Health Committee on June 1st, 2016

[Dr. Cindy Forbes]

It's possible. There are other ways to do it, and I think it is happening across Canada right now; more and more systems are being developed within the provinces so that we can see all of the prescriptions that might be coming from multiple drugstores.

But there's still a potential advantage to having one system. I'd like to point out that probably the best advantage of national pharmacare for physicians is being able to treat our patients, for them to get the medications that they need. That's really what we're talking about with all of this: the advantage to patients of not going without treatment.

I think we all recognize that this happens; I certainly see it every day. It's one of the questions I ask. As I'm writing a prescription or typing it on my computer, I'm asking some general questions about whether they're going to be able to afford it. I think that's the big event.

[John Oliver, Liberal, Oakville, ON]

Is there any downside to a national pharmacare system, for a family doctor or for physicians in general? I was hard pressed to think of one.

[Dr. Cindy Forbes]

Right. I guess it really depends on its administration. If I were going to come up with something, it would be that it not be administratively burdensome. That would be an obvious one for me, and that it be more seamless. The upside would be perhaps better information, more guidance in more evidence-based formularies. That would be obvious to me.

[John Oliver, Liberal, Oakville, ON]

Does Mr. Ayoub have more time or not?

[The Chair, Liberal, Bill Casey]

No, he hasn't. Your goose is cooked.

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

On Monday, Dr. Robyn Tamblyn, a professor from McGill University, suggested a model whereby we have a national formulary of essential and efficacious drugs, such as insulin or asthma medication, which are proven to work and which we know will, if taken properly, prevent more serious illness. She suggested a plan whereby those would be provided free to all Canadians, and then drugs that are more experimental or are more expensive, without any proven additional efficacy, might be offered to Canadians on a co-pay basis.

Is that a model that has some attraction for you, Dr. Forbes?

[Dr. Cindy Forbes]

I haven't considered it exactly in that form. In some ways, we have a sort of two-tier system, even with patients who have private plans and patients on pharmacare. If their medication isn't covered on the plan, they always have the option of purchasing it by themselves.

In some ways those decisions are being made when formularies say they don't think a particular drug works but that patients can buy it if they want to. That actually does occur somewhat, but I hadn't really considered it as a model to move forward with.

Do you have any comments on that, Owen?

[Owen Adams]

Briefly, it would depend on who else was then going to pick up the rest. Just how broad would it be, and then how would you cover the rest of it? That would have to be thought about.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I understood you correctly, Mr. Adams, you made what I consider to be a fairly strong statement that you thought the movement towards universal pharmacare today is a bigger gulp than the action in the 1960s to create medicare for Canadians, to provide free physician and hospital care for all Canadians.

Do you think this is a bigger economic and policy move than the creation of medicare itself was? Do I have you correctly?

[Owen Adams]

Yes. For one thing, at the time of the Hall Report, I think prescription drugs accounted for 6.5% of total health spending, and today that number is about 13.4%, so it has grown in that sense. In terms of medicare, the first medicare payment was made in 1968-69, and it was $33 million. Then it grew quickly thereafter. Of course, I haven't looked at the previous hospital expenditures, and those were ramped up.

As we said in our brief, the National Forum on Health recommended the shift, and at the time I think they were talking about $6 billion and some further amount. That's $9 billion in today's dollars, and actual spending is much over that amount. You've had growth in spending of about 200% versus population growth of 20%, to give you the magnitude of the shift.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have data to support your statement, or are you just—

[Owen Adams]

It's all in the brief, sir.

[Don Davies, NDP, Vancouver Kingsway, BC]

But is there a study you could point me to that shows that moving to universal pharmacare today would be a bigger shift than to move to pharmacare as it was phased in? I'm just trying to find out whether this is your opinion or you have a study or data that backs up that statement?

[Owen Adams]

No, I have nothing definitively established. I'd have to think about how you would show that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, thanks.

Dr. Forbes, in terms of the public-private mix, right now Quebec has moved to a system under which the public carries everybody who doesn't have a private plan, and private plans from employers are mandated to provide coverage to their employees, so it's exactly a public-private mix, and we've heard criticism of that plan here on two counts.

Number one is that it has proven to be very expensive on a per capita basis because of the administration costs of the insurance plan. Also what they're finding is that the private plans are cherry-picking. They are dumping the expensive costs onto the public plan and cherry-picking the cheaper applicants onto the private plan. These are some of the criticisms, if I have that right.

Has the CMA looked at the Quebec plan and done an assessment of the issues around that?

[Dr. Cindy Forbes]

I actually can't answer that question. I've not seen any analysis that we've done on the Quebec plan.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Thank you. I'm done.

[The Chair, Liberal, Bill Casey]

And we're done.

We're going to have bells shortly and we have a little bit of committee business to do. I want to thank the presenters very much.

Ms. Mistry and Mr. Harrington, if you have written reports, we'd like to have them. Can we have copies of your presentations? There's information in them that we'd like to be able to go back over. We found them very interesting and helpful.

We'll just take a little break, and then we'll reconvene.

We have two quick issues I need to talk to you about.

[The Chair, Liberal, Bill Casey]

We'll reconvene.

There are just two issues. Our next meeting is June 6, and we have a guest list, but for June 8 we don't. There are the supplementary estimates that we can or cannot look at.

Is it the wish of the panel to have a look at those on June 8 if we can get the proper people to come in and answer questions on them?

[Colin Carrie, Conservative, Oshawa, ON]

That would be great. Can we have the minister and her officials come by?

[The Chair, Liberal, Bill Casey]

We can invite. Normally we have the minister, do we? Or do we have officials?

[Colin Carrie, Conservative, Oshawa, ON]

We have both.

[The Chair, Liberal, Bill Casey]

We can ask for the minister.

Everybody has the supplementary estimates, I believe. They should have been distributed.

Are there any comments over here? You're a quiet bunch.

All right, we'll try to get the minister for June 8. If we can't get the minister, do we still want to go ahead with the supplementary estimates?

[Colin Carrie, Conservative, Oshawa, ON]

With the officials probably we could. My preference would be to have the minister.

[The Chair, Liberal, Bill Casey]

We could with the officials. All right. We'll see what we can do.

That's the first item. The second item is that tomorrow is the liaison meeting between all the chairs of committees. I'm going to tell the committee that we are intending to travel, but I need your direction on where you want to go.

I think you all have the proposed travel schedule. It's broken down into two options, option A and option B, although we can reconfigure them. Those are the recommended ones. Option A is the United Kingdom and Sweden; option B is New Zealand, Japan, and Australia.