Health committee  Obviously having formulary restrictions would help, but at the same time, we don't believe formularies are the best way to make doctors take cost-effectiveness more into account when they write prescriptions. Under systems of managed competition, there are ways in which you can, for example, delegate to primary care practices responsibility for part of the cost of the drugs that are prescribed for given patients.

Health committee  If I may ask, do you sympathize with the idea of drug budgets for primary care practices?

Health committee  If we didn't have a system that divided federal-provincial jurisdiction over health care, incrementalism might have worked a little better.

Health committee  I'll mention that I don't think it's fair to say that we are advocating the status quo. We are advocating things like managed competition, for example, in the pharmaceutical sector, but we also advocate managed competition with respect to hospital and physician services. We think the Canada Health Act at the present time is interpreted in a way that is actually counterproductive with respect to reforms that provinces could undertake if they weren't hamstrung by the desire of the federal government to be visible in the health care field.

Health committee  Value-based pricing is a somewhat technical concept that health economists like. One of the few ways we can actually try to quantify better health is through the concept of quality-adjusted life years. In the institutions across the world that make decisions whereby they ultimately may say no to certain expenditures that cover certain procedures or drugs that do have health benefits but for which the incremental health benefits are too small, given the cost, the metric they tend to use is the concept of quality-adjusted life years.

Health committee  No, I don't think so. There are presumably some cases of breakthrough drugs that enable people to deal with health problems that previously could not be treated at all, and in this situation pharmaceutical companies are effectively in a position to blackmail the individual buyers, including individual countries.

Health committee  When you are talking about mixed public-private systems, the model we favour in general is to have a public default plan so that everybody is automatically insured through the public plan, but people then have the right, if they so desire, to opt for an alternative private plan.

Health committee  Our paper gives a menu of areas where we think the federal government does have a major role to play, and the pricing of pharmaceuticals is one of those. It is true that the patent system is the main reason pharmaceuticals, especially brand-name pharmaceuticals, are so expensive.

Health committee  I'm all in favour of managed competition with respect to setting certain limits that would provide rules that pharmaceutical companies can follow, including issues of compulsory enrolment in group insurance plans, along the lines that are now the backbone of the system in Holland, for example.

Health committee  No, I'm sure of it.

Health committee  Being up to date, in my opinion, is not the major issue. The major issue has to do with how you interpret people's responses to survey questions. All of you, I'm sure, have answered survey questions of various kinds. You're asked on a scale from zero to five whether you have had severe difficulties, some difficulties, whatever, and you know how arbitrary the answers are that people give to questions of that type.

Health committee  All I'm familiar with is that most of the evidence that is cited on the difficulties that Canadians have accessing health care are based on answers that people gave to questions in various kinds of survey questionnaires. I'm not clear on how reliable that data is and exactly how it should be interpreted.

Health committee  Thank you. My name is Ake Blomqvist. I am an adjunct research professor at Carleton University and co-author of the C.D. Howe publication called “Feasible Pharmacare in the Federation”, which we have submitted to the committee. I am a part-time health policy scholar at the C.D. Howe Institute, but I am also presenting on behalf of my co-author, Colin Busby, who is an associate director of research at the institute.