main website below for more detail. For job research definitely use the Chamber of Commerce websites for each location for great information on the local businesses.
The Town Of Ajax – In 2005 Ajax will celebrate its 50th anniversary as a town and has many events planned to recognise this. A small town in the South of Durham Region on the shore of Lake Ontario, it was named after the World War two British Warship The Ajax.
With a population in excess of 80,000 the Town covers an area of over 65 square km. The unemployment rate was 5.4% (2001) with an average family income of around $80,000 a year. The average price of a house was in the region of $215,000 making Ajax one of the cheaper areas in the GTA. Transport is provided by the Ajax/Pickering Transit that also links in with GO Transit and the Greyhound Bus.
There are two recreation centres in the Town that offer a full range of activities and sports. There are skateboard parks for the kids as well as summer camps for various activities during the school holidays. The Lake provides great recreation for the residents during both the summer and winter months. All education and healthcare are administered by the Durham Region and can be accessed via the Region website.
The Municipality of Clarington – A collection of several smaller communities, the municipality now has around 75,000 residents and occupies just over 600 square Kilometres of the Lake Ontario shoreline in the south of Durham Region. The main settlements are Darlington, Newcastle and Bowmanville/Courtice. The area is growing quickly with a 10 year population growth average of 4% per year.
The main businesses are agriculture (and the services), aggregate excavation and cement works, tourism, manufacturing, retail and construction. There is an average unemployment rate of only 4.9% as the area is very business friendly, with the average household income around $74,000. There are great transportation links with 3 major highways, docks, rail links, a regional airport with 2 runways and of course – Pearson International. The Clarington Transit connects with Whitby and Oshawa Transit and you can even use the same tickets on each system.
There are good facilities with a modern hospital that continues to expand, plenty of schools and the newly built University of Ontario Institute of Technology. There are 5 golf courses, 2 marina’s, 2 indoor and 2 outdoor swimming pools, 5 arena’s with 7 ice surfaces, extensive parks and 7 conservation areas that have downhill and cross country skiing. Last but not least – Bowmanville even has its own Zoo!
The City Of Pickering – Ideally situated between Downtown Toronto to the West and Port Whitby Marina to the East, the 94,200 population of the City of Pickering enjoy life on the shores of Lake Ontario. With the Waterfront Trail extending along the shores and the “environmentally significant” wetlands of Frenchmen’s Bay residents are provided with some great scenery and recreation opportunities. On top of that the impressive leisure centre has fantastic modern facilities that any community would be proud of. For those with interest in the History of the region, a visit to the Pickering Museum Village should not be missed.
With all the hoopla over the healthcare debate in this country I thought it about time I share my experience that was up close and personal. In the summer of 2008 I was enjoying a little relaxation with friends at our cottage on the French River, just south of Sudbury, Ontario, Canada. Now as I share this let me make it clear, we’ve been going to Canada for five decades and personally I love the place and the people. The healthcare on the other hand, not so much.
One evening one of the ladies visiting made her ‘to die for’ roast beef dinner and I nearly did. On the second bite mine got stuck in my throat and I was in for a long, painful and at times, downright terrifying night. I began choking about 4PM and it was weird, it would come and go in five minute cycles. I gutted it out for an hour thinking I could dislodge the blockage myself. Then another episode made me think I might check out right there in the north woods. My wife called 911.
The Regional Medical Center was over 80 miles away so it wasn’t going to be a quick fix. Inside the ambulance and on the way I had my worst episode of the day. I thought I was a goner, hacking into a little pale while the EMT sat quietly looking at paperwork. The whole time the computer I was hooked to was saying over and over again ‘check the patient – check the patient’.
When my episode was over I said to the EMT, “Aren’t you going to do something?” He was a nice young fellow who promptly said, “No sir that’s why we’re taking you to someone who makes a lot more than us to fix you”. It was then I realized my wife could have driven me up with our own pale and saved what turned out to be a $650 taxi ride.
When we arrived at the Regional Medical Center in Sudbury, a city of over 100,000, they whisked me into emergency where I would hack for the next 9, yes that is 9 hours. They gave me a pan and told my wife to call if I got worse. Well, I can’t make sounds on the computer but my wife says I sounded like a moose bellowing in mating season. And it hurt. After one episode about 3AM I once again thought I was going to check out for sure. My wife retrieved a nurse who brought with him a young lady, an intern.
