Campaigning politicians in Canada like to accuse their opponents of being secretly in favour of two-tier health care.
That’s out of date. In the Yukon, it turns out we already have three tiers. It’s kind of like an airline frequent flyer program.
In the basic level — let’s call it Bronze — you get free healthcare but not a personal doctor. Instead, you go to Emergency if you need help or call 811 to get advice from a nurse. You used to be able to go to the walk-in clinic, but it closed. According to the Canadian Institute for Health Information, 21 per cent of Yukoners don’t have a regular health care provider. That’s about 9,000 people with Bronze Yukon health cards.
Silver is where you have everything the Bronze folks have, plus a regular doctor. You can book regular appointments for checkups. The staff will help you book blood tests or specialist appointments. Over time the doctor can get to know you and give you more personalized advice. They will also have your old tests and records if you need to check any new conditions with your baseline.
The Silver tier has the other 79 percent of the Yukon population.
As for Gold, we’ve had Gold with drugs, dental and vision care for years. But only for those Yukoners lucky enough to have coverage from work.
More recently, however, a new Gold tier has come in. This is Zoomcare. You log onto your app and sign up for digital housecalls from doctors or nurses, who are often available the same day or outside normal working hours. There are several services available in the Yukon, such as Maple, Dialogue and Mycare.
I decided to try it.
After forgetting to sign up during business hours, I logged on at around 6 p.m. It took me 14 minutes to sign up, complete the series of questions on my medical background, pick my Whitehorse pharmacy from the drop down menu, upload a photo of my health card and the offending lump (from two different angles), and book myself a doctor appointment for 7am the following morning.
At 7 a.m. sharp, my computer pinged that I had an incoming secure video conference. It was a doctor from Toronto, calling in from a home basement. The doctor seemed highly professional and we discussed my lump at some length.
In the end, the doctor advised that my kind of lump was too tricky to diagnose via video conference or uploaded photos. This was a relief since I had forgotten to draw the blinds and was wondering what the neighbours would think when I took my shirt off and started to show my body to the laptop camera. The doctor suggested I should go see my regular doctor in person. Fortunately, I have Silver health care (and quite like my doctor’s office), and had an appointment within a week.
We don’t know how many Yukoners have Gold zoomcare, but my doctor said they zoom with lots of Yukon patients. Unlike British Columbia and Alberta, the Yukon doesn’t cover zoomcare appointments. Some Yukoners get zoomcare via their workplace health plans. Others can pay cash, starting at $49 per session with one provider.
In addition to digital doctor house calls, a number of Yukoners have told me about zoom mental health services they have been using.
The attractions of zoomcare are obvious, which is one reason why private investors are jumping into the business. During the pandemic, we have learned to do everything from work to education to book clubs by video conference. Why not doctor visits?
Local doctors are busy, so why not tap into doctors elsewhere in the country that have free time? It’s too expensive to have the front-office staff in a doctor’s office working 24 hours a day, so do the pre-appointment screening and scheduling via a digital tool with automated chatbots. If the chatbots don’t mind working around the clock, why not let the doctors do appointments at hours that suit them and the patients on weekends or outside regular hours?
The systems tout how much time they save for patients and bosses if employees don’t have to commute to a doctor’s office and sit in the waiting room.
The platform I used is also designed to send reminders, follow up messages and allow me to keep track of what the doctor said. Within minutes of hanging up, there was a recap “care plan” from the doctor recorded in my account along with a handy three-page Mole Assessment checklist for future reference.
The system is not perfect, however. For my kind of lump, Zoomcare was not that useful. You need to see someone in person. However, if routine doctor visits can be done quickly and effectively, this frees up more time for local doctors to see more complex cases.
Some are concerned about care quality. This may be the case for some platforms, and there have been horror stories with telecare in other countries. But the one I used has fully regulated Canadian doctors, and its website brags about its medical and data security quality controls. I felt no pressure from my zoom doctor to buy any other services from the platform, and they encouraged me to take my skin lump to a local in-person doctor as soon as I could get an appointment.
Health data is another issue. Now data on my visit and care plan are on a Toronto computer, not in my local doctor’s office or the Yukon health system. But this is how it works now. For example, your visit to Emergency does not show up in your local doctor’s system next time you visit, or vice versa. I even heard the words “fax machine” last time I was at my pharmacy checking on a prescription.
But the biggest issue is access. Around 9,000 Yukoners are stuck in the Bronze tier. Media reports last week said 2,472 Yukoners are on the official waiting list for a family doctor, some languishing there for almost two years. Currently these people have to go to Emergency for care. On the other hand, those with money or the right job have access to convenient Zoomcare.
Back in April 2020, the Yukon’s Putting People First health panel said “we are suggesting that virtual care become a normal way of providing Yukoners’ care, rather than a pilot project or technology available only to a few people.”
The Yukon government continues to work on health care reforms. It needs to budget for more doctors and nurses to serve everyone on the waiting list. And it also needs to offer quality Zoomcare to every Yukoner, whether that’s contracting with a national service or hiring new doctors to staff an online hub here.
Keith Halliday is a Yukon economist, author of the Aurore of the Yukon youth adventure novels and co-host of the Klondike Gold Rush History podcast. He is a Ma Murray award-winner for best columnist.