So that it's means tested in some way.
Anybody else?
Evidence of meeting #11 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was insurance.
Evidence of meeting #11 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was insurance.
12:05 p.m.
NDP
12:05 p.m.
Professor, College of Pharmacy, Dalhousie University
Related to your other question--I don't have drug company funding now, but I have in the past--I think one of the biggest questions is which drugs, so that when you have a certain amount, whether it's $1,500, $3,000 or $5,000, it's really critical to think about which drugs are funded within that. That makes a big difference.
12:05 p.m.
Conservative
The Chair Conservative Rob Merrifield
The time has gone, but I'll allow another answer. If there is none, we'll go to Mr. Batters.
Mr. Batters, you have five minutes.
12:05 p.m.
Conservative
Dave Batters Conservative Palliser, SK
Thank you very much, Mr. Chair. Thank you to the panel for being here today.
I have a number of comments and a few brief questions. I'd like to frame my comments by saying that I think, and perhaps all of us can agree, that patient access to medications that are most appropriate for them and their condition is of paramount importance. That's the overwhelming goal that I think we should be dealing with here. It's certainly the priority of Canadians. This does not seem to be the goal of the national pharmaceutical strategy, with the exception of catastrophic drug coverage. The NPS seems to focus on cost containment measures--and, Mr. Chair, I'd respectfully submit that the NPS is something that I think should be specifically studied by this committee.
Ms. Mintzes, I'd like to ask you and perhaps Mr. Skinner to comment on this very simple question. Should physicians have the right to prescribe the specific drug they believe is best for their patient? You mentioned COX-2 inhibitors. If a physician believes that a certain COX-2 inhibitor is best for their patient--they think a traditional NSAID is going to give them a GI bleed--that relationship, doctor-patient, in my mind, is sacrosanct. Should they have the right to prescribe the specific drug they believe is best for their patient, yes or no?
12:05 p.m.
Centre for Health Services and Policy Research, University of British Columbia
To go back to the COX-2 inhibitor story, for instance, you're also looking at a situation where part of the information was actually kept from doctors in terms of the outcomes of those drugs on their patients. What I would say is that if you are looking...I think both the doctor and the patient should have a right to access the full information on the safety and effectiveness of the products that are being prescribed and used, in order to make sure they can actually get the best health outcomes out of them.
12:10 p.m.
Conservative
Dave Batters Conservative Palliser, SK
Absolutely.
I have very limited time, so I have to get to other questions. But provided they get the information and they're informed, does the physician have that right, the right as a clinician, to prescribe the specific drug they want for a patient?
12:10 p.m.
Centre for Health Services and Policy Research, University of British Columbia
In Canada currently, if it's on the market, the physician has the right to prescribe it. That does not mean, for instance, that as taxpayers we would necessarily say that we would reimburse that particular product.
12:10 p.m.
Director, Departments of Health and Pharmaceutical Policy Research and Insurance Policy Research, The Fraser Institute
Emphatically, yes, doctors should be able to prescribe whatever they think is best for their patient. But I would agree with Barbara that as an insurer you have a responsibility to determine what you will pay for. I think under a public program that's financed by taxes in a redistributed fashion and that proposes virtually universal coverage, you will run into a problem of unsustainability that will lead you to rely on rationing and central planning exercises, like telling doctors what they can prescribe for patients.
I think a better way to approach this is through a private insurance model and mandatory purchase rule that would achieve better outcomes, including preserving a physician's right to prescribe what they see fit for their patient.
12:10 p.m.
Conservative
Dave Batters Conservative Palliser, SK
In July of 2004, the premiers issued a communiqué, acknowledging the value of pharmaceuticals in that they
reduce admissions to hospitals, help reduce wait times, prevent illness, allow individuals with mental illness to lead more productive lives, allow patients with chronic disease to regain a sense of health and independence, and improve end of life care through a robust palliative drug plan.
Despite the fact that numerous studies support this view, the NPS activity to date would not appear to take this into account. It seems to be a balance sheet exercise.
I would also point out that innovative patented medicines represent less than 8% of the total health care budget in Canada. Those are 2004 figures.
This is my final question, Mr. Chair.
Mr. Skinner, I would like to ask if you believe that prescription pharmaceuticals represent a net cost or a net savings to our health care system. From hearing your comments on the Quebec model, I can guess what your response is.
Considering medications, such as ACE inhibitors and statins, one has very good evidence to look at reductions in hospitalization, then quicker discharges from hospitals, and reductions in diagnostic procedures and surgery. So are prescription meds a net cost or a net savings? Of course, we're not even talking about the human costs, in terms of—
12:10 p.m.
Conservative
12:10 p.m.
Conservative
Dave Batters Conservative Palliser, SK
—drugs that help patients live happier, healthier lives. But in pure economics, is it a net cost or a net savings?
12:10 p.m.
Director, Departments of Health and Pharmaceutical Policy Research and Insurance Policy Research, The Fraser Institute
The evidence on this is very clear. There was a comment made earlier that new drugs don't have an impact. If you look at that impact over the entire range of new drugs, there is an impact. In fact, that's where it is most pronounced. As I mentioned earlier, Dr. Frank Lichtenberg of Columbia University has shown that a dollar spent on new pharmaceuticals saves up to $7 spent on non-pharmaceutical health spending elsewhere.
So you have to ask yourself the question, if we spent zero on pharmaceuticals, would we save money, or would we spend far more on other non-pharmaceutical health care goods and services to replace that? I think if you look at it from that perspective, you will see that there is a net savings. The research is clear on this. The Quebec example, among those in the other provinces, is also clear.
