Something is rotten in the state of Canadian health care.
In a system that purports to be about equity of access, the lack of universal pharmacare – public coverage for prescription drugs – is increasingly becoming unacceptable, according to Dr. Danielle Martin, MD’03.
“Canada is the only industrialized country in the world that has universal health coverage that doesn’t include prescription medications,” said the physician, a Schulich School of Medicine & Dentistry graduate.
Last year, Martin, vice-president of medical affairs and health systems solutions at Women’s College Hospital in Toronto, spoke as part of an international panel presenting to the U.S. Senate’s Subcommittee on Primary Health and Aging. Her policy expertise and passion for equity have made her an emerging leader in the debate over the future of Canada’s health-care system.
“We find ourselves in a situation now where we have really fallen behind our peer nations. As more and more health care is provided outside of the hospital and in the community, more and more health care is about ongoing management of chronic disease, as opposed to short-term management of acute problems,” Martin said.
As it stands, prescription medications have become a cornerstone in the management of illness. The fact Canada doesn’t offer universal coverage for pharmaceuticals is negatively impacting patients who sometimes opt out of taking necessary medication because they can’t afford it. It also negatively impacts Canada’s health-care system, which pays great sums of money for both medication and ongoing care for those who can’t afford their prescriptions.
While universal drug coverage has long been regarded as a pipe dream due to perceptions of associated high costs, Martin recently co-authored a study on financing pharmacare showing it is possible, without increasing taxes by a single penny. In fact, the study shows universal drug coverage could reduce total spending on drugs in Canada by $7.3 billion.
“Since the start of Medicare, people have been talking about getting prescription drugs into our public plans, but one of the major reasons we haven’t seen traction in this issue – even though commission after commission has recommended it – is because governments are concerned about the potential cost,” Martin noted.
“Everyone knows it would save us money overall – because we would get better prices – but people have assumed it would be a significant increase in costs to governments, if you moved that payment out of the private sector and into the public sector.”
Martin and her team set out to estimate the actual cost to government, if it implemented universal drug coverage in Canada. The study looked at what the government currently spends on all prescription medication and what other countries spend on the same drugs.
“We modeled what would happen if we got prices similar to countries that have universal plans and we did a very conservative estimate, a less conservative estimate and a much less conservative estimate, to get a range of costs for universal coverage,” Martin explained.
“If we were to design the worst pharmacare system in the world, we would still be saving over $4 billion a year. If we were to get prices similar to middle-of-the-road countries, such as Italy and Spain, we would be saving over $8 billion a year on drugs, which would amount to approximately $7 billion saved to the private sector – employers, unions and individuals paying out of pocket, with an incremental cost to governments of about a billion dollars, shared across all 13 provinces and federal government,” she continued.
“If we got prices similar to the U.K. and New Zealand, which have the lowest drug prices in the world, we would actually not only save money to the private sector, we would save money to governments. We could pay for everybody’s medication across the entire country publically, and still spend less publically than we already spend, because the savings would be so significant.”
There are three sets of problems in Canada with respect to prescription medication, Martin said. The first is an issue of insurance, making for inequitable access. One in 10 Canadians does not fill a prescription, or take medication as prescribed, because of cost concerns.
“Many Canadians have to make difficult choices about their medications because they have no insurance and have to pay out of pocket,” she said.
The second issue is cost. Canada pays among the highest prices for prescription medications in the world. There are dozens of purchasers of prescription medications in the country – hospitals, private insurers, public insurers and more.
“Because we don’t pool our buying power, we can’t negotiate the prices other countries are able to negotiate – either through bulk purchasing or price negotiations,” Martin explained.
The third problem relates to quality and appropriateness. While there are Canadians who can’t access the medicine they need, there are also Canadians taking drugs inappropriate for them. One of the reasons for this is a lack of guidelines for prescribing medications.
And so, all this begs the nearly $8 billion question: Why isn’t Canada jumping on board with this model of pharmacare?
The issue, as Martin sees it, requires political courage at the federal level. Provinces can’t do this on their own.
“I hope we see this become an election issue. It is a no-brainer across every axis. It’s the right thing to do for people’s health, for equity. It would save us money. It’s a win-win for everybody,” Martin said. “What’s required is some courage and political leadership, so we have to hope those won’t be in short supply.”