The Intern told me to take a sip of water. It was about 7 hours into the process and I had tried that before. It sent me into a coughing, hacking tailspin. She insisted, annoyed at her inability to listen I chugged the water she held as she stood silently for the next five minutes, looking quite embarrassed as I hacked my guts out.
She apologized and then decided to put a scope down my nose to insure I didn’t have a wind pipe blockage. Now I know little about these kinds of things but I knew I didn’t have a wind pipe blockage or I’d already be dead. She insisted so I relented between episodes as she stuck the instrument in my nose, down my throat and then said, “Oops”. It seems the batteries were dead! She quickly left and came back with a couple double A’s and proceeded again. To only her surprise, I didn’t have a wind pipe blockage; it was apparently an esophageal blockage.
A couple hours later a Surgeon came to get me, yes he wheeled me to the operating room himself. He said if he had to wait on an orderly he’d be there another two hours. Once inside I started having an episode on the operating table. The Anesthesiologist insisted I lie down. I told her I needed a bucket to cough into and she said, quite irritated at my lack of cooperation, “This is an operating room and we don’t have buckets!” I barfed into a towel and turned to the Surgeon and said, “You got five minutes.”
That’s pretty much the end of the Canadian story. The Surgeon told my wife he’d ‘pushed’ the food through and indeed it was an esophageal blockage, meaning it was below the wind pipe. They sent me on my way and other than sore ribs I seemed none the worse for the wear of the 13 hour ordeal. I was thinking the whole time ‘where is Michael Moore when I need him?’
Fast forward six weeks and I’m in Decatur, Illinois having lunch with a friend of mine. At this point I’d become a vegetarian like my youngest daughter just on the chance this might happen to me again. But as time moved on I’m in the Mexican restaurant for lunch the chicken taco’s I love got the best of me. I thought ‘what the heck’ and made one, took one bite and was hacking within seconds, I’d done it again.
The only advantage this time was to know the fix I was in. My wife and I took a quick trip to Decatur Memorial Hospital, one of two in this city of just over 100,000 people. It was a Friday so we expected a wait. We walked in as I hacked every five minutes. A nurse took me right in to emergency and was immediately joined by a Doctor and another nurse. The Doctor said, “You have an esophageal blockage. We get four a week, tow real and two imagined”. He then gave me a shot and said, “This will stop you from hacking until we can get our Surgeon to you”.
Wow! It worked and after about a 45 minute wait the Surgeon walked in, smiled as he was making a motion as if he was reeling in a fish and said, “I hear I get to go fishing?” We talked about my history and what had recently taken place in Canada. He asked me whether they had enlarged my esophagus while they were in there. I told him if they did they didn’t tell me. He explained how easy it was to do since he’d already be in there anyway. An hour later I was on my way with before and after pictures of my esophagus and feeling great. The Surgeon told me it was good for 18 months to 2 years.
I know this is just one example of many but we have to be careful what we wish for because we just might get it. That same summer a good friend of ours from Canada had been waiting for gall bladder surgery, she waited a year. Another friend of ours up there in his 70’s had cancer and couldn’t eat. He waited upwards of two weeks for surgery.
With all the debate raging about our healthcare crisis in America we need to take a chill pill. We don’t have a crisis of healthcare; we have a crisis of the cost and coverage of healthcare. I don’t think anyone disagrees that we should have coverage for everyone in this country. But there is something badly wrong with a plan that is now before Congress that ‘saves’ all this money and increases the cost of those on Medicaid now. That’s just a red flag as to where these Bozo’s in DC are leading us.
I consulted in business for years, with large companies. The first thing you do is identify the problem you’re trying to solve. I don’t believe Congress is doing that. I believe they’re playing to the new President’s agenda supported by a few nut cases already in place, namely Reid and Pelosi. The real healthcare crisis is centered on three things:
1. Cost not Quality:
Our outrageous costs are getting worse. Why, because of all the lawyers and greedy drug companies, period. Do you think we can change that? No! Because Congress is made up of 98% lawyers and they take big money from the drug company lobby.
The problem in America is not the poor, they have coverage now. I know people in that category and they just go to the emergency room and everything is covered. The problem with coverage is the middle and they have no voice America anymore.
I’m not talking racial inequality but the inequality of our leaders and their privileges versus ours as a people. I believe that every single law they vote for us, from healthcare to pensions must apply to them. And their raises… put it on the ballot for all of America to vote. And while you’re at it place term limits of two terms for every elected position.
