Move to Canada or not

[Rupali]

Hi all,
I know there are some people on this forum from Canada and lot from the US. I need some help from you to make some very important decisions in life and me and my husband are totally confused about it, so I decided to post our confusion here to hear what you would have done in this situation.

We are from India and my husband works in the US on a H1B visa which is a non immigrant visa. Our Green Card in US has been filed and it will probably take another 1.5 -2 years to get it.
Meanwhile we applied for Permanent Residency in Canada and in January 2005 we got Canadian Permanent Residency equivalent to Green Card in the US.
At the same time in December 2004 I got diagnosed with stage 3C BC with a 9 cm large tomor and 11/21 nodes positive. I got AC/T and Herceptin for 2 years and I am currently on Aromasin and Zoladex plus a long list of supplements. My husband is curently debating with the insurance company to get me at least 6 months of Tykerb as a monotherapy.

Now we just came to know that if we do not move to Canada by January 2008 then we will loose out Canadian Permanent Residency. So we both have been thinking what to do.
What we are not sure is to how to compare the medical systems in Canada and US. My husbands company is ready to move him to Canada and he can work from Toronto.

In Canada can you buy Tykerb out of you pocket if you want to have it as a monotherapy.
How is it with Aromasin and Zoladex? We have also heard that first 3 months we will not recieve any medical coverage from the Government and we will have a Private insurance. Will we be able to get aromasin and zoladex thru them?

How is the medical system of Canada as compared to the US?
Generallly how is the life in Canada. Please comment.

[Rupali]

Someone please respond

[StephN]

Dear Rupali -
You DO have a quandry.
You might want to try a private message to Sherri. She lives in Vancouver, B.C. I bet she could give you some information. Also Pink Girl lives in Canada as do several others. Maybe you can do a search as I think there was a recent thread on some health insurance issues in Canada.

All the best in this complicated decision.

[pattyz]

Hello...

You might try asking about this serious topic over at bcmets.org where we have 'lively discussions' on just this subject!

Hope you find helpful information quickly.

patty

[BonnieR]

Does your husband's company have a Human Resources department that can help sort this out? If they have employees in Canada perhaps they have answers to these concerns...

[Louise O'Brien]

Rupali:

Come to Canada. You are not moving to a medical backwater. I'm Canadian and I can't tell you how grateful I am for our healthcare system. Both my husband and I have been treated for cancer (he was diagnosed with prostate cancer five years ago while my diagnosis was a year ago). Once diagnosed, our treatment was instant and immediate. And free. We have not had to pay a cent. And we've been treated by the best.

We have internationally renowned physicians here and if you are relocating to Toronto you will have access to some of the best specialists in the world.

It would be a shame for you to lose your residency status when there are so many people waiting to get into this country.

Toronto is also a lovely city with great benefits - terrific restaurants and theatres and a nice quality of life.

I will give you this advice though. If you are considering a move, get your oncologist to refer you to a Toronto specialist. You need that referral and you should be working on it now. You can't just walk in cold and make an appointment.

You will have to wait three months until you get health care coverage so make sure your husband's company covers you for that period. They should.

I can't tell you if our health care system covers the three drugs you mention but the information is on line and I'll try to research it for you. Nor can I tell you if your private health care carrier will - only your husband's HR department can.

As far as treatment goes - I can tell you that Herceptin for early stage breast cancer patients was approved in our country several years ago. I believe the FDA in the U.S. only approved it for early stage patients last year.

We don't have to worry about private insurance carriers refusing to cover us because the cost of the medication is too high. You may hear stories about long waiting lists but I can only tell you that much of that is a myth - we experienced none of that once we were diagnosed. Our treatment followed quickly. My surgery took place three weeks after my diagnosis.

Given your diagnosis and the prospect of future expenses, I personally feel this is a move you will never regret. I have many friends who moved to the U.S. for career opportunities who want to come back - and it's because of our health system.

[Cathya]

Rupali;

I just noticed your post and agree with Louise. I am also Canadian and live in Ontario. As I am not familiar with how health matters work in the US I can't make a comparison but I can say that my own care has been excellent. Although outsiders look at our health care system as a national one, please be advised that it differs province to province. When originally set up each province matched the Federal governments' contribution to health care and it was an equal partnership. Over time the federal government has reduced the amount of money they contribute to our health care system and now, because of this, have very little real control. Medical decisions such as which drugs to cover, etc. are made individually by each province. I would not worry about this too much but realize that our experiences could be different depending on which province we live in. Ontario's health care is very good and among the top in Canada. In order to be referred to an oncologist here you must have a biopsy confirming your diagnosis. I believe this is why Louis is rightly telling you to get a referral. While you can chose your own MD, you must be referred to an oncologist.

I do notice that more of our US members comment on PET scans and MRI's than CT's. I personally have MRI's when needed and CT's on a regular (every 2 or 3 months) basis. PET scans are really not standard here in Ontario yet. I am told that will be coming soon but I know my own oncologist would like me to have one and can't get it arranged.

I have not doubt you will find other differences but I can assure you that there is tremendous comfort in knowing that all your health needs are freely met here. Cancer is considered a top priority here and service is very quick.....appointments, tests, etc.

