Evidence of meeting #14 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cost.
A recording is available from Parliament.
4:25 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
If Canada did move to a one-buyer system, could you foresee a situation where companies would choose to not offer certain products to Canadians, thereby reducing patients' choice? What would that look like?
4:25 p.m.
Vice President, Innovation and Health Sustainability, Innovative Medicines Canada
One of the challenges is that we struggle with “pharmacare” as a term. We hear it a lot, but it's sort of seeking a definition. It could mean making having a very all-encompassing program making many products available for coverage, or it could be highly restrictive. If it gets highly restrictive and it's very difficult to make drugs available, I wouldn't say that the drugs wouldn't necessarily get filed to come to Canada. That may happen from time to time, but the speed at which they would choose to file them in Canada might in fact slow down. This means the drug might be available in the world and still take that much longer for Canadians to have access to it.
4:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Ms. Kurl, if my math is there, about 90% strongly support, or moderately support, a universal pharmacare system. Now, in politics, numbers like that make politicians do crazy things. Is it fair to say that this represents overwhelming support by Canadians for a universal pharmacare system?
4:30 p.m.
Executive Director, Angus Reid Institute
Mr. Davies, don't do anything too crazy just yet. Yes, that is an overwhelming amount of support, and it indicates a great deal of buy-in. However—and there are many howevers and caveats to this—we have yet to find a universally agreed upon number in terms of budget and administration and exactly what drugs are covered, and what are not, and how much such a plan might cost.
4:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I'm going to stop you there.
But conceptually, I take it that the lesson we derive from all this is that Canadians want such a plan.
4:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Dutt, I want to ask you about cost-related non-adherence. We've heard a lot about that. I'm referring to how much it costs our medical system when people can't afford to take their prescription medicine. It's been difficult to get an actual number on that, for obvious reasons. Do you have a number for what that non-adherence costs our system today, or at least an idea of the significance of these costs?
4:30 p.m.
Chair, Canadian Doctors for Medicare
We know that about 6.5% of hospital admissions in Canada are the result of non-adherence, or people not taking their medication. In light of the present over-capacity in hospitals, to decrease that by 6.5% would be significant. In Canada, non-adherence is estimated to cost between $7 billion and $9 billion per year. In the U.S., the costs are $100 to $300 billion in avoidable health costs. That has been costed out, and there is a large cost attributable to people not being able to take their medications.
4:30 p.m.
Chair, Canadian Doctors for Medicare
I can get that to you. It's all in the submission that was given.
4:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
That would be great.
Some have suggested that moving to a universal drug coverage plan of some public type would invariably result in reduced coverage or less access to innovative medicines. What's your comment on that? If we go to a universal system, does that mean Canadians won't be able to get the drugs they need?
4:30 p.m.
Chair, Canadian Doctors for Medicare
No, I disagree. I think a system could be set up in which the medications that Canadians need most would be accessible through that system. If there were to be exceptions, a process could be put in place for that. The argument that having more access to more medications is better for people's health is not the right way to look at it.
One of the key parts of a pharmacare program would be the evidence-based aspect of it, including the evaluation of a medication's effectiveness and cost and what should be on the formulary, along with options for accessing some of the innovative medications. More medications and faster inclusion in a plan doesn't necessarily mean better health outcomes for people.
4:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Mr. Romanow, it's a pleasure to have all the witnesses here, but may I tell you, sir, it's a distinct privilege to have you here today. On behalf of our committee, thank you for your service to our country and what you've done.
4:30 p.m.
Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
The honour is mine, I'll tell you that.
4:30 p.m.
Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
Okay. I have Marchildon to answer the hard ones, and I take the easy ones.
4:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
That's experience.
Canada has unique challenges as a federation. I think you're uniquely positioned to know that, having been right at the table when we were discussing our constitution.
If universal public pharmacare were to be introduced, what do you think some of the difficulties or challenges in implementing a Canada-wide program would be? Do you have any recommendations about how we would approach federal and provincial jurisdictional discussions?