We’re rushing into this thing way too fast. It should be a priority but at what expense. If you keep doing the same thing you’ll certainly get the same result. Why will this quick hit initiative be any more successful than Social Security which Congress has robbed and is bankrupt? Will it be any better than Medicaid and Medicare now in place? If you think so, why would it? And we know this type of program can be done well. I have a friend in England who swears by their coverage and has given me example after example of how even I as an American would go to England, have the problem I had in Canada and not pay a dime. Now that is something to think about – how did they do that?
I’m no longer against healthcare reform but I’m solidly for solving the correct problem. And I don’t think we’re about to do that. Einstein said, “You can’t solve a problem with the same level of thinking that got you into it.” I think we need new thinking, not just change. I decided we really should Go Green in 2010 and recycle Congress!
Benefit from fantastic savings on medical , just by taking a look at lighthousetreatment.com
Canada is located in North America and stretches all the way from the Atlantic to the Pacific, being made up of ten Provinces and three Territories. To the North is the Artic ocean; Davis Strait on the North East separates it from Greenland, to the East is the Atlantic Ocean; the South is bordered by the United States of America and the West by the Pacific Ocean and Alaska.
A country of outstanding natural beauty, Canada has a wide variety of landscapes; the mountains, the prairies, lakes and rivers with many national and provincial parks to protect the habitats. With a total land mass of 9,984,670 sq km (3,855,103 sq mi), Canada is the second largest country in the world. There are more lakes and inland waters in Canada than any other country, in fact 7.6% or 755,180 sq km (291,577 sq) is made up of fresh water.
Most images of Canada refer to the Mounties, bears, snow or the Rocky Mountains with the amazing turquoise lakes though there is truly more to this vast landscape. Tourism is a large part of the economy with the abundant natural resources quickly turning Canada into a rich and vibrant country that is a permanent listing at the top of the best places to live. With distinct seasons – the winters are cold with plentiful snow and then warm summers, the best way to survive is to make the most of natures offerings. Skiing, snowboarding and snowmobiling are popular pastimes and great exercise and fun. In the summer, hiking, camping and exploring the great outdoors are fantastic ways to spend your free time. This is especially true when you are amongst the most breathtaking and fabulous scenery the world has to offer!
The monetary unit is the Canadian Dollar. It is made up of cents with 100 cents making 1 Canadian dollar. There are 1 cent coins usually called a penny, 5 cent coins usually called a nickel, 10 cent coins called a dime, 25 cent coins called a quarter, 1 dollar coins called a loonie and two dollar coins called a twoonie. The notes or bills are in 5 dollar, 10 dollar, 20 dollar, 50 dollar and 100 dollar denominations. The Canadian dollar traditionally trades at a lower value than its American counterpart but is now coming closer to parity.
All motor vehicles are driven on the right hand side of the road and are left hand drive. Each Province or Territory is responsible for its own driving laws and regulations so each has a different system.
Canada has a population of 30,007,094 (2001 Census), compared with 28,846,761 (1996 Census) which shows a 4% increase. Most of the population lives in the cities and most of these are located in the South of the country; about three quarters of the population live within about 300 kms of the U.S border. The most populated Provinces are Ontario and Quebec with Toronto (in Ontario) being the most populated city.
There are two official languages – English and French – and Montreal in Quebec is the world’s largest French-speaking city outside of France. All of the services offered by the Federal Government are in English and French. Almost every product you buy has English and French on the labels and most public services are available in both languages. Outside of Quebec the majority of people speak English; about 18 percent of Canadians are fluently bilingual.
The First Nations or Indian people were the original inhabitants of Canada and the name comes from their language and means “Village” or “Community”. The Vikings, who arrived in the 11th century and didn’t stay for long, were the first Europeans to land in Canada.
More Europeans arrived in the 16th century bringing with them manufactured goods which they traded for furs and native products – because of this they were made welcome by the indigenous people. The two main groups of European settlers were the French, who came first, and then the English. Despite France losing its part of the territory to Britain in a war in 1760, many of the French speaking people stayed. In 1867, three colonies of Britain merged in an event called Confederation; this created a partially independent state of four Provinces. Six more Provinces and three Territories have since been added and in 1931 full independence was achieved. Canada still belongs to the Commonwealth of Nations.
