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Aaaarrrrrgggghhh!  I just got into, ahem, a discussion about healthcare in the U.S. versus healthcare in Canada.  According to the person I was in this "discussion", Canadian healthcare is no good, terrible, horrible and Canadians are crossing the border in droves to be treated here lest they die in Canada waiting from treatment if they can even get it.

The Bill O'Reilly impersonator with whom I had this discussion is relying on anecdotes from an healthcare worker who lives in Ontario but works in the States at a hospital in a surgical support role.  According to this Canadian resident, a patient in need of cardiac surgery cannot get treatment in Canada before expiring and so must seek surgery in the States.  I asked if the Canadians were paying cash, had private insurance or were relying on their national health care plan to pay.  The Billo guy had no idea.  I pointed to a study that I had sent him (this is not the first time we have engaged in this discussion) regarding Canadians' satisfaction with their national healthcare.  According to this study, Canadians are satisfied, know the system needs improvement, do not want to gut it but rather put more money into the system to improve it.  The Billo guy didn't read it, didn't care and said it was all anecdotal anyway so it proved nothing.

I pointed to the problems with our healthcare or lack of healthcare.  That many people don't have insurance.  That as a population we are less healthy than the Canadians.  He still insisted our system was better than theirs because Canadians have to wait too long or die before they are seen by a doctor.  I said they wait about as long as it takes us to get an appointment with a doctor especially a specialist.  He said he doesn't wait, can get in immediately because he just calls his friend, a doctor and gets in.  Seriously folks, he didn't understand that most of us do not have these kind of connections, do not live in the world of professionals who live in the neighborhood and golf at the country club (this Billo guy lives in that world).

I know the Canadian system isn't perfect.  I know our system is far from perfect.  But I assume that Canadians would have thrown out a healthcare system if it was so terrible and ineffective a long time ago.  I know Canadians don't go bankrupt due to illness.  Americans do.  I know Americans die because they don't have health insurance.  I know Canada has lower a maternal mortality rate and infant mortality rate.  I know a lot of American health statistics look like a third world country.

So Canadian Kossaks I ask for your help in fighting the trash talk about your healthcare system.  

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Comment Preferences

  •  Small Assist From a Once-Almost Canadian (14+ / 0-)

    All my American friends who left for the land of the free to become Canadians are never coming back. If we 2 hadn't been trapped here by the American health care system via a needy relative, we'd be New Democratic Party voters ourselves.

    I qualify for retiree health care 2 ways: 1, I was a state employee for almost 20 years; 2, I am spouse of a 20+ state employee retiree.

    Both of those qualifications will be taken away from me at the same time this or next year. I will lose my health care for which I fully I qualify, 2 different ways.

    You bet your sweet ass I wish I were Canadian.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Mon Apr 08, 2013 at 08:05:29 PM PDT

  •  Saved my life (16+ / 0-)

     I felt really bad for 2 weeks and woke 1 morning and could not catch my breath, headed to emerg and was in surgery within 2 hours to have an infected heart valve replaced with a pig valve. I was in hospital for 10 days. The bill I had to pay was ZERO.
      Nobody who needs life saving surgery has to wait thats a lie.

    •  Pretty much what I thought (3+ / 0-)

      and confirms what I've read.  Like most medicine, there is triage.  If you are not critical, you wait.  If you are, they take you.  The billo guy was relating a story that a family, Canadian citizens, were at a wedding in Toronto, their daughters were sick with pneumonia and had to wait in the ER.  The mother called someone (not related in the telling of the story who) who arranged for them to go to a Buffalo hospital and be treated immediately.

      I am pretty sure, they would have been seen in the Toronto hospital ER before they died and would have been treated.  Why they felt the need to drive 2 or more hours to Buffalo is beyond me.  And billo never answered who paid for all of this. Good luck getting admitted in most American hospitals if you cannot pay.

    •  Wow (4+ / 0-)

      troj21, that's some story. It must have been shocking to discover what they were proposing to do to make you well!

      I'm glad it turned out okay, from the health perspective. And you could definitely afford that Zero bill.

      My theory is that I'm happy to contribute my taxes into the community pool of money for health care. So far, I haven't needed anything extraordinary, and I hope I never do. I am glad my tax contribution can support the families that do face something extraordinary, like your surgery.

