Canada's Dirty Healthcare Secret

We have a problem with our health care here in Canada. It's something that the more I ask the more I've learned that this is a problem that most Canadians have encountered in one form or the other. That problem is the companies controlling our extended health benefits and their systemic issue of them delaying or outright denying coverage.

Let me start by laying out my particular situation. As some of you may be aware, I have a chronic disease called Crohn's. It's an autoimmune disease that effects my digestive system and can be incredibly debilitating and painful, usually requiring several surgeries over the course of a patients lifetime. After having surgery myself in 1998 and suffering a crippling bout in 2001 I've been largely symptom free, in large part due to a drug that at the time was in human clinical trials, of which I was a part. Since then the drug has been approved for use in Canada, so therefore it's now a medication that I have to pay for.

This is where our health care system has a problem. For most Canadians, medications are not covered by our basic medical plans provided by the government. Which means we pay for them out of our own pockets. Granted most Provincial governments have programs which subsidise some of the cost, but not all. This is where private insurance is introduced to our system. Most people, either individually or in most cases through their employer have extended coverage which includes in most cases the cost of all prescription drugs. Can you see where the problem is yet?

That's right, you've got private corporations, typically publicly traded companies, responsible for paying for the public's medications. Being a private company their first and main responsibility is not the welfare of it's clients, but rather profitability. One of the easiest ways to maintain that profitability is to pay out as little as possible for medications.

Now it's not as bad here as it is in the States, for example. Here if your doctor prescribes you a drug, legally they have to pay for it, which sadly is not the case in America. So how they get around that here is by delaying payment as long as possible.

It's a story I've heard far too often from too many people. They get a prescription and submit a claim to their insurer only to find there's a "problem" with their paperwork, or they never received the claim, the list of excuses goes on and on. For most this is little more than an annoyance as their drugs typically cost relatively little, usually under 100 dollars. But the strategy here, as far I can tell is exactly that. to annoy most people to the point where it's not worth re-submitting the same forms over and over again. They'd rather forget the 50 bucks and get on with their lives.

But what about those whose medications are necessary to their day to day wellness and which cost considerably more?

This is where I come back to my story. That drug that has kept me healthy for the last 10 years ain't cheap. In fact it costs about 36,000 for a years supply. It's largely subsidised by the Provincial government here, leaving my insurer, Manulife, to pick up the remainder, which is just shy of 10,000 bucks. Because of it's price, the government requires I go back to my doctor once a year in order to assess if I still require the medication, and re-apply for provincial coverage. Something that to me seems perfectly reasonable.

Whether the government decides to cover me or not, Manulife is still required to pay for my treatment. The catch? They need either my approval or rejection forms from the government. This is where the stall tactics come into play. I'm lucky that there is an advocacy group for patients on humira, (my medication) who handle all my paperwork and navigating all the bureaucracy for me, and they received my government approval at the beginning of August. Since then they've attempted FOUR times to get that paperwork to Manulife, the first three times Manulife claims to have never received it. I'll know tomorrow if the fourth attempt was received. So all said and done It's been over a month since I've been on my medication and could possibly be even longer. All so Manulife can save a buck.

In my case it's not so dire. I'll survive with only minor complications that should clear up shortly after I start treatment again. What I wonder though is how many people are being treated in the same manner whose health is in much worse shape than me? What about people who need chemotherapy, organ rejection drugs or HIV treatment? Are they getting the runaround as well?

Maybe it's time for us to put our health in the hands of those whose goal is to maintain our well-being instead of maintaining a healthy bottom line.