There is one other thing I want to address, which is the issue of distinctions being made between new products, such as biologic products, that are being hit harder in this rationing even than pharmaceutical products, which are being hit very hard.... So there are some distinctions the committee should be aware of.
12:10 p.m.
Conservative
The Chair Conservative Rob Merrifield
Thank you very much.
Now we'll go to Monsieur Laforest.
You have five minutes.
12:10 p.m.
Bloc
Jean-Yves Laforest Bloc Saint-Maurice—Champlain, QC
Good morning to the witnesses and to all committee members. I'm delighted to welcome you here.
My first question is for you, Mr. Skinner. You claim that governments ration the amount of new drugs available on the market because costs are out of control at this time and because they can't easily conceive of making new expenditures. You also said that governments are able to maintain this position because sick people make up only a small proportion of the electorate. That statement carries some political overtones.
I find it rather hard to believe your statement. We know, and various polls confirm this belief, that the primary concern of Canadians is health care. Since politicians are very mindful of polls, surely there must be some other explanation for this situation. And while sick people account for a small proportion of the electorate, they nonetheless have families and friends, all of whom are concerned about improvements to the health care systems and more affordable drugs.
There have to be some other reasons. Would you not agree with me? This can't be the only one.
12:15 p.m.
Director, Departments of Health and Pharmaceutical Policy Research and Insurance Policy Research, The Fraser Institute
Thank you for your comments.
I would argue that the number of people directly affected by waiting times--for hospital services, for physicians, for access to medicines--is in fact very small. The evidence is clear on that. So the general population, the bulk of the population, does not see in a direct way the failures of our health policy and the failures of our health care system. Because of that, there's not a lot of political momentum for change.
In fact, when you poll people on what they think of the health care system, they generally think it's pretty good. But then ask them how much they use the health care system: it's generally very little. So if you were to poll only those people who were very sick, I suspect they would have a very different opinion on how well the health care system is performing, including access to medicines.
That explains, I think, the lack of political momentum for change to make things better. It's not that we don't have high technology or advanced hospitals or well-trained physicians and nurses. Look, our medical staff can go anywhere in the world, and their skills translate very well. The problem is that our system is not allowing people timely access or appropriate access to an appropriate level of resources, and that's a function of its centrally planned design.
12:15 p.m.
Professor, College of Pharmacy, Dalhousie University
I think there can be an overuse of medicines. Antibiotics in particular can sometimes be overused, especially for viral infections. There can be an inappropriate use of medicines as well. We just looked at every single patient in our hospital who had a fall from their bed, and we found that 60% were on Valium-type drugs. So there's a quality issue there. There can also be an underuse of medicines--in heart disease, diabetes, and so on.
I think many issues around the quality of medicines need to be addressed more systematically across the country.
June 20th, 2006 / 12:15 p.m.
Conservative
Rick Dykstra Conservative St. Catharines, ON
Thank you. I appreciate it, Mr. Chairman.
I have a couple of questions.
First, obviously the amount of research and development necessary is always on the cutting edge. Somebody wants to find, somebody wants to develop, the cure for cancer. How much money is actually spent on research and development in terms of the non-generic companies that are into it? Is there a number we bandy about, one that you're comfortable using?
12:15 p.m.
Centre for Health Services and Policy Research, University of British Columbia
There are some numbers bandied about that have been highly contested, and that keep going up, of about $1 billion. But that's based on a tiny proportion of drugs and on factoring in about 40% to 50% opportunity costs. So just the idea that at the top of the stock market bubble, the money could have been spent elsewhere....
Within the pharmaceutical industry, generally about twice as much is spent on marketing than on research and development. The whole rationality of research and development could be greatly improved if there was more of an incentive towards producing drugs that are real health benefits--
12:15 p.m.
Conservative
Rick Dykstra Conservative St. Catharines, ON
I don't meant to cut you off, Barbara, but I have only five minutes; we have to rock to the answers here.
Brett, do you have something?
12:15 p.m.
Director, Departments of Health and Pharmaceutical Policy Research and Insurance Policy Research, The Fraser Institute
My understanding, and this is based on government data, is that the pharmaceutical industry is the most R-and-D-intensive industry in the country. That's the basis for comparison, I think.
I'd also say that governments spend some amounts of money supporting medical science research, but they spend heaping loads of money supporting public policy research that favours the status quo. Now, it's interesting to note that none of us were asked if we received any money for our research from governments; clearly our interests could be influenced by that as well.
If you were to compare government R and D spending in Canada with the R and D spending in the United States, I think you would see significant differences. That's something worth studying.
12:20 p.m.
Conservative
12:20 p.m.
Director, Departments of Health and Pharmaceutical Policy Research and Insurance Policy Research, The Fraser Institute
Sorry, I'm not aware of the statistics on that. But it would be in the thousands, the tens of thousands.
12:20 p.m.
Conservative
Rick Dykstra Conservative St. Catharines, ON
Madam Demers brought up the fact that there's a 78% difference in cost between generic drugs in Canada versus in the United States. Is that relationship because...?
Sorry, I'm totally new to this business. I'm learning as you speak, so I'm asking questions that may be somewhat rudimentary.
Is there a relationship between the fact that there are companies that do the research and development, that produce the product, and the fact that generics are 78% more expensive? Is there a relationship here, that generics are taking advantage of the fact that someone else does the work, and therefore keep the price up?