  •  It sounds like it wouldn't matter how much (12+ / 0-)

    information you found. He isn't going to listen, believe you, or care. For people like that, I just don't engage, but I know there are people who enjoy it.

  •  Is the person you are debating living in the 80's? (8+ / 0-)

    Way back in the day, some medical procedures were quicker to get on the southern side of the border.  I have friends that live on both sides of the border.  30 years ago, the person you are debating might have been right.  Now, today, Canada has got us beat hands down.  I have a Republican friend that had a heart attack while visiting Vancouver, That friend was so very impressed with the Canadian healthcare system that they are now for single payer.  My duel resident relatives are all encouraging their children to take the Canadian citizenship.

  •  I lived in Canada for 30 years (6+ / 0-)

    I have very few complaints about the system. It's especially good for the self-employed, which I was for a few years. It's a lot harder to make self-employment work if you have to pay AT LEAST $6,000 a year for private health insurance.

    And you're wasting your breath talking to this Repugnikan with a cranial-anal inversion. And please tell him I wrote this.

  •  The singular difficulty with the Canadian (4+ / 0-)

    healthcare system -- specifically, an occasionally acute shortage of available medical care -- is 100% the responsibility of a continuous right-wing assault on the institution, which began from the moment of its enactment by Parliament and has continued unabated.

    Canada devotes about 10% of its GDP to health care. If Canada devoted 15% of GDP to health care -- still a smaller fraction than the US -- there would be no doctor shortages and no waiting lines (except for procedures of dubious usefulness to the patient, including the oft-cited coronary bypass).

    To put the torture behind us is, inevitably, to put it in front of us.

    by UntimelyRippd on Mon Apr 08, 2013 at 09:33:09 PM PDT

    •  thanks for the insight (1+ / 0-)
      Recommended by:
    •  My parter is alive (1+ / 0-)
      Recommended by:

      because he had a quadruple bypass.

      Nothing dubious about it.

      •  sigh (1+ / 0-)
        Recommended by:

        the word, in English, for induction on a sample of one is "superstition".

        google abounds in serious studies that demonstrate that many, many, many bypass operations are ineffectual at best, harmful at worst. here's a quote by an author of one study, which in this case found bypass surgery to be inferior to balloon angioplasty (referred to as PCI):

        Over three years of follow-up, total medical costs for the PCI group averaged $63,896 per patient, compared with $84,364 in the CABG group. After five years, costs were $81,790 in the PCI group versus $100,522 for CABG. The five-year survival rate was 75 percent for PCI and 70 percent for CABG, although this difference in favor of PCI was not statistically significant.

        "Angioplasty maintains a significant cost advantage with no adverse impact on survival rates, even after five years," said lead author Kevin T. Stroupe, PhD, a health economist at the Hines, Ill., VA Medical Center.

        just because it may have been the best thing for one person you know does not mean it is the right thing for everyone in the US for whom it is prescribed; nor should you assume that it is impossible to discriminate between good candidates and bad candidates.

        To put the torture behind us is, inevitably, to put it in front of us.

        by UntimelyRippd on Mon Apr 08, 2013 at 10:08:39 PM PDT

        [ Parent ]

  •  Satisfaction, US and Canada (7+ / 0-)

    I'm an American. I've been living in Canada for a long time and I wouldn't move back to the States.

    Some did a study of American and Canadian views of health care. As I recall, the question was: is there any health care you've needed but couldn't get, and why?

    The percentages were about the same in both countries.

    The reasons were different:
    Americans said they couldn't get treatment because they couldn't afford it.

    Canadians said they couldn't get treatment right away but had to wait to get it.

    Me, I'd rather have the second problem if I had to have one or the other. Waiting to get to the head of the line seems easier than rectifying one's financial or insurance situation.

    As to waiting:

    1. The only problem I've had with seeing my family physician is that he goes on holidays with his family for three weeks. I can see someone else in the practice, though. American doctors probably have vacations, too.

    2. I haven't needed to see a specialist immediately. I know a couple of people who were diagnosed with something very serious. They both said that they were moved straight to the head of the line because of their condition at the time of diagnosis. They were happy with the treatment they got. (Cancer for one, heart for the other.)

    3. I see my ophthalmologist every couple years. The wait time there is about three months from when you call the office--but it is up to me to make the call. Sometimes, I get in to see her within the week, if there has been a cancellation.