Canada is a Democratic Federation and has both a Federal and Provincial Governments. The responsibilities and powers are divided between the Federal and Provincial Governments which make for a complex political system (see http://www.onestopimmigration-canada.com/canadian_political_system.html for more details).
Public education is the responsibility of each Provincial Government (please refer to our Provincial pages for more information) and is paid for through taxes. Public education is free and all children are required by law to attend school from the age of 6 years until they are 15 or 16, the majority of students continue until they are 18 and graduate high school with a high school diploma.
The main languages of instruction are English and French.
You can save up to $2,000 by managing your United Healthcare drug plan coverage gap. This article provides recommendations for managing your drug plan. There is up to 90% savings connected with buying drugs off plan through Canadian pharmacies. The strategy is to buy expensive items off plan to keep within the United Healthcare drug plan allowance of $2,700. Assess your situation by identifying big ticket items. Then see which of the examples below best fit your situation. We were buying at Wal-Mart on the United Healthcare plan but Wal-Mart has a $4.00 per month plan for generic items weather you buy on the United Healthcare drug plan or directly from Wal-Mart off plan. The most economical strategy is to buy Wal-Mart generic and big ticket items from Canada, abandoning the United Healthcare plan entirely.
In our case there were four items that were prohibitively expensive through the United Healthcare plan. These expensive items were exhausting our allowance prematurely. The most expensive drug plan items were around $5.00 per pill vs. $0.50 per pill off plan. When we went over the allowance we had spent $2,200 of the $2,700 on these four items. Here are the details of the savings in our case.
Example of savings delivered by Canadian pharmacies:
——————————-Wal-Mart———Canada Rx—————Canada Rx %
——————————- Per Pill ———- Per Pill——————- Savings
Plavix 75————————$4.90———— $0.43——————– 91%
Tricor 160 ———————-$3.90———— $0.78 ——————- 80%
Namenda 10 MG —————- $3.00 ———– $0.63 ——————- 79%
Premarin 0.625 —————– $2.19 ———– $0.39 ——————- 82%
Pot Chloride 10 MEQ ———— $0.47 ———– $0.25 ——————- 47%
This article is divided into four parts.
# A case for abandoning the United plan which maybe best for some.
# A case for supplementing the United plan with inexpensive online Canadian meds.
# A case showing the expense of not supplementing the United drug plan.
# Details about the United plan. Actual billing information for 2009.
1. A strategy for abandoning United Healthcare and using Canadian meds plus Wal-Mart $4.00 generic.
The subscriber expenses for the United plan are $2,151. If you’re total bill for meds is less then this it’s more cost effective to abandon the plan. To determine if this is so in your case review your United Healthcare billing and determine your big ticket items. Then see what these items cost from Canada. Our cost for getting everything from Wal-Mart ($4.00 generic) except the four big ticket items was $500. Our big ticket items from Canada cost $1,350.
Canadian only – abandoning United Healthcare:
Canadian ———- $1,350 ——– No United or part D.
United ————-$- 500 ———Wal-Mart $4.00 generic and other low priced meds.
Gap copay ——– $ — 0 ——— Coverage gap pay 100% after $2,700.
Total year ——– $1,850 ——— Save $2,000 over worst case.
2. A strategy for a mix of United / Wal-Mart and Canadian:
The subscriber expenses for the United Healthcare plan are $2,151. We were getting a mix of generic $4.00 items from Wal-Mart and some expensive items from the United Healthcare plan. By September we were $300 over the allowance of $2,700. Buying the four big ticket items from Canada for the rest of the year cost $350. If we did not go over the allowance we could have reduced our total spend by $200 and stayed within the allowance.
Supplement United with Canadian: (actual spend 2009)
Canadian ———– $ 350 —— Off plan Canadian.
United ————– $2,151 —– Total subscriber expense – see details below.
Gap copay ———- $ 300 —— Coverage gap pay 100% after $2,700.
Total year ———- $2,801 —– Save $1,000 over worst case.
3. A case for not using United only:
This case is a based on our exceeding the allowance in September and paying 100% copay for the rest of the year. In our case we would have paid an additional $1,500 copay and never reached the stop loss threshold of $4,350.
United only – no Canadian: (pay 100% copay United coverage gap – to $4,350)
Canadian ———— $ — 0 ——– Off plan Canadian.
United ————— $2,151 ——- Total subscriber expense – see details below.
Gap copay ———– $1,800 ——- Coverage gap pay 100% after $2,700.
Total year ———– $3,951 ——– No savings – worst case scenario.
