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How Does the Canadian Healthcare System Work?

How Does the Canadian Healthcare System Work?

A quick guide for immigrants.

Having immigrated to Canada a few years ago, I was lucky enough to get a job that provided me with extended health benefits. I’ve had access to those benefits beyond the coverage already offered by the provincial plan. That gave me, for example, coverage for Chiropractors, Physiotherapy, Massage, and many other wellness services.
However, I quickly realized that having full health benefits was far from the reality for many Canadians, especially newcomers. Whether or not you are a native Canadian, the struggle to find proper care is real. In this post, I’ll focus on how new immigrants struggle to find care and understand how the healthcare system works in Canada and how to use it properly.
Before coming to Canada, what you hear are things like:
While those statements are partially true, they are misleading. The focus for most immigrants is the immigration process, where to live, how to get a job, and how to survive in a completely new environment. Dedicating time to understanding and learning how to use the Canadian health system is usually a low priority in other things.

The Challenge Newcomers Face

What happens is that many newcomers default to the same habits and behaviour from their home country when using the health system. For example, it is common in some countries for people to go to a hospital’s emergency room for a low-grade fever or stomach issues. Imagine that behaviour multiplied by the thousands of families moving to Canada yearly. It’s a lot to a system that is already overloaded and short-staffed. Healthcare professionals reading this know that many low-acuity patients end up in the wrong places. That may be contributing to the health care crisis we are currently facing, and that Medimap is trying to help solve.
So, to help newcomers and the health system itself, I’ve prepared an overview of the significant entities (not all) that new Canadians need to get familiar with, understand their purposes, and when to go to each one of them.

Main Resources:

Before I go into each of them, it’s vital to note that the way the Canadian healthcare system works is that the funds come from the federal government, but each province decides how they will allocate their budgets. That usually means that each province works differently. But the below guidelines should be valid for most provinces.

Family Doctors / Nurse Practitioners:

What are they?
Primary care practitioners will accompany you and your family’s health throughout the years. The purpose of this sort of doctor is for them to be your first point of contact with the health system, especially for elective and non-emergency concerns. For example, if you have high cholesterol history in your family and want yours to be checked, you should ask your family doctor. Those doctors will do longer-term care, know all your history and past exams, and automatically get a copy of your exams if – for instance – you go into a hospital and have to do a CT scan.
When to go?
Reach out to one when you have recurring issues or that don’t need you to go to an emergency room. For example, if you have Diabetes, Asthma, regular Stomach issues, Mental Health issues, etc. If you need a specialist (e.g., a Gastroenterologist), then your family doctor will provide you with a referral, but you can’t go directly to a specialist as a rule of thumb.
How to find one?
Generally, all Canadian citizens and permanent residents have the right to a family doctor. Go to your respective provincial health authority, and learn how to get a family doctor:
You can also find family doctors on Medimap. You need to search by Walk-In Medical Clinics, then click the orange banner on top of the search.
What is covered?
If the provincial health plan covers you (e.g., MSP in British Columbia or OHIP in Ontario), you don’t have to pay anything. Your doctor will bill your public health plan for your visit directly to the government.

Medical Clinics / Walk-in Clinics:

What are they?
Medical Clinics are usually private and bill the provincial governments for the care you get. When you don’t have a family or need care sooner than your FD availability, however, they won’t have access to your historical data. They will usually treat your most acute symptoms now. Those doctors can also refer you to a specialist.
When to go?
You have some condition that is not urgent enough to go to an emergency room but it also cannot wait for your family doctor’s availability. Also, it’s the most commonly used resource for those who don’t have a family doctor.
How to find one?
The easiest way to find a Walk-In Medical Clinic in Canada is to go to Medimap and select the first option in their search. However, most walk-in clinics operate on a first-come, first-served model. Also, note that each doctor can only bill the government a pre-defined number of patients daily. That results in jam-packed clinics, often reaching their capacity early in the mornings. To avoid waiting, go to Medimap to see the wait times in your area. Some clinics even allow appointment bookings, providing a time window to be seen.
What is covered?
Those clinics will usually treat the acute symptom you are feeling, for example, a sprained ankle, a migraine, a cast, etc. Those clinics can also provide paid services not covered by most provincial plans—for example, sick notes for school or work.

Specialists:

What are they?
Doctors specialized in certain areas of health—for example, an Oncologist, Dermatologist, Gastroenterologist, etc.
When to go?
In Canada, you can only access those professionals via referrals. Those can come from your family doctor, a walk-in doctor, or a practitioner. But as a rule of thumb, you can only reach out to those specialists directly with a formal referral from one of your doctors.
How to find one?
When a referral happens, usually your doctor will indicate a specific specialist for your case. However, nothing stops you from finding your specialist as long as you have a formal referral and know they can treat your case.
When can I see one?
If your need is urgent, you will be a higher-priority patient. Additionally, if a specialist can only assess the health concern, a referral is issued from a general practitioner, such as a family doctor.

Hospitals (Emergency Rooms):

What are they & when to go?
This is self-explanatory and should be leveraged after you’ve tried to use the resources above. As you can see, you can try your family doctor or your local walk-in clinics and even call the 811 number. 811 is a nationwide phone number you can call to talk to a nurse, quickly assess your symptoms, and clarify whether you should go into a hospital.

Extended Health / Wellness:

What are they?
Usually provided by employers, extended health care is a supplemental plan that pays for medical services and products not covered by the provincial health plans. It will reimburse you (in full or partially) for various practitioner services such as Chiropractors, Physiotherapists, Massage Therapists, Naturopaths, Acupuncture, etc.
When to go?
When you have an extended health program or you’d like to see such a professional pay out of pocket, you can go directly to one; many will offer direct billing to your insurance company.
How to find one?
The easiest way to find the best healthcare practitioner near you is to go to Medimap and search for the specialty you want.
What is covered?
There are different types of extended health benefits plans and most of them will differ. Take a look at your benefits package to know what is covered by your plan and if there are any maximums. Some companies also offer health spending accounts (HSA). Expenses claimed through an HSA are dictated by the Canada Revenue Agency (CRA) and are the same as the medical expenses that could otherwise be claimed on an individual’s tax return.

Other Resources:

811
Call this number for non-emergency or to consult with a registered nurse, and they will advise whether you need to go to a hospital or not based on your symptoms.
Add this to your bookmarks. On Medimap, you can find all sorts of wellness practitioners, such as Naturopaths, Mental Health Specialists, Physiotherapists, Optometrist Dentists, Audiologists, Chiropractors, Nutritionists, osteopaths, and much more.
While most hospitals will see you for non-urgent symptoms, given the current state of healthcare in Canada, we all have a role to play in ensuring that the system is not overloaded with non-urgent visits. We should explore all our options for care before going to the hospital.
Everyone, from newcomers to Canadian citizens, can spread knowledge on how to better navigate and utilize the system properly, so we do our part to ensure that we are heading towards a more sustainable and fair system.
If you’ve learned something from this post, please consider sharing it with your friends 😉

To learn more about health practitioners in your area or to ask about providers who address specific treatment needs, contact us today.

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