    I'm in Alberta, and, from what I've seen, the medical people do try to triage effectively so that patients who need immediate specialist care get it.

  •  Going to the States (5+ / 0-)

    I live in Alberta.

    Some patients are sent to the U.S. for treatment by the health care system here, and the costs are covered.

    For example, I believe there was a pregnant woman who was sent to Montana before her expected delivery to be cared for there.

    My recollection is that she was expecting multiple babies--more than twins, I think it was. The local hospitals were aware of what the possible demand for maternity care might be. They had other patients who might have needed the high-powered care that multiple newborns require, and, of course, with pregnancies you can't be sure who will need care, and when exactly.

    Out of an abundance of caution, wanting to be sure that she and the newborns had the medical care they needed, when they needed it, the provincial health care system sent her to a U.S. hospital.

    It was expensive, I'm sure. I don't think they need to do this often; it was just a case of having too many potential customers at the same time, and jeopardizing moms and babies as a result.

    Some people go to the U.S. to get diagnosed, rather than treated, if they are worried that the local doctors missed something.

    I've known a few people who went to the Mayo Clinic for testing, paying for it out-of-pocket. They got their test results shipped to their doctors here.

    These were all people who could easily afford the American health care charges.

    People of more average means stay as far away from American health care as they can, in my experience.

    •  I kind of think the crap billo hears (1+ / 0-)
      Recommended by:

      and repeats is from tea baggers (I think they have a few in the Great White North too) and those who can afford to come to the States for testing and/or treatment.  Wealthy people don't like to wait for anything.  

      When you have a national healthcare system that is coordinated, you can see future demand and act accordingly as in maternity care. I wouldn't think of Montana having great NICU care but it's great that the Canadian government had the ability to  see the need for flexibility and that the provider would send her to another country for care. When I had my first born, I got the last bed on the maternity floor and the next woman got a bed in the lounge.  When they ran out of space in the lounge, they started putting women on other floors.  There was no ability to plan and suggest OB's with admitting privileges in other hospitals send their patients to those hospitals.

  •  I know a lot of Canadians (3+ / 0-)
    Recommended by:
    Mortifyd, Hirodog, domestic goddess

    None of the Canadians to whom I spoke about healthcare during my stay there would trade what they have in Canada for what we have in the US.  None of them.

    I think there are surveys or studies that illustrate this, but I don't feel like searching right now.

    Yes, sometimes people with non life-threatening issues have to wait.  It's called triage and anyone with a serious illness or injury will get seen quickly.

    Also, for any horror stories that surely exist from the Canadian system, be sure to stack them up against horror stories from the US "system."  Anything involving human beings will not be perfect and medical care is no exception but you just don't hear of Canadians going bankrupt due to medical issues.

    That said, costs are rising in healthcare - faster than GDP growth and faster than inflation.  

    The really interesting thing is that the costs are rising across the board regardless of which delivery model is used.  i.e. The fully government run NHS in the UK, privately run and publicly financed system in Canada and various hybrid systems in other countries are all seeing increasing healthcare costs.

    I'd still prefer to see single payer come to the US, but one of the things I like about Obamacare is that there are things in it to try to identify cost effective ways of delivering medical care.  

    "Why do we see the same old Republicans all over the news all the time when they were kicked out for screwing everything up?" - socratic's grandma

    by Michael James on Mon Apr 08, 2013 at 10:42:32 PM PDT

  •  Comparative access is relatively easy... (1+ / 0-)
    Recommended by:
    domestic goddess measure.

    Then there's comparative quality.

    Boehner Just Wants Wife To Listen, Not Come Up With Alternative Debt-Reduction Ideas

    by dov12348 on Mon Apr 08, 2013 at 11:05:12 PM PDT

  •  I'll repost something I put on Facebook in 2011 (6+ / 0-)

    (for my stateside peeps who think Canadian Healthcare is worse than no healthcare at all)

    Today (Tuesday) my father-in-law Peter (a Canadian living in Nova Scotia) had a pacemaker implanted after a series of arrhythmias caused him to pass out on Monday morning. Very glad he's going to be okay, and probably feeling better than before. Of course it got me to thinking again of the claims I often heard (from bogus sources) during the U.S. healthcare debate.

