Okay.
Thank you for inviting us. I am here from Ward Health Strategies, and I want to send my apologies from Chris Ward. He had every intention of coming, but there was a death in his family, so he couldn't attend. So you are stuck with me instead.
Ward Health Strategies is a health policy communications consultancy, with offices in both Canada and the U.S. Our clients include pharmaceutical and medical device companies, as well as government and health-related non-profit organizations.
I'd like to thank you for inviting us to present today on some of the major issues of drug policy that are impacting the quality and the sustainability of Canada's health care system. It is our perspective that the common drug review, or the CDR, can be viewed as a marker or an instructive example of how and why Canada is falling behind other countries in providing access to health care innovations that both save lives and improve the quality of care by producing better health outcomes.
In Canada, spending on health care consumes more than 10% of gross domestic product and represents the major share of total public sector expenditures. Managing that spending is critically important, putting issues of health care affordability and sustainability at the very top of Canada's public policy agendas.
Canada's population is aging, and as we age we use our health care system more. Today, 62% of Canadians are living with a chronic condition, and 75% of Canadians die from the side effects of these chronic conditions. These figures will rise as more of the baby boom generation reaches retirement age and become seniors.
Most health spending today is on chronic disease and the complications associated with these diseases. According to the Canadian Centre for Chronic Disease Prevention and Control, chronic disease is estimated to account for a full 87% of disability in Canada and two-thirds of all direct health care costs.
Many seniors rely on provincial drug plans for the drugs they need. The provinces and our national government came together to establish a common drug review with the stated goal of reducing duplication and making recommendations about what drugs will be covered by the publicly funded drug benefit plans in Canada.
There has also been some thought that the process of a common drug review can lead to better consistency and drug access in Canada and help form the basis of a future national formulary. From a public policy perspective, these may seem to be reasonable goals. However, from the perspective of Canadian patients, the CDR has been a monumental failure.
In the few short years of its existence, the CDR has already helped put Canada farther behind other countries in terms of health outcomes. Nowhere is this more evident than in the area of cancer. In its annual report card on cancer care in Canada, the Cancer Advocacy Coalition of Canada has clearly demonstrated on a province-by-province basis the association of reduced cancer mortality with increased access to treatment. The CDR has repeatedly recommended against listing of new and innovative cancer treatments. The case of Nexavar and Sutent, the first new hope for kidney cancer patients in over 10 years, is the most recent example. But when you compare the cancer outcomes between the United States and Canada over the last four years, the effective restricting of access to new treatments in Canada is even more alarming.
Between 2000 and 2004, the number of people dying from cancer in the United States has increased by little more than one-tenth of one per cent. In Canada the cancer deaths are up a full 7% for the same period. The American health care system has its share of deficiencies, of course, not the least of which are the more than 40 million people without health insurance. However, Canadians, I'm sure, will be shocked to learn that seniors and individuals living on low incomes in the United States have better access to drugs through publicly funded programs like Medicare Part D and Medicaid than similar populations in Canada who rely on our publicly funded drug programs.
Last year we did an analysis of drug access for American seniors under the U.S. Medicare drug plan and concluded that seniors living in Michigan would have access to 82% of the drugs that had been reviewed by the CDR by the beginning of 2006. In contrast, a senior living in Ontario would have access to only 15% of these drugs.
We believe this disparity has grown, and will continue to grow, unless government drug plans ignore the CDR recommendations that act as a barrier to new drug access in Canada. Medical innovation has had a profound effect and a profound impact on the prevention, treatment, and management of chronic disease. Let's take another example. Although it is still the number one cause of death in Canada, the death rate from heart disease and stroke has been cut in half over the last 30 years. In fact this year it is likely that cancer will replace heart disease as the number one cause of death in Canada.
Better knowledge about the risk factors associated with cardiovascular disease has led to a number of interventions that have had a profound impact on health outcomes. New medicines help people control their blood pressure and cholesterol. New medical devices and surgical interventions also play a part. The challenge for health policy-makers in funding medical innovation is to ensure that decisions are not based solely on cost containment--in other words, simply managing the supply side of drugs, devices, and procedures. The focus instead needs to be, must be, on improving outcomes through early detection and screening, preventing chronic disease, managing the risk factors associated with chronic disease, and reducing complications. Of course, access to drugs is not the only thing that will make a difference in an aging population. In order to increase health outcomes for individuals living with chronic diseases, health promotion and detection programs are important, as are screening programs and access to the physicians who treat the patients.
One has only to look at the difference in drug coverage between public and private sector employer-sponsored drug plans and government-sponsored drug plans for seniors and other vulnerable populations to realize that employers understand far better than governments the importance of improving health outcomes by providing better access to medical innovation. Employers fully understand the importance of maintaining the health of employees so that they can remain productive, so that they can remain out of hospitals and out of long-term care facilities and therefore avoid the costs associated with both long- and short-term disability. This approach would be equally advantageous if applied to those who rely on the publicly funded drug benefit programs.
Ultimately, oversight of the common drug review is from its board of directors, which consists of federal, provincial, and territorial deputy ministers of health, who in turn are appointed by the premiers and the Prime Minister. Those making decisions for the CDR have clearly demonstrated that their primary interest is to contain costs, and they have responded to the issues of health system sustainability by making it increasingly difficult for those using public drug plans to get access to the drugs they need to maintain their health.
Chronic conditions are costly. The Canadian Coalition for Public Health estimates that chronic conditions cost our economy over $77 billion in 2005 and that two-thirds of direct health costs and 60% of indirect health costs result from chronic disease. If a chronic condition is maintained and treated, however, many of these more costly complications can be avoided.
The Canadian Institutes for Health Research have indicated that prescribed and non-prescribed drugs are among the fastest growing components of our health care system, that they now consume over 17% of our health care budget. This is seen by most to be a cause of great alarm and an indication that our health care budgets are spiralling out of control. However, we believe that a perfect health care system is one in which an even greater proportion of health spending is consumed by drugs and vaccines that manage or prevent disease and its complications.
It is unlikely that the outcomes I mentioned earlier in the U.S. are related to overall quality of their health care system alone, as Canadians do have better access to acute care than their counterparts in the U.S. Canada also has fewer uninsured residents than the U.S., but there is no doubt that access to treatments is making a difference in the health of populations as well as in terms of health care spending.
Putting more money into giving Canadians access to drugs will improve health outcomes. Allowing Canadians to have access to vaccines, to drugs to manage chronic conditions, coupled with patient education on compliance and adherence programs and monitoring for adverse events, can help ensure that Canadians are among the healthiest in the world.
In conclusion, we believe the CDR needs a major shift in order to properly serve the needs of Canadians and their health care system. The CDR needs to broaden its perspective and begin truly looking at the advantages of incorporating new health technologies into our system.
The CDR must allow physicians to care for their patients with the best tools available, and the CDR needs to allow more patients to be involved in the decisions it makes.
Thank you.
