Canada's healthcare system is publicly funded through taxes. Each province is responsible for their healthcare coverage, with each province handling things a little different then the next. Depending on where they live in Canada, some people have no costs due to government coverage, while others without access to coverage by government, employer or private insurance plans must spend thousands of dollars annually to manage their diabetes.
What happens if you need to see a doctor?
In an emergency patients would go to the hospital and a doctor will look after them. At busy times there can be a wait of hours. Usually when the words “Type 1 diabetes” are mentioned the situation is upgraded in the triage portion of your wait. This means a Type 1 patient can be are placed on a higher priority.
In terms of regular visits for new Canadians, or for Canadians who have moved provinces, there can sometimes be a wait to see a family physician. Family doctors can refer out to an endocrinologist or specialist. There are some clinics that will take self-referrals, so calling might get you an appointment. Many larger cities have a full team of diabetes specialists – nurses, dietitians, social workers, psychologists, doctors etc. Smaller, rural towns usually do not have access to all these professionals. Endocrinologists sometimes hold special hours in these locations (for example, every Thursday) or people are expected to drive into town for access.
Every time a family physician or specialist is seen, the doctor's office will bill (charge) the provincial insurance companies, so people rarely have to pay bills unless they choose to pay for private healthcare. Prescriptions are covered with individual benefits. Some provinces may have a public health insurer which you pay towards and get some insurance coverage for insulin and supplies. Many employers have benefits for their employees which, along with payment, covers you.
Who decides what doctors can prescribe?
Health Canada is our federal governing body. They approve all drugs and medical guidelines in Canada.
Practically, what is like to live with type 1 diabetes in Canada?
Living with Type 1 in Canada can be fairly comfortable, but cost can be a barrier and often people might skip testing or a shot to save money. According to the Canadian Diabetes Association, 57% of Canadians with diabetes say they do not comply with their prescribed therapy because they cannot afford their medications, devices and supplies. “Low-income Canadians face a heavier financial burden given their inability to afford private insurance plans and reliance on government diabetes programs for support.”
There is also lot of advocacy that takes place in Canada. The big national organizations, Canadian Diabetes Association and the Juvenile Diabetes Research Foundation (JDRF), work with many community partners and volunteers to push for the rights of people living with type 1. Much of this work has led to new provincial pump programs and has highlighted the cost of diabetes on the health care systems to the government.
What about get admitted to the hospital?
Type 1 diabetes is treated pretty seriously across Canada. Factors relating to diabetes, such as DKA and hypoglycaemic reactions are dealt with in a very timely fashion.
How does diabetes vary throughout Canada?
Again, standard of care is fairly equal across Canada. There are stories of some endocrinologists who don't communicate well or spend enough time with their patients. This is more of a headache for people in rural towns with smaller populations as they wouldn't have the option to switch unless they wanted to drive farther distances. Most provinces are adopting publicly funded insulin pump programs. This means the provincial government will buy your insulin pump and pay for some supplies. Criteria for these programs vary per province. One province may cap the program at 18 or 25 years of age, while others will have an HBA1C minimum before going on the pump.
Type 1 and Type 2 have very different cultures in Canada. Type 2 usually consists of 80-90% of the “diabetes population” and so most media reports are towards the “more general” diabetes. Of course this perpetuates stereotypes.
Thank you to Russ Thompson in Canada for help with this section.
To learn more about life with type 1 in Canada, check out our blog:
The Diabetes Cowboy on living with Type 1 in Canada