4. Details of the United Healthcare plan as well as actual billing for 2009.
The United Healthcare insurance provides a drug plan which requires social security part D. This plan is aggressively marketed by United Healthcare. Large segments of the senior population have signed up for this drug plan.
United Healthcare drug plan structure:
Annual deductible ———— $295
Initial coverage ————– Up to $2,700 in total drug costs.
Coverage gap ————— After $2,700 in total drug costs; up to $4,300 in copay.
Catastrophic coverage ——- After $4,300 in out of pocket (copay) no limit.
It’s important to recognize the following:
1. The primary benefit is $2,700 worth of drugs.
2. The $2,700 is combined copay and plan pay.
3. The coverage gap is $4,350 of copay only. – 100% your money.
The following represents the total of subscriber payments. There are four elements of expense to the subscriber. These are actual figures are from a family member’s plan.
Premiums ———————— Month ——– Year
Medicare Part D —————– $40 ———- $ 480
United Rx Plan ——————- $23 ———- $ 276
United Deductible ——————————- $ 295
Co-payment ———————————— $1,100
Total year ————————————– $2,151
The actual benefit to the subscriber is as follows:
Allowance ———————— $2,700 Combined subscriber copay and plan pay.
Co-pay ————————- – $1,100 Subscriber copay.
Actual benefit ——————– $1,600 Plan pay.
Plan benefit ———————- $1,600
Plan expense ——————- – $2,151
Actual plan benefit ————– ($ -551) – loss
The primary benefit of $2,700 allowance includes co-pay and plan pay. Deducting the co-pay of $1,100 from the $2,700 allowance produces an actual benefit of $1,600 and a net loss of $551.
Canada’s primary healthcare system provides services to individuals, families and communities. It also involves a proactive approach to preventing health problems and ensuring better management and follow-up once a health problem has occurred.
These services are publicly funded from general tax revenues without direct charges to the patient.
A patient may be referred for specialised care at a hospital or long-term care facility or in the community. The majority of Canadian hospitals are operated by community boards of trustees, voluntary organisations or municipalities.
Healthcare services are mainly provided in long-term institutions, paid for by the provincial and territorial governments, while room and board are paid for by the individual; in some cases these payments are subsidised by the provincial and territorial governments.
Healthcare services can also be provided in the home and/or community. Referrals to home care can be made by doctors, hospitals, community agencies, families and potential residents.
These services, such as specialised nursing care, homemaker services and adult day care, are provided to people who are partially or totally incapacitated. Needs are assessed and services are coordinated to provide continuity of care and comprehensive care.
The provinces and territories also provide coverage to certain groups of people – seniors, children and social assistance recipients, for example – for health services that are not generally covered under the publicly funded health care system.
These supplementary health benefits often include prescription drugs, dental care, vision care, medical equipment and appliances (prostheses, wheelchairs, etc.), independent living and the services of allied health professionals, such as podiatrists and chiropractors.
Funding the system
Like the NHS in Britain, Canada provides a good but not perfect system of healthcare. The level of coverage varies across the country and many Canadians have supplemental private insurance coverage through group plans, which covers the cost of these supplementary services.
The Canadian Medical Association believes an estimated four million of Canada’s 33 million population don’t have a family doctor and more than one million are waiting for treatment.
Canada has 2.1 physicians per 1,000 people, while Belgium has 3.9, according to the Organisation for Economic Cooperation and Development.
Much of the resentment towards the healthcare system is caused by the fact that so much of Canada’s already high tax goes towards it. The average Canadian family pays about 48 per cent of its income in taxes each year and, while rates vary from province to province, Ontario, the most populous, spends around 40 per cent of its tax revenue on health, according to the Canadian Taxpayers Federation.
The federation, which campaigns for tax reform and private enterprise in healthcare, believes the system is suffering serious financial challenges. It calculates that by 2035, Ontario will be spending 85 per cent of its budget on healthcare.
The federal government and most provinces acknowledge there’s a crisis: a lack of physicians and nurses, state-of-the-art equipment and funding. In Ontario, more than 10,000 nurses and hospital workers are facing layoffs over the next two years unless the provincial government boosts funding, says the Ontario Hospital Association, which represents healthcare providers in the province.
In 1984 Parliament passed the Canada Health Act, which affirmed the federal government’s commitment to provide mostly free healthcare to all, including the 200,000 immigrants arriving each year. The system is called Medicare (no relation to Medicare in the United States).