4:35 p.m.
Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
Clearly, I would favour holding discussions as a beginning, because I do believe that with rational men and women getting together for discussion and consideration of the facts—and these are not always absolute answers—compromise can result and allow the best plan to come forward. If I didn't believe in that, I would not have been involved in all of the experiences that I have been. Invariably we live in a federal system, which is a difficult system. Our federal system is a difficult system, and at some stage or another we may well find ourselves at an impasse. If I may take briefly some extra time to give you an example. Sometimes political will, in the best sense of the word—political, small p—simply has to be used.
I had the pleasure a few years ago of talking about health care at Saint FX University in the Allan J. MacEachen Lecture Series, and Allan J. was there. He was seated to my left. The president, Sean Riley, said, “Allan J. wants to say something after you finish your address”. You can imagine my trepidation at that. He described the political leadership in the following context, after describing the fact that the federal cabinet was truncated on the debates, numbers, and outcomes, and divided for a whole number of reasons and couldn't come to a conclusion about whether or not medicare should include pharmacare, as recommended by Emmett Hall back in 1964-65, and by me in 2002. MacEachen's answer was—and it'll be brief, Mr. Chairman, with your consent—that, well, it would be unnatural and unexpected for the provinces to remain silent. They took advantage of the divisions within cabinet by renewing their opposition to medicare—strike “medicare”, and put the word “pharmacare” in there. Pearson felt the full brunt of the provincial premiers' discontent on the subject of medicare. Eight provincial premiers confronted him with complaints that the federal government had no right to force the pace of medicare, and so on. It was in this atmosphere of provincial opposition and division within the cabinet that Mr. Pearson finally decided—according to MacEachen—that he would go ahead with the medicare program. Without this decisive action at this time, and because he finally made the decision, we may have lost the whole issue.
My point in retelling this is that there will be scientific debate about how the costs are to be judged or evaluated, including their distribution, and what that will mean for the system and outcomes. We've heard some of those comments today. If we have any model to build on, then it is this one that I give you. It took federal leadership by a federal government in a minority situation to implement medicare. I don't think anybody around this committee table would say that was a wrong decision. I could be wrong, but I doubt it. There were many doubts about it. There are many doubts about pharmacare, and perhaps even some competing figures in that regard. However, on the principle and the philosophy of it, since it naturally follows from medicare, and since the drug costs in our current system are the next highest to America's—all the others beat us, the European countries—I think there's a model there for us to follow.
Sorry to be long-winded, but I think that is exactly what I would say should be done, as a former practitioner of the dark arts of federalism, because of the evidence internationally and nationally
4:35 p.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
My first question is for Mr. Romanow. It's an honour to have you here, sir, after your remarkable work done in your public life.
Since the publication of your report “The Future of Health Care in Canada” in 2002, what major changes have been made regarding access to medication and access to health care in remote areas? What do you think needs to changed first when it comes to access to prescription medications?
4:35 p.m.
Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
With the permission of the committee, Mr. Chairman, we've agreed to divide this, because I rely so much on my chief executive officer, Dr. Marchildon.
4:35 p.m.
Professor and Ontario Research Chair in Health Policy and System Design, Institute of Health Policy, Management and Evaluation, University of Toronto, As an Individual
There are really two questions here. The first is on rural and remote coverage, and I'll come back on your second question to ask you for clarification, but really, nothing much has changed on the rural and remote.
Of course, we're talking mainly about coverage here, as opposed to service delivery, and that deals with the area of primary care, the way in which prescriptions are provided, and the way in which follow-up is done. We can see from our studies on primary care that there is still the same fragmentation—the same difficulties—that we faced 15 years ago at the time of the Romanow report. There's really been no change there.
Can you clarify your second question a bit?
4:40 p.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
What do you think needs to be changed first when it comes to access to prescription medications?