    Note that Peter's treatment was immediate - he got the necessary surgery the day after his incident. No months long delay, no ignoring his needs because he was 72, no calling and fighting with insurance companies to get "pre-approval." It was ordered on the specialist's authority alone, and it was done. There will be no retroactive denial of payment for the hospitalization costs, because these costs were paid by everyone's tax dollars.

    Now Peter will be able to start feeling better without any worry at all about a massive $80,000 bill for the procedure, hospitalization and doctor's fees. And that's the way it should be.

    If you've been swallowing the FoxNews, Rush Limbaugh, and Glenn Beck lies about single-payer healthcare, I'm here to tell you that they are just that - lies. Canadians in every poll express approval of their single-payer system, especially when compared to the U.S. system. Every one of my experiences with the system here (during 14 years) has been superior to any experience I had in the United States as an adult. Single payer is better for people, it's better for doctors and it's less expensive for the taxpayer (by a massive amount) so you are probably wondering what's standing in the way of the U.S. adopting it?

    Probably the biggest obstacle is a decades-long campaign of deception by the health insurance industry, the middleman who takes much of the cash and provides nothing in return. They don't provide any care or any value to the doctor-patient relationship - only aggravation and a lethal dose of greed. If single-payer is adopted, they will be out of business. But don't be naive - they're going to fight for their yachts and for their 24 million dollar compensation packages. The for-profit insurance industry needs to die, and it needs to die now.  It provides nothing of value, and only takes lives. For those of you who say "but it provides work for so many!" you should think more seriously about what it is they're working at. It's an industry that has no right to exist - because it has set up a system that's killing thousands of Americans every year. It has a disgusting sense of entitlement not only to a third of your income, but to your very life and death.

    You may not be able to change the world, but at least you can embarrass the guilty.
    - Jessica Mitford

    by Swampfoot on Mon Apr 08, 2013 at 11:23:06 PM PDT

  •  My wife (an American), my brother, my sister (2+ / 0-)
    Recommended by:
    flowerfarmer, chimene

    and I all have had serious conditions which were treated promptly and at a world class level.  My brother and sister both had serious heart problems--one a by pass and the other a bypass and valve replacement.  Sure, there are things that we want to improve and holes in the system that need to be fixed.  But I and the vast majority of Canadians would not trade this for the US system ever.  My portion of my taxes that goes to support healthcare for my wife and I is, according to the Department of Finance website, approximately $3200 annually

  •  I am a Canadian. (3+ / 0-)

    I was born in the United States.  I lived there for my first 23 years.  I've been in Canada for 34 years now.  I am a Canadian citizen.  I'll never go back to the United States to live.  A good part of that is the fine health care that I get in Canada.

    I had a brain tumor in 2000.  I got radiation surgery, pinpointed to the tumor.  The tumor has receded to a fraction of its original size and I get an MRI every 6 months to make sure.  I did a lot of research on treatment as this developed and I am sure that I got the best treatment available in the world.  

    I have a wife and three kids.  We've always had good experiences with Canadian health care.  My son is now a nurse in the system, working in the field of psychology.  He is positive about the system but of course aware of ways that it could improve.  I pay about $2000 per year for my family health care.  Our kids are on the plan as long as they are in university.

    There was an Angus Reid poll (Angus Reid is the Canadian Gallup Poll) about ten years ago that found that 91% of Canadians support the health care system.   If our health care was bad would you get that result?  Do you honestly think you would get that kind of response in the United States?  In our system the provinces run the healthcare system.  If the voters feel that the health care system is not being run well we can vote them out.  That has happened.  There is nothing like the fear of being voted out that keeps the politicians on their toes.

    Of course, no system is perfect.  There is a lot of room for improvement, and you can always find people in any health care system with complaints - sometime fair and sometime not.  Some health care issues have bad outcomes and people don't want to accept that, which is entirely understandable.  Of course, in any systems doctors or nurses can make mistakes.  There are waiting periods for some elective care (non life threatening) that are too long, but if you have a heart attack or a cancer development, we expect immediate treatment.   As I understand it, there are waiting periods in the United States as well.

    At least nobody goes bankrupt in Canada or loses their home trying to stay alive.  That can't happen.  The system pays for everything.  Also, if you lose your job you don't lose your health care.  I feel better knowing that a bank president gets the same treatment as I do.  As I understand it, a few rich people do go out of the country to get health care, but that doesn't happen very often.  If you are rich you can do whatever you want.