Despite the financial burden, Canadians value their Medicare as a marker of egalitarianism and independent identity that sets their country apart from the United States, where some 45 million Americans lack health insurance.
In 2000 The World Health Organisation ranked Canada 30th in the provision of public healthcare and the United States 37th. France’s system was ranked the best, followed by Italy, Spain, Oman and Australia.
The Canadian Federal Government subsidizes the system of healthcare in Canada. This is done through the taxes and individual pays to its province and these contributions are put back into the health care system of the province. This single payer system, as it is called, allows for the payment of the entire cost of the services by the government at the same rates throughout the country.
Since Canada is the second largest country in the world, it’s the national system of healthcare in Canada is governed by the Canada Health Act. The law provides for universally available coverage for permanent residents regardless of income levels. This coverage is comprehensive and can be availed of throughout the country as it is publicly administered. The provinces and territories are the primary providers of their healthcare plans and each of them must provide prepaid coverage for all medical services from provision, public health and prescription of necessary care for the individual.
Another benefit of the system is the provision for partial reimbursement of treatments obtained while outside Canada. It is also advised that Canadians traveling overseas obtain the proper medical insurance to avoid the higher medical costs in other countries especially for emergency care. As for prescription medication, the Canada Health Act requires hospitals to provide for free the necessary medication and supplies for the individual so long as they are admitted into the hospital.
Thus the main issue in the system of healthcare in Canada is the burden of costs for post hospital care. Drugs and prescription medication are very expensive in the country also rehabilitative treatment such as physiotherapy, dental treatment and other services are not covered by the system. This is addressed by the employer-employee comprehensive medical insurance coverage. Though only 80% of this rehabilitative cost is assumed in this program, this is already a big savings for you. The remaining 20% can be covered by a private medical insurance provider after your payment of their premiums.
As observed by many experts, the quality of healthcare in Canada differs among the provinces comprising the country. This is most especially highlighted in the rural communities of the country, as many specialized medical functions are not available compared to the urban areas. This is due to the differentiated funding and policies of the provincial governments and this correlates directly to the quality of health care in the areas. A secondary issue is the increasing flight of medical professionals to the more lucrative practices in the United States. This is clearly seen in the nursing profession, as many Canadian nurses opt to go to the United States for higher pay. A third issue is the increasing waiting time for patients to see specialists or choose to undergo elective surgery or even have diagnostic testing. This is clearly seen in the crowded emergency rooms in many of the hospitals all across the country.
You might be thinking I am crazy to say that and wondering how can a cold country with a meager population of 35 million be better for immigration than the mighty superpower with a population of 318 million? Don’t get me wrong. USA is a great country to immigrate. Most of the times when I said “I am going to a foreign country”, people used to ask “which state in USA?” So, yes, USA is the most favorite country among immigrants around the world. No doubt about it. However, there are a few reasons why I chose to come to Canada, and why I prefer to live in Canada rather than USA. Let us see what they are:
1) Friendly Immigration Policies: People who have crossed both the borders can easily tell you the difference in the airport itself. Yes, Canadian immigration policies are lot simpler and lot friendlier than that of US. It’s relatively easy to obtain a Canadian Study Permit, Work Permit, Tourist Visa, Permanent Residency (PR) or even a Citizenship than that of US. The process that needs to be followed and the documentation required for any of the above are lot easier for Canada rather than USA.
Snippet: Do you know that your spouse can work here in Canada even when you are on a study permit/work permit? Try that in US!
2) Better Healthcare System: Healthcare system in Canada is one of the best publicly funded healthcare systems in the world and everyone receives same level of care regardless of financial status. Not only that, according to Canada Health Act, if you are a resident of Canada, then almost anything that is medically necessary will be treated for free. Don’t get me wrong, you have to pay your monthly premiums as per provincial or territorial health insurance plans though. Believe me, those monthly premiums you pay in Canada are very reasonable and nowhere near the premiums that people pay in US. In British Columbia you will be treated even if you failed to pay your health insurance premiums in the past few months (they might collect the premiums afterwards though). I mean to say, you won’t be denied treatment just because you are not insured.
Snippet: Do you know that all the basic medical and surgical services that are medically necessary are covered for a monthly premium of $70. Try that in US!
