We recently launched a series on Diabetes Around the Globe because while diabetes doesn't discriminate, life with diabetes looks very different depending on where you are in the world. We started off with Mike, a British ex-pat living in Spain, followed by Anke from Germany. Today we bring you Jamie, from the Great White North a.k.a. Canada!
Jamie Naessens lives in a small town in Ontario, and works in Toronto. She's the mom of a twentysomething and is married to an American ex-pat. Jamie has lived with type 1 diabetes for 21 years and has been pumping for the last four. Buckle up as she takes us on a brief tour of what it's like to live with diabetes in Canada...
A Guest Post by Jamie Naessens
So, Canadians are almost the same as Americans, aren't they? Except they have free health care, right?
Hanging around in a town like Petawawa, you might hear:
"So, how is it going, eh?" (So, how'zitgoin'ay?)
"If ya got one, I need a ... loonie ($1 coin, named for the loon engraved on it) for that parking meter, or a toonie ($2 coin, rhyming nicely with the loonie) if we're going to be waiting here any longer for that endo appointment."
"Let's go to Timmies (Tim Horton's - Starbucks of Canada) afterwards for a double double to go" (coffee, double cream, double sugar).
And finally, who can't love a country that has places with names like Spread Eagle, Conception Bay, and Dildo. Really! I kid you not.
Well, now that I hopefully have your attention, let's get back to the question of free health care. It's a nice idea, and it is indeed tax-supported, but alas, it's no free ride.
Most people who have been touched by diabetes already know that Canada is the birthplace of insulin and its discoverer, Dr. Frederick Banting, so shouldn't diabetes care be a shining jewel? Well perhaps there's a little tarnish on that crown.
One might reasonably ask, what is covered by the health care system, notwithstanding provincial differences? Visits to physicians and specialists, hospitalization, most lab and other diagnostic tests are covered. A few provinces (not many) will pay for insulin pumps and supplies. If one is lucky enough to have insurance benefits through their employers, they are likely to be covered for prescriptions, dental and other such "perks." But that's not a given in this economy. In the provinces that don't cover pumps, insurance companies may pick up the tab for pumps and supplies.
Health Canada governs health care, and divvies up federal funding to the provinces and territories. Now, imagine two levels of government involvement before care gets handed to the health providers and patients — bureaucrazy (spelling intended!).
Because decisions about coverage are made in each province and territory, coverage is rather uneven across the country. Each province or territory covers what it deems necessary, driven by its own agenda and legislators. For example, what is covered in Ontario may not necessarily be covered in Quebec. Also, due to doctor shortages in some areas, wait times to see specialists can exceed 6 months. In other areas where wait times to get a family physician can be 2 years or longer, visits to walk in clinics are the norm. Needless to say diabetes self-management is essential.
So what about new technology? It comes slowly and manufacturers must jump through hoops to get it approved; both federal and provincial approvals are needed, and labeling must be in French and English to comply with our language legislation. It can certainly be daunting.
Availability of diabetes technology in Canada has lagged behind the US. It hasn't been until the last few years that pumps have become more common, but their use is far from the norm. Continuous glucose monitor use lags even further behind. Provincial plans do not cover them. Insurance companies are slow in accepting them, and very few of the more progressive plans will cover them. If pumps are the new kid on the block, CGMs are virtually absent.
What it comes down to, is that those who want them must pay out-of-pocket. Under the current system, it could be years before CGMs are allowed to become a must-have for Canadians. What is most alarming is the simple fact that devices which could ultimately prevent a health care drain down the road are likely to remain off limits for all but the most fortunate Canadians.
As in the US, changes need to happen in Canada. However, Canadians tend to let the system drive the bus. That's not to say that there aren't people already doing some great advocacy work. They are out there, slogging through the bureaucratic slush and system iciness.
Although Canada is a little larger than the US in geographical size, its population is smaller than that of California. With the population spread out as it is, and the different provincial coverages, those few brave advocating souls must somehow make themselves heard — certainly a logistical challenge to coordinate efforts to dispel the diabetes myths and initiate change in a country often averse to such change.
Our neighbors south of the border have got advocacy right. Kudos to the DOC in the work they've done to organize a united voice, making a difference in the diabetes community. In addition to our own advocacy efforts, I can only hope that changes taking place in the US will spill over the border, making a positive difference in Canada.
And now you know some basics about health care in Canada. If any lesson is to be learned, it is from Canadian Tommy Douglas, the father of Canadian Medicare:
"Courage, my friends; 'tis not too late to build a better world."
~ Tommy Douglas (1904-1986), Leader of the New Democratic Party and 7th Premier of Saskatchewan
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