Health Committee on Nov. 1st, 2012

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you.

I read on your website that health care is the number one priority for Manitobans. Your website states that 43% of the Manitoba budget is spent on health care. These funds should be used in the most efficient way to provide the best standard of care.

What kinds of examples do you see of efficient and cost-effective health care delivery in the province of Manitoba?

[Dale Lacombe]

That's a good question.

A recent example is the merger of the 11 regional health authorities down to 5. There's a very concerted effort to manage the administrative expense of the health care system, and we've seen evidence of that. That is a major undertaking. It's been implemented, but the government is still working through that. We thought that was encouraging.

We've also seen a very strong focus from the department on managing expenses, so the growth rate is down. We are seeing those types of examples.

The merger of the regional health authorities from 11 to 5, I would say, is the most evident and the most recent.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you.

How much time do I have?

[The Vice-Chair, NDP, Libby Davies]

You have one and a half minutes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

I have a question for Madame Côté.

You are currently working on a number of research projects with funding from the Canadian Institutes of Health Research. How is this funding assisting with the creation of new jobs and innovation in the health care system?

[José Côté]

I have received a few grants from the Canadian Institutes of Health Research to develop and evaluate innovative health care practices. Of course, that creates work for the research assistants who do the evaluation of these new technologies, but it also enables us to form unusual health care teams, in terms of computer science and media. On my research teams, there are a lot of people who work in computer science and media. Developing these innovative health care practices creates jobs on an ad hoc basis.

I don't know whether that answers your question.

[Diane Saulnier, Chair Coordinator, Research Chair in Innovative Nursing Practices, Université de Montréal]

If I may, I would like to add to that answer.

In fact, our objective is not so much to create jobs as to evaluate the effectiveness of new health care interventions and determine whether those interventions will have a positive impact on the public's health. This should not be considered as a gain in jobs in health care. These computer-based virtual tools may involve creating a few new jobs, but it is mainly the expertise of the nurses, pharmacists and physicians that is being put to use in this case.

The indirect impacts will be more in the health care technologies industry than in the health care system, given that the professionals who work with us already have jobs in a clinic, a family medicine group or a community network. We therefore cannot talk about job creation as such. In any event, we will have to make sure that this is eventually marketed, which is another matter.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much, Madame Saulnier.

Now we'll go to our five-minute round, and we'll have time, probably, for one question. We'll begin with Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you very much, Madam Chair.

Thank you to all the witnesses today. I found your stories very interesting, and, frankly, depressing in a way, in that we come to this study about innovation and what we find here is a very old idea of collaboration. When one looks at the evidence you've put forward today, it's a reminder of all the great opportunities we've missed, all the billions of dollars needlessly spent on health care, to say nothing of the health care implications for Canadians for things such as adverse drug reactions and over-medication and those sorts of things.

On the brighter side of things, I guess that idea is still with us today; it's a matter of applying it. What we have before us particularly, Mr. McBane, in the documents you provided, is this low-hanging fruit that's available for us to pick off the tree, and what a huge piece of fruit it is, too. I mean, even if the studies are wrong, we're still talking about savings in the order of billions of dollars for Canadians, and a better health care system along with it.

I was wondering if you could perhaps provide us with a few details on what a country like New Zealand does, in fact, to reap these 50% savings and maybe, too, comment on Australia, if that's a more applicable political system for us to compare ourselves with.

[Michael McBane]

In terms of New Zealand, it's referred to in Marc-André Gagnon's study because that's kind of the source of the major savings, if we were to implement their purchasing strategies.

In a nutshell, I remember asking the head of the New Zealand drug program, “How did you do this? Is there a document? Can we read it? Can you share it?” He said, “Well, it's not really on paper. We bargain prices.” New Zealand bargains. Canada does not. So billions of dollars are saved in New Zealand.

There's an example of a study at UBC with four classes of drugs only, where you bargain for four classes, like New Zealand does. We'd save $2 billion in just four categories, $2 billion for exactly the same product. It's because we're not bargaining for purchases.

[Matthew Kellway, NDP, Beaches—East York, ON]

It's just the application of another old idea.

[Michael McBane]

Australia is even more like Canada in size and jurisdictional makeup, so instead of letting the states go on their own, it's the national government of Australia that establishes the formulary and establishes the bargaining with these multinational companies. That's actually a pertinent example of having one purchasing agent do the bargaining and saying, “If you want access to Canada, you have to give us a break on the price.” These companies will give you a break. We're not even asking for a break.

[Matthew Kellway, NDP, Beaches—East York, ON]

Okay.

Very quickly, you mentioned 30%, the extra cost we pay in Canada compared to most industrial countries, and in Quebec it's even higher, 40%. Is that incorporated into the 50% and the 9% that you're talking about in comparison to New Zealand and Australia?

[Michael McBane]

The 30% comes from.... Basically, if you analyze the impact of the Patented Medicine Prices Review Board, what they do is pick a basket of seven countries that have the highest prices to set Canada's introductory average, so it's an artificially high introductory price. Instead of taking the OECD average, say 30%—

[Matthew Kellway, NDP, Beaches—East York, ON]

Do you know why they do that?

[Michael McBane]

Well, I do know why. At least my theory is, if you look at the history of the Patented Medicine Prices Review Board, it was established by Brian Mulroney's government as a gift to the drug companies. The rationale at the time was that if we gave them higher prices, they would give us research in return. They promised in that deal under the Mulroney government, when the Patented Medicine Prices Review Board was set up, to invest 10% of sales revenue in R and D. Now we're down to about 5%. They never met their promise, so we should not be rewarding their price.

[The Vice-Chair, NDP, Libby Davies]

I'm sorry to cut you off, Mr. McBane, but thank you very much. We've now concluded our time to hear from the witnesses and members of the committee.

Thank you all very much for coming. It was a very good discussion, and it will help us in our study. I'm sorry to the other members of the committee who were waiting to ask their questions. Maybe another time.

Welcome, Mr. Toone, to the committee.

Thank you very much for coming. We'll suspend now for a minute, and then we'll come back in camera.

[Proceedings continue in camera]