It looks like the Canadian medical system will only get worse. The leaders are turning to hard core DEI to solve medical personnel shortages.

Doctors protest proposed DEI emphasis in Canadian medical school training - Do No Harm

Canada’s DEI doctors | The Spectator

Better care, no! Had a friend of a friend I met in Canada that worked as a Superintendent for CP rail. He developed a brain tumor, needed an MRI. All of BC had fewer MRIs than we had in Wichita Falls, TX and they couldn't get him in for 6 months, which he probably wouldn't have lived to make. The friend is a radiologist, few him to Texoma, did the MRI, read the MRI and sent him back with everything. Another doctor I knew in MS was trained in England. What both have said is their national health systems do well with acute care, but other than that they're pretty bad. They do have boards that basically ratio care by limiting availability, who gets it, and it is also why wealthier people in Great Britian can still carry private insurance to get care. Health/Death Boards are real.

Coach K's hospital does frequently turn down medical insurance companies price negotiations. If that is the case, one is notified and told if they want to remain in their system, they need to find an acceptable insurance provider. They have turned down United Health, a well run mafioso organization, and one other local insurer more recently.

It will happen more and more as the insurance profit growth model collides with the hospital population / medicare reimbursements, and current cash flow needs. Hospitals aren't in business to operate with negative cash flow. However, if you want to make the case that hospital management pay relative to customer facing (physician) pay is out of line, then one has a different gripe about legal reporting requirements, legal suit prevention and the costs associated with continuously improving patient experiences and outcomes, mandated by CMS, and reimbursed by CMS, along with the cost of procuring and maintaining EMR, electronic medical records systems. EMRs require constant maintenance for ever changing regulatory filing requirements.

Not entirely accurate. According to the Medicare/Advantage adviser I use, Crystal (Sphere Coverage Solutions Inc.), that was only for the Saint John's County area.

The hospital I retired from late Spring was grossing more money than ever but was still losing money each month in large part to nationwide workforce shortages and having to pay travelers 3x normal pay. Salaries at every hospital I've work have lagged behind real inflation for decades, and I was one of those higher paid people! For the past 13 years, a good raise was 2%. It's been so bad; the hospital has had to make bulk salary adjustments to keep from bleeding people because they can make more going elsewhere. The last person I hired to help me started out of graduate school at what it took me 30 years to earn. Healthcare staff shortages are very real and VERY COSTLY!

IMO Health care as we know needs gutted. Single payer the government. Let all those billions in plans be paid to government and not insurance crooks. When you get insurance laws written by lobbyists this what you get. SAFU. ACA just made it worse cause they didn’t read what was in it. Also IMO in person has insurance it should be against law for clinic or medical field to refuse that insurance. Medical industry shouldn’t be steering public to their favorite kick back insurance and refusing care who don’t have that plan. And yes I can have opinion.

Wrong. The insurance company does not care what the bill total is... they pay exactly the same no matter what the bill, unless the provider charged less than the allowable. So if test A has an allowable of $10, and hospital Z charges $12 for it, they get paid $10. If hospital Y charges $200 for it, they get paid $10. You do not get paid more for billing more

It’s called negotiations. The medical groups want more and the insurances want to give less. They are both in business to remain profitable. Eventually they will reach an agreement until the next time!

You wouldn't happen to have evidence for that 70% denial would you. Because if it were true nobody would be on a MA plan and everyone would be experiencing denials of over 1/2 their charges. It simply is not true.

Here's one reference I easily found
And another article looking at hospital system charges
where the Medicare Advantage initial claim denial was 15% and the TRADITIONAL MEDICARE denial rate was 8.4 %. So your claim that Medicare never denies is also wrong.

Now this is for payment, not authorization. So what is the rate of denial of prior authorization by Medicare Advantage?

Try this highly reliable source using 2022 data, KFF

Well that means that for things requiring prior authorization, which most do not, the final rejection rate is 1.3 % not the ridiculous 70% you throw out to scare people. And I suspect 1.3% of people wanted things that were not medically needed... I want an MRI because I had two headaches last year kind of requests.

This is not how MA plans work. They are not between you and Medicare. In fact Medicare is not involved with you once you join a MA plan. Medicare contracts with the MA insurance company and pays that company every month a fixed amount per enrollee who otherwise would have been on traditional Medicare but opted for MA instead.
The amount given to the MA company is rate based on costs in the region, the health of the insured group etc. For almost all MA plans, they are given more than the expected amount Medicare would pay but the MA plans are offering additional benefits including removing CMS from claims processing. MA plans do get a higher monthly payment if the patients are sicker which is why your MA doctor lists every single thing you ever might have had in your diagnosis list.

But the MA plan is not waiting to be paid by Medicare. They have the monthly capitation which is well over 1000 per person and they make money if your care costs less than that amount, and lose if you are more costly.

And they lived happily ever after

Is that because we all know government is far more efficient and far less wasteful than the private sector?????? :1rotfl::1rotfl::1rotfl::1rotfl::1rotfl::1rotfl:

And please let me know where I can sign up for those "kickbacks"----especially since in 40 years I never saw one or heard of one----except from the "experts" on social media.

Maybe you wasn’t looking cause you wasn’t in insurance business while making millions and lobbying. UHC good example.

Too bad, I could have cashed in 😂😂😂

Very good post. For a healthy person in 2025 MA Plans will receive an $1191.56 capitalization payment each month per enrollee. They get that whether you go to a doctor or not. As per the rate book. 2025 | CMS

The behind the scenes rejectors of medical procedures denials. . .

EviCore, the Company Helping U.S. Health Insurers Deny Coverage for Treatments — ProPublica

Exactly! I worked with a guy from Canada. When I asked him how he liked the healthcare system there his answer was, "if you like waiting 3 months for an mri it's great. That's why the pro hockey players go to the US for medical care."

Be careful what you wish for, the government healthcare system is the UK is in big trouble as well.

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Yup, shocking isn't it? >>$1000 per month for every person in an Advantage plan.
The funny thing is, on average, the government spends nearly that much for EVERY Medicare eligible citizen, no matter what their plan: advantage, supplement, or straight / plain / original Medicare.