Best regards,

Cathy

[mke]

You got some good answers. Pay particular note that health care is provincially administered. It really is a hard choice you're facing. I had all my cancer care in Toronto and I was satisfied with my care. I don't think I ever had an MRI or a CT. I had my care at Princess Margaret. I think that if you have very good insurance in the US you probably get faster care and you get more tests and scans and stuff than you would in Ontario. But we just go and get on with it and don't have to consult insurance companies about anything and there are no co-pays or forms.

It seems a long time since your permanent resident approval, are you sure that your medical exam is still valid. I ask because there was some question about acceptance of 1 year old x-rays when I came to Canada (but that was long ago).

I think life in Canada is pretty good. I live downtown in a comfortable area, fairly close to an area called "Little India". Crime rate is low by North Am standards, the city has a good symphony, new opera house, active theater, many art galleries. Library system is great, parks are pretty good, transportation system is good in downtown area - not so good in the suburbs.

On the down side, it's cold here, but not hideously - about like New York City. It is not an inexpensive place to live. Taxes are fairly high by US standards, we have a sales tax of about 13%, houses in my neighborhood run 500,000 and up and at present the Canadian dollar is at something like 1.06 US.

I can't answer your question about drugs, but I could probably find out if it is a decision point.

[caya]

I live in a suburb called Thornhill, just north of the Toronto city boundary lines. It's true that the transit system in the burbs isn't as good as in the city itself, but things are improving.

I have been very happy with the care I have received since I had my dx. in Oct. 2006. I found out on a Thursday afternoon, my GP had my DH and I in her office the next afternoon, and she already had referred me to 2 doctors downtown - my breast surgeon at Princess Margaret Hospital (PMH), which is a world reknowned cancer hospital, probably in the top 5 in the world, and my oncologist, at Mount Sinai Hospital, right next door to PMH. I chose to be treated at these hospitals, no insurance company or HMO dictates which dr. I saw and at which hospital. I saw both of these specialists within 10 days. Despite alot of the bad press you hear in the States, the wait times for certain procedures are exaggerated and the exception, not the rule.

My oncologist and I determine the drugs/protocol I receive, I do not have to answer to any insurance company. I have had MRIs and CT scans when my drs. and I felt it necessary, with no worries about payment or filling out forms. The drs. and the chemo nurses are top notch, but again Toronto is generally equated as being the "New York City" of Canada, so you will be getting the "best of the best" here.

Our system is not perfect, and we do pay higher taxes here, but everyone is covered at all times. You do not have to worry that if you lose your job, you will lose your health care - this can NEVER happen here. So all in all, I think most Canadians will tell you that our universal health care system is something we appreciate, would never give up, and would willingly pay higher taxes for.

The city itself is very multicultural, with lots of culture, dining, etc. It's a great place to live. But check out the status of the drugs you need to get and all the ramifications involved, this will definitely have an impact on your decision.

all the best
caya

[sherri]

Rupali,

Like other Canadians said, if you have a very good insurance in US, you get better care than here. But on the other hand, there is no Doctor here that benefits for more tests etc... So they are more honest about your situation. You can ask your Doctor to give you drugs that are not approved, and you get cheaper price than US.
Overall Canada is a great country and health care system is for all the people, children get the best of health care and prevention is much better here than US.

[Merridith]

Hi Rupali:

I am Canadian. Here are some of the things that I think that you should think about:

1. Each province controls Canadian Public Health Insurance individually. These plans are not identical. For instance, most provinces will cover the cost of Herceptin, but some will only cover it if your cancer is described at a certain “stage”.
2. If you want to buy Tykerb and have it administered, you can do this at a private clinic. Most provinces have these in the LARGEST cities. You will also have to pay for the cost of infusion in addition to purchasing the Tykerb. These private clinics are (depending on the province) exist on the political fringe of acceptance and have been targeted at various times for shut down by politicians by limiting the types of treatment that would be deemed legal under our socialist medical system.
This political wind can put these private clinics in a precarious financial position and as a result make it slightly risky to rely on their continued existence. Some provinces are more politically opposed than others.
You can circumvent this problem by living close to the border. It is common for Canadians to travel to the US to get treatment – and as a result all the US border towns have lots of medical clinics available just to accommodate this – such as infusion clinics.
3. Look carefully at the fine print of your husband’s extended health insurance, as there are sometimes exclusions for existing conditions. The question to ask yourself is “If we move to another country i.e. US or Canada - does our carrier remain the same or does it CHANGE?”
4. Pharmaceuticals such as Aromasin & Zolodex are only covered by medical insurance if your income is under a certain amount. The other condition is that if you spend a total amount of more than X annually on prescription medication this subsidy will kick in. You need to check what the income cut-off is as it differs with each province. Additionally the medications that are covered ALSO vary with each provincial plan.
5. While it is true that Canada offers universal medical access – it has in many areas of its’ medical system very long wait-lists to access it. These waitlists are prioritized based on medical urgency and you can be continually “bumped” down the list if someone more urgent upstages you.
Cancer in general is considered “urgent”. However if a different medical condition were to arise – for instance if you needed a knee replacement, you could easily be forced to wait many months for the necessary surgery. Here again – wealthy Canadians solve their problem by going over the border to the US to those handy clinics set up just on the other side to deal with this.

On a different note - the Canadian currency is rapidly gaining value against the American currency. You will be able to purchase more treatment using Canadian currency than if you are paid in American currency. The difference in valuation in currency is likely to increase because of the ongoing worsening of the American credit crisis and more and more countries refuse to hold and deal with the American currency. (I am an active investor)

Good luck!
Merridith