Monday, August 3, 2009


Tara over at Living Day-to-day with Multiple Sclerosis responded to a comment I made about her weekly polls being very American-centric. She had no idea that other countries did things that differently.

Lisa Emrich of Brass & Ivory asked if I would put more information about the costs of having MS where I am. Let me see if I can break it down.

All basic, emergency and chronic care is paid for or heavily subsidized by the provincial government through the tax base and transfer payments from the federal government. What do I mean by basic, emergency and chronic care? If it is deemed medically necessary by the physician you are seeing in that doctor's office, walk-in clinic, urgent care facility or emergency room, the province pays. No doctor will give you a procedure that isn't covered so there are no "claims" to be denied.

Health Insurance BC is the "government bureaucrat overseeing my health care". They administer the two programs that take care of my health, the Medical Services Plan (MSP) and PharmaCare, including Fair PharmaCare. I have never had to speak to a person that works there in the 5+ years I've lived here.

In BC most people pay a premium based on family size and income as of your last income tax filing. The monthly rates are:

$54 for one person
$96 for a family of two
$108 for a family of three or more

However there is Premium Assistance available. If you lose your job/have a big change in circumstances you can submit an application to have your income reconsidered.

There are also ongoing subsidies for people with low incomes.

The current adjusted net income thresholds are:

$20,000 - 100 percent subsidy
$22,000 - 80 percent subsidy
$24,000 - 60 percent subsidy
$26,000 - 40 percent subsidy
$28,000 - 20 percent subsidy

Every resident of the province gets a BC Care Card. One only need to present this at a health care facility to receive treatment. If you are in an emergency situation they don't worry about it until your next of kin is contacted. If you are from a Canadian province (other than Quebec) there is a level of reciprocity for provincial plans. You will be asked to confirm/change your address and contact information that scans from the card. You will then be asked what's wrong with you. In the case of a primary care physician you won't even have to do that, as the receptionist will often remember you if you attend the office more than twice a year and you will just be checked off in the appointment book and you wait for your room to open up.

The costs of drugs are not covered but the BC PharmaCare Program has 7 plans that will cover drugs for the majority of residents.

Fair PharmaCare
Permanent Residents of Licensed Residential Care Facilities (Plan B)
Recipients of B.C. Income Assistance (Plan C)
Cystic Fibrosis (Plan D)
Children in the At Home Program (Plan F)
No-Charge Psychiatric Medication Plan (Plan G)
BC Palliative Care Benefits Program
B.C. Centre for Excellence in HIV/AIDS

Most employers with 25+ employees will offer a benefit package administered by a private health insurance company. That includes prescription drug coverage (usually 80-90% of the cost), vision (usually an annual eye exam and $250-$500 every 2 years for frames and lenses) and dental (coverage caps of $2000-$5000 per year depending on the procedures). If you have Fair PharmaCare, that private coverage will apply to the portion you are out of pocket. There is an annual deductible based on income and a MAXIMUM amount that you will pay in a year before the province covers the expenses 100%. Here's a neat calculator to figure out what you would theoretically pay

The CARB drugs used the treatment of MS are covered 70% by the province under the "Special Circumstances" program for people who need drugs for conditions outside the mainstream illnesses. This coverage is requested by your neurologist treating you for MS and must be renewed every 12 months with a 3 month grace period. The coverage will start usually in 24-48 hours after the request is phoned in by the doctor.

The doctor doesn't have to call in for permission. In the case of the drug plans, the doctor is calling in to notify, not ask. We don't fill out claim forms. All billing is done by the doctor you've seen. The only interest a doctor/hospital/whatever has in your pre-existing conditions is from a medical perspective, not to deny you care.

You can see any doctor licensed to practice medicine in the province that will agree to make an appointment with you. You can go to any walk-in, urgent care and hospital ER in the province. You will not have a co-pay. There are no forms to fill out except at walk-in clinics where you'll be asked to fill out a name, address, and health complaint form, listing drug allergies, what drugs you are on now, and any conditions you have on it.

You can self-refer to specialists, but you'll be put on the "Not a priority" list and offered an appointment 6 months to a year from now. If you go to your doctor or local clinic and get a referral you will get in to them much faster as the referral will include triage information. If a doctor thinks you are in severe distress they will send you immediately to a hospital. You will see whatever specialist you need to see within hours, not days.

This is the long overview. If you have any specific questions about how it works, my comments link is open.


  1. This is wonderful information, Lori. Thank you. Very nice that even the formula for subsidies is clear-cut and transparent. You've done a great service in providing this information to educate those of us who do not live within the Canadian health system.

  2. Hey Lori
    Interesting post.Let me tell you how it works in South Africa.The poor people go to government hospitals and your bill is based on your income.No income no bill.But the standard and medication is terrible.The people with jobs pay for medical aid based on their income.Lots of different medical aids companies,some better than others.But they are in this to make a profit.I am on a private medical aid and I pay R2300.00(divide by 8 for USD) for myself and 2 kids.
    This system sucks.2 years ago a young girl I was working with (age 23) died because she had tonsitlitis and never went to doctor because of the long queues at government hospitals(she had no private medical aid).She actually died from dehydration.In this day and age,I am disgusted!! All this money being spent on trivial stuff by the gvt and so little on social welfare.

  3. That sounds incredibly frustrating and sad. Maybe after the US gets it stuff together we can work on reform in SA.