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This this man have died from his tooth infection had he been in Canada?
September 9, 2011 4:04 PM   Subscribe

How would this story I read today of a man who died after an untreated tooth infection have ended had it happened in Canada? Would he have had better care or would the result have been the same?

So the story is that a guy who had to have his wisdom tooth pulled out didn't have insurance and couldn't get the procedure done. Tooth was infected and he went to the emergency room when it got bad. He was offered prescriptions for antibiotics and painkillers but couldn't afford both so he opted for the painkillers. The infection then spread to his brain and he passed away.

My instant reaction was that this was a sad commentary on the state of healthcare in the States. However, I wonder if this would have had the same result in Canada. I'm not expert in either system, so I'm just curious. Would he have been able to receive emergency dental care in Canada? Would he have been able to get both prescriptions filled? Would his odds of dying have been the same?
posted by fso to Society & Culture (19 answers total) 3 users marked this as a favorite
 
No "free" drugs or dental care in Canada. Had he been unemployed in Canada he would have faced largely the same situation. Some cities may have community dental health clinics, but it's by no means guaranteed or universal. Drugs in Canada are pretty much the same type of system as the US where most people pay via insurance provided in conjunctions with employment.
posted by GuyZero at 4:18 PM on September 9, 2011 [2 favorites]


Depends where in Canada he was. In Quebec, all drugs are insured ish, either through the govt program or through your job. Dental care is not, though I do not know about emergency dental care. Other provinces have other rules.
posted by jeather at 4:22 PM on September 9, 2011 [1 favorite]


I think (also in Quebec) that if there's signs of a tooth infection becoming systemic then it crosses a line and you can get medical help for it, not dental, and then it's covered. But I suspect you'd have to be already pretty bad for an ER triage nurse to take it seriously.
posted by zadcat at 4:32 PM on September 9, 2011


Dental is the elephant in the room when it comes to u.s. healthcare (ok so there's a herd but this is a big one). Dental is condoned off to its own wasteland in the medical provider universe. Why I don't know but it is. The insurance is alwAys different even when BigCorp provided. The only overlap is oral surgery. If you have an infection so bad that the jawbone is threatened then it becomes "medical" otherwise it is dental.

There was a case in the u.s.--- a friend of mine --- who had a similar situation. He spent a week in hospital had his jaw rotorrooted and now owes about 90K in bills. So he lived so that's different. But I think a similar survivor in Canada would owe a lot less.
posted by yesster at 4:32 PM on September 9, 2011


But I think a similar survivor in Canada would owe a lot less.

Make that $0 ... yes, a lot less than 90 k$.
posted by aroberge at 4:35 PM on September 9, 2011 [8 favorites]


I know you were specifically asking about Canada but FWIW, in England tooth extractions are available on the NHS for £47 (free under certain conditions and if his income was low enough he could have received support with the costs). NHS prescriptions are currently £7.40. In theory, if he was bad enough to end up in the ER he may have been able to have the tooth extracted for free by the hospital dentist (not sure how many hospitals have dentists on staff though) and any drugs/medication he needed would have been free for the duration of his hospital stay.
So if your more general question was whether this man's life could have been saved by a different health care system, the answer is yes - the NHS may have its flaws but it almost certainly could have saved his life.
posted by missmagenta at 4:40 PM on September 9, 2011 [3 favorites]


Well, I'm not so sure about Guy Zero's answer. It is true that there in most places in Canada dental is not covered. However, in this story the person ended up going to the Emergency room which would be fully covered as would any medication needed during an in patient stay. If the person showed up in the ER with such a serious situation they may have required an admission and IV antibiotics - the ER visit, the in patient stay and the medications would have been fully covered provided the patient was Canadian and had a valid health card for the province or territory in which they resided. In fact even if the person showed up in another province or territory with a valid health card they would have received free treatment as there is a reciprocal agreement between the provinces and territories which allows Canadians to seek medical care at any institution in Canada in the event they are traveling or are away from their home or usual place where they would seek treatment.

There are also a number of options available for those who can not afford medication and these do vary a bit by province or territory. Being unemployed there are a number of benefits available to support the costs of prescription medicine and also some dental care in some cases.

This remains the issue of medical misadventure in Canada and there are times, like anywhere in the world, where people show up to be treated and are misdiagnosed or receive suboptimal treatment - but that is another story and question all together.

Another interesting point is that when dental procedures are carried out in a hospital setting then they are covered under the insured health services program of most provinces and territories.
posted by YukonQuirm at 4:40 PM on September 9, 2011 [5 favorites]


FWIW this would be covered in one of two waysin Ireland, neither of which is ideal. Unemployed and with no income other than public support, he'd qualify for a medical card. This would entitle him to free dental. He'd be unable to get it within this two week time frame given the wait list, but at the ER he would have been treated at no cost and the medical card would have given him completely free drugs.
posted by DarlingBri at 4:47 PM on September 9, 2011


I know you were specifically asking about Canada but FWIW, in England tooth extractions are available on the NHS for £47 (free under certain conditions and if his income was low enough he could have received support with the costs). NHS prescriptions are currently £7.40. In theory, if he was bad enough to end up in the ER he may have been able to have the tooth extracted for free by the hospital dentist (not sure how many hospitals have dentists on staff though) and any drugs/medication he needed would have been free for the duration of his hospital stay.

So if your more general question was whether this man's life could have been saved by a different health care system, the answer is yes - the NHS may have its flaws but it almost certainly could have saved his life.