    I get to choose my own doctor in Canada.  Our daughter had a friend visiting a year or so ago.  He arrived very sick.  We took him immediately to our family doctor who saw him in 15 minutes.  Within an hour we were home with the proper drugs for his treatment.

    I've still got family in the United States and I get back  there a lot.  I've heard a lot of crazy things said about Canadian health care in the United States.  One time as I was driving through Utah I heard some "expert" on a right wing radio show say that the object of Canadian health care is for the old people to die as soon as possible.  Do the people listening to that radio show really think that Canadians would tolerate that?  I don't know why people are driven to lie like that.  I know there was some lady on Bill OReilly that was complaining about her Canadian health care treatment.  The health care system didn't comment on her case because of privacy laws but some of her friends in Canada finally went public and said that what she had was apparently not that serious and she was just a crazy lady.  There was also a report on Fox News a few years ago that the Premier of Newfoundland got a minor operation in Florida.  They made a bid deal out of that.  It turns out that the guy went to the hospital in Florida for his operation because he had a condo on the beach and he want to spend his time recuperating there.  Also the Canadian health care system covered most of the cost of his operation in Florida by paying him what it would have cost in Canada.  They once tried bringing Fox News up here and nobody watched it so they gave up.

    God is innocent: Noah built on a flood plain.

    by alphorn on Tue Apr 09, 2013 at 05:09:24 AM PDT

  •  I live near Canada, have cared for a few Canadians (2+ / 0-)
    Recommended by:
    Claudius Bombarnac, chimene

    ...and near as I can tell, all the Canadian complaints about their universal health care are just normal belly-aching about any public service. Consider it the equivalent of U.S. griping about the Postal Service.

    As in, "Yes, I can send a letter anywhere in America for 44ยข with 99.999999999% certainty that it'll get there within 4 days. But that guy at the Post Office counter looked at me funny and wasn't servile enough when I was buying stamps last Tuesday. And I think they get paid too much. And a monkey could do their job. and......"

    Will you have to wait to have a trivial hernia repaired in Canada? Probably yes. Do people die awaiting coronary bypass surgery in Canada? A hell of a lot fewer than in America, because in Canada no one dies because they can't afford care.

    No one in Canada is bankrupted by health care, whereas in America it's the cause of more than half of all bankruptcies. Every week I see a patient who's been suffering terribly at home without care because they were uninsured and couldn't afford to come to the ER or office for care until the pain became unbearable. In Canada that simply does not happen. Period.

    The U.S. health care "system" is a moral atrocity by comparison.

  •  if it was so bad in Canada (2+ / 0-)
    Recommended by:
    CFAmick, chimene

    and all these people are coming to the US for private pay care, wouldn't some capitalist in Canada open up a private pay only medical center in Canada.  They could be raking in cash from the flood of people that would be going to the US for care instead.  Unless, of course, there really isn't any significant number of people doing that.

  •  Let us know how it goes. (0+ / 0-)

    Shop Liberally this holiday season at Kos Katalog

    by JamieG from Md on Tue Apr 09, 2013 at 07:15:09 AM PDT

  •  Gift him a dvd copy of Michael Moore's (1+ / 0-)
    Recommended by:

    'SiCKO'. There's plenty of the Canadian Vs. American info. in that movie. Even Moore's website contains the info. you seek, it also debunks the RWNJ lies told about the movie.
     Like a typical Right Winger he wants to be the Grifter but doesn't realize he's the Mark.

    "We thought about it for a long time, "Endeavor to persevere." And when we had thought about it long enough, we declared war on the Union."

    by voodoochild62 on Tue Apr 09, 2013 at 10:20:35 AM PDT

    •  He's got his and no one in his world (1+ / 0-)
      Recommended by:

      doesn't.  He's an attorney with his own specialized practice.  He came from a solidly middle to upper middle class family and his college was paid for by his parents.  His father pulled strings to get him into a top school.  I could go on but he's never been poor or deprived.  He's not really that bright or worldly except for his specific field.  