3) Affordable Education System: Canada’s education system is mostly public (read “free”) and every child has to go to school starting from the age of 5 until 16 or 18 depending on the province in which they live. You can choose to put your children in public schools (free education) or in Private schools where you need to pay. Don’t misjudge that public education is substandard or is only for poor children, as it is the case in many countries across the globe. According to Statcan, close to 95% of children enrolled in elementary and secondary schools in 2010/2011 are in public schools. Even after your child crosses secondary education, the money you will spend for his/her college/university education can be far less than that you could spend on similar quality of education in USA.
Snippet: According to research conducted by HSBC Canada, the average tuition cost for an international student (based on fees charged in top 10 colleges and universities in Canada) is $18,474. Try that in US!
4) Better Security: Unlike USA, Canada doesn’t have the gun culture. Most of the US states have provisions that allow a common man to carry a concealed weapon. When is the last time you heard that there was a shooting in a US University where a school boy shot his teacher and other classmates? Not very long ago, isn’t it? But, not here in Canada. Canada has strict firearm regulations where gun licenses are managed very well with proper background checks, personal interviews and safety training courses.
Snippet: You will feel absolutely safe travelling in a bus/train even at morning 2am, in most parts of Canada. Try that in US!
5) Better Overall Life Style: Though lifestyle means different for different people, according to OECD Better Life Index, it comprises of Housing, Income, Jobs, Community, Education, Environment, Civic Engagement, Health, Life Satisfaction, Safety, and Work Life Balance. Except for Housing and Income, USA scores less than Canada in every other measure. When I compared 4 factors that I consider important for my life style – Health, Life Satisfaction, Safety and Work Life Balance (go to oecdbetterlifeindex.org to compare different countries’ Better Life Index) – I could clearly see where I want to go!
Snippet: People in Canada are nice and very helpful people. When you get bumped in to a Canadian by mistake, even before you say anything, you will hear a “SORRY” from him. Try that in US!
Both Australia and Canada are beautiful countries; both have high living standards and quality education to offer. Both have common elements including British heritage among other things. Both these countries are popular among the immigrants who are thinking to migrate. People often approach us looking for Visa Immigration Services but most of them are always confused between Australia and Canada. So, here are some comparisons made out.
Australia the smallest continent in the world but is the largest island with warm weather, typical climates are temperate, subtropical or Mediterranean. Canada has mostly the continental type of climate it’s very cold here, during winters. The northern part of Canada mostly covered with snow for around 6 months. When comes to unemployment, Canada has the higher unemployment rate which is 7.1% whereas Australia has an unemployment rate of 6.0% also immigration to Canada is easier and less stringent. The cost of living including housing, rent, groceries are a little high in Australia than in Canada. Healthcare system is slightly better in Australia. People of Canada are friendlier towards the immigrants than in Australia. It would be bad and judgemental if it’s said Australia is a racist country which is not anymore, even though few cases of racism are found but then those don’t make the headlines. Canada is ethnically diverse and multicultural nation which is a product of large scale immigration from many parts of the world.
For permanent residency, both countries follow a point based system, the processing is around 3-4 months in Australia where as in Canada it’s around 5-6 months.
Permanent Residency in Canada
To become a permanent resident, a foreign national must make an application to IRCC (Immigration, Refugees and Citizens of Canada). There are various ways in which one can the fastest being The Express entry system. The express entry is considered the fastest in Canada it has 2 stages first, apply for PR invitation and get selected from a pool of candidates based on total point score (based on age, language, work experience, studies etc.). Secondly, on receiving an invitation, the visa application form has to be to the immigration office. Then it is processed by the IRCC within 6 months from the receipt of application. The PR in Canada sub categorised as federal PR and PNP (Provincial nominee program), the former is applicable all over the country. PR expires after every 5 years and has to be renewed after 5 years. The benefits being a permanent resident holds same rights as Canadian citizens, they also may obtain other social as well as Canadian pension plan benefits.
Permanent Residency in Australia
The processing time is around 3-4 months for key permanent residency visas. There are the skilled independent visas and the skilled nominated visas. To apply for PR one needs to follow the point based immigration system firstly there has to be an online submission of an application that is EOI (Expression of interest) in Skill select online system which is an online form which asks a series of questions about your skills depending upon the visa subclass you select. The score is calculated based on education, skills, experience etc. And if you are selected you will get the ITA for the visa.
Also, there’s another factor that affects your visa which is the rules and regulations, considering the immigration rules and policies of both the countries Canada has easier and flexible immigration rules.