Yep. Indeed, the fellow in this case was unemployed, which means not only would his prescriptions have been free, the hospital might even refund his bus fare. There's a 0% chance this person would have died under the NHS if the sole cause was ability to pay.
posted by Jehan at 4:54 PM on September 9, 2011 [2 favorites]


[folks, question is about Canada, not this weird story and not US fuckity health care. Please feel free to email the OP your asides.]
posted by jessamyn at 5:13 PM on September 9, 2011


I’m from Ontario, and on Disability Support. My underlying medical issue causes a great deal of dental loss. Having been in many ER’s for similar problems I can say it’s mostly covered, with a few exceptions. If you are an out-patient then it costs $2.00 per prescription, plus a $60 “top-up” fee for the dentist on call. The wait times vary but I’ve never been more than 6 hours. (In-patient meds/treatment are all covered.)
posted by whowearsthepants at 5:15 PM on September 9, 2011


No "free" drugs or dental care in Canada.

This's nonsense; see YukonQuirm's answer.

It is a bit of a mess with different schemes from province to province. Here in Ontario, for example, drugs and children's dental work are covered under the linked schemes if you're low-income. Full prescription drug and non-cosmetic dental coverage (and vision care) are included with Ontario's welfare and disability benefits.

My city's web site says "Dental for adults and seniors with low income: Limited emergency dental care may be available. Call the Community and Social Services Department."

(canadiansocialresearch.net is a good site for...er, for what it says in its URL.)
posted by kmennie at 5:16 PM on September 9, 2011


I live in BC and had infected wisdom teeth with no insurance. I ended up getting them pulled out in a hospital for free. Also since I was low income I ended up getting my antibiotics covered by the province. I did have to jump through a few hoops and get various forms filled out and wait a few days to get them. I had to wait a few weeks for the surgery as well.

Also no doctor offered me anything stronger than Tylenol 3 and you can get a lower dose of tylenol with codiene over the counter here (even a generic brand) so I just survived on that.
posted by kanata at 5:47 PM on September 9, 2011 [1 favorite]


"Would he have been able to receive emergency dental care in Canada? "

This is essentially the situation a family member was in three months ago. If you show up at an ER in BC with a serious oral infection caused by infected teeth your hospital stay for extraction and your drugs while you are there will be covered under the MSP. Total cost to the patient: $0. MSP won't however pay for an appliance to substitute for the missing tooth/teeth. Because this family member is on disability their post hospital drugs were also covered.
posted by Mitheral at 6:17 PM on September 9, 2011


I only know about BC and QC, but in either province drugs are available at very low or no cost to those who have very low incomes. Often, doctors will scrounge up some samples for those without drug coverage as well. No one is going without antibiotics in Canada if they truly can't afford them (though there may be forms to fill out, etc.).
posted by ssg at 6:34 PM on September 9, 2011


What ssg says is also true in the United States, but people with any income can access the very low to no cost drugs, specifically, antibiotics. This gentleman may not have died if he had been more familiar with how to access cheap antibiotics.

Cheap to free antibiotics are available at many large grocery store chains, the most famous of which is probably Wal-Mart's $3 antibiotic list. They usually have a short list of antibiotics which are either free or less than $5, including the antibiotics typically used to treat dental infections - we typically use the very simplest - penicillin. The actual cost of penicillin is less than pennies, and the fact that anyone is still dying for want of it, in the USA or anywhere else, is heartbreaking.
posted by treehorn+bunny at 8:29 PM on September 9, 2011 [1 favorite]


"One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared with as few as 5 percent of adults in the United Kingdom and 6 percent in the Netherlands." 2010, source. You can look at the international comparisons by following the links there.
posted by cushie at 12:05 AM on September 10, 2011


The answer would be different from province to province as the health care system and the welfare system is very different in each province. As well, services in large urban areas will be very different than rural areas.
In B.C., if you are on welfare, very minimal dental care coverage is provided. If you are on provincial disability, you can qualify for more care. In general, because of the minimal funds - most dentists extract, rather than treat the tooth. What clients rarely get is any cosmetic care (crowns etc).
There are a few dental clinics that will do extractions for free, for people not on welfare. As well, the local Dental School may provide free extraction.
There are some dentists that will take those on welfare and "fudge" the paper work for welfare. If applicable, they may even treat the tooth (ie: root canal), rather than extract.
Just to compare though - I work and have a simple dental plan with my employers’ health care plan. My portion for the health plan is about $150.00 a month. Currently, I have a root infection that has apparently gone in to my jawbone. After a year of seeing "specialists" and numerous x-rays later - I've been told that to repair ("save") the tooth, my fee portion would be about $2,500.00 - and even then, the procedure would have a 70% success rate. As well, the insurance company (Blue Cross) is arguing that it is not an essential service. To pull the tooth - it would cost me $25.00.
So even if you have health care here – it’s not always accessible.
posted by what's her name at 8:24 AM on September 10, 2011 [2 favorites]


Another factor in how this might have played out in Canada is that you're more likely to have extended health insurance, including dental and drug coverage, via your job or separately from your job, because basic health insurance, which is where the prospect of giant hospital bills tend to jack up the rates, is already covered. So there's a lower chance that someone would even be in the situation that they didn't have dental coverage or couldn't afford their prescription drugs -- but just lower, there are certainly people in both those situations in Canada.
posted by jacquilynne at 10:26 AM on September 11, 2011


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