  •  Health care a provincial matter - B.C. notes (0+ / 0-)

    1. B.C. Medical Plan has a waiting time website for non-emergent procedures. Here's the link:  For example, CABG (Coronary Artery Bypass Graft), province-wide 1.1 weeks wait-time for 50% of the cases and 90% operated on within 9.4 weeks, broken down by health region, hospital and coronary surgeon. The historic problem has been hip replacements, knee surgery, etc. Currently hip replacement: 50% within 12.3 weeks, 90% within 32.8 weeks province-wide.

    2. B.C. is one of the few provinces with a separate medical plan premium. It's $798/year single, $1,536 for a family of 3 or more. It's reduced to zero for low-income residents. The top provincial individual income tax rate is 14.7% on taxable income over $104,754. Provincial sales tax rate is 7%. Health care spending accounts for approx. 40% of provincial budget but combines Medicare, Medicaid, and 100% of everybody else. B.C. long-term debt is rated AAA.

    3. If a procedure is medically required, there is no co-pay, no deductible, in fact, no invoice. Doctor visits, lab tests, X-rays, hospital stays, surgery. NOT dental, psych, pharma, vision, physio which are often covered by employer extended health insurance or optional private insurance.

    4. My family doctor is an independent contractor who works in a multi-doctor practice with two offices (guess 40+ doctors?). If I phone on Monday, I would expect to get an appt for Tuesday or Wednesday. I have phoned on an urgent basis to see a doctor within two hours (ER waits can be long during the day). All medical records computerized. After-hours walk-in clinics on evenings and weekends.

    BTW, B.C. Medical paid my family doctor $304,844.36 and my internist/specialist $664,367.68 in the fiscal year ended March 31, 2012. (Practice administration overheads and expenses come out of these amounts.)

    5. Drug prices dropped on April 1, 2013, to 18% for 6 generic drugs negotiated by a group of provinces. For example, Lipitor generic 90 days $30.99 plus $10 dispensing fee (no tax). The others at 35% of brand price, dropping to 25% next April 1. Government funds low-income patients' pharma.

    6. Ageing population drives two concerns: seniors accumulate chronic diseases and health conditions over their lifetimes and are more expensive to treat. Doctors and nurses are getting older and will retire with insufficient replacements being trained up. These are not "hair-on-fire" concerns - they are seen as issues that government has to address in the future.

    Solving the problems of health care in Canada is a direct political issue. If I believe my care has been sub-standard, after addressing the hospital or care provider, I can complain directly to my MLA (state representative), to the B.C. Health Minister, or to the Premier (Governor). Doctors and nurses are organized and negotiate province-wide contracts for reimbursement rates and pay rates.

    In the U.S., who listens to patients' complaints? Who does anything about them?

    7. "In a Canadian National Population Health Survey of 17,276 Canadian residents, it was reported that only 0.5% sought medical care in the US in the previous year. Of these, less than a quarter had traveled to the U.S. expressly to get that care." Anecdotes at

    I would be more interested in a survey of Canadians who EVER expressly sought medical care in the U.S. I have a hard time criticizing Canadians who can afford to who seek specialized medical treatment, e.g. Mayo Clinic, when Americans and people from outside North America frequently travel out of their home towns/countries for similar reasons.

    8. Included in the 40% of provincial budget is the B.C. Centre for Excellence in HIV/Aids

    B.C. has experienced a marked decrease in HIV/AIDS morbidity and mortality since the implementation of HAART in 1996. This has been associated with a nearly 60% decrease in new HIV diagnoses, to the current level of 301 cases diagnosed in 2010. More recently, HIV treatment as prevention initiatives have been initiated in a number of jurisdictions around the world, including San Francisco, New York City, Washington, D.C. and China.
    STOP HIV/AIDS is a pilot project to expand HIV testing, treatment, and support services to clinically eligible individuals in British Columbia. Hon. Kevin Falcon, former Minister of Health Services, announced the program on February 4, 2010. The initial four-year pilot phase is supported by a $48-million funding commitment by the Government of British Columbia to Vancouver Coastal Health, Northern Health, the Provincial Health Services Authority, Providence Health Care, and the BC Centre for Excellence in HIV/AIDS.

    STOP HIV/AIDS aims to increase treatment for all clinically eligible individuals who wish to access care. The pilot project specifically serves individuals facing multiple barriers to care in Vancouver's inner city and Prince George. These barriers include addiction, mental health issues, homelessness, and other social or environmental factors.

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