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.

On the agenda

MPs speaking

Also speaking

Shachi Kurl  Executive Director, Angus Reid Institute
Roy Romanow  Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
Gregory Marchildon  Professor and Ontario Research Chair in Health Policy and System Design, Institute of Health Policy, Management and Evaluation, University of Toronto, As an Individual
Glenn Monteith  Vice President, Innovation and Health Sustainability, Innovative Medicines Canada
Monika Dutt  Chair, Canadian Doctors for Medicare
Brett Skinner  Executive Director, Health and Economic Policy, Innovative Medicines Canada

4:40 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

Dr. Gregory Marchildon

The first thing is that in a multi-payer, fragmented system of both public and private payers, you have very different rules of access everywhere. They're by jurisdiction and they're by individual, depending on where that individual sits. Is that person on social assistance? What is their income, etc.? It depends on whether they have the kind of job that will continue to have an employment-based plan that will be fairly rich.

What can you do about access? Generally, in terms of this mixed picture, you can try to improve the equity of access so that there are not entire regions of the country, such as the Atlantic region, that really suffer in terms of access because they have very thin provincial programs and, on top of that, there are many fewer private plans. In a sense, you have a whole region of the country at a disadvantage.

That would be the first step. How do you address that?

It's very hard to address that issue through a very incremental approach when you have this kind of fragmented system. That's why you have had a lot of evidence before you over the last few weeks on the benefits of national pharmacare: because that's the only way you can really address the issue of equity of access in a really fundamental way.

4:40 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

I have another question related to that. Since your report, have you seen any improvements regarding access to medication?

4:40 p.m.

Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual

Roy Romanow

Well, I haven't seen very much. There have been some individual plans. Even before my report, in Saskatchewan there was the beginning of a provincial pharmacare plan, but that changed as political circumstances changed. I think the evidence is quite clear in looking at some of the material filed before your committee. I'm overstating it, but to make the point, I don't think it has improved at all, and I think there is an urgent need.

I'll finish off by saying that if you look at the OECD numbers, it's either that the army is out of step or that Johnny is out of step. Somebody is out of step in this situation, both with respect to costs and with respect to health outcomes and coverage. I have seen very little evidence to refute that of the OECD and what we have in our report—which I think requires some updating—so to me, the answer is that this is, as Dr. Marchildon has pointed out, the number one essential reform that should be implemented. It may take federal leadership à la Mr. Pearson, the great prime minister that he was. It may take this committee. But that's what we need.

4:40 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Thank you.

My next question is for Shachi Kurl.

Do you think there are intersectional challenges that we can specifically plan for where people face multiple barriers to prescription drug access?

4:40 p.m.

Executive Director, Angus Reid Institute

Shachi Kurl

With the permission of the chair, could I ask you to clarify the question a bit for me?

4:40 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Do you think there are intersectional challenges that we can specifically plan for when people face multiple barriers to prescription drug access?

4:40 p.m.

Executive Director, Angus Reid Institute

Shachi Kurl

What I can tell you is that intersections certainly meet around coverage. Coverage is a key driver to worry and stress when it comes to Canadians and their pharmacare costs, and again to their income levels and the complexities of their own health.

We know, for example, that while seniors may have more complex care needs around their prescription drugs, they tend to have some of the greatest access to care, especially in some provinces more than others. That is versus younger, lower-income Canadians who are struggling a little more, but on the other hand may be dealing with simply better health outcomes at that stage in their life because they are younger and haven't had the wear and tear of life on them.

I think what Canadians will want to see in order to provide a more engaged opinion on this particular issue is more detail and more agreed-to detail around what such a plan might end up looking like. Again, that can be at a very high level or a very exploratory level. Without more information for them to digest, it remains at this point more of a value statement for most. For those who are suffering the most, again it is a cry or a call to action, but one that certainly bears deeper inquiry on our part, with the assistance of health policy experts who can prepare and provide agreed-upon information on what such a plan might look like.

I would be happy to come back to this committee and report on that when we have that information and can take deeper measurement on it.

4:45 p.m.

Liberal

The Chair Liberal Bill Casey

Sorry, the time is up. That completes our first round.

We'll move to the second round of five-minute questions.

Dr. Carrie, you're up.

4:45 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

I would like to ask Mr. Monteith a question.

You mentioned that we should be focusing on the uninsured and the underinsured. We hear a lot of numbers thrown around. Even at the committee today, I think Mr. Romanow said that 50% of Canadians don't have any coverage. I think Mr. Oliver said 60% of Canadians do have some type of coverage. We've heard other witnesses say that 70% of Canadians have coverage.

I am wondering what percentage of Canadians fall into the category of uninsured and underinsured in your opinion?

4:45 p.m.

Vice President, Innovation and Health Sustainability, Innovative Medicines Canada

Glenn Monteith

It's a great question.

4:45 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

It sure is.

4:45 p.m.

Vice President, Innovation and Health Sustainability, Innovative Medicines Canada

Glenn Monteith

There was a study done in 1999, I believe, that identified that approximately 20% of Canadians were uninsured or underinsured, and it really hasn't been refreshed— although that number has come to have a life of its own.

I'll use Alberta as an example, which is a province I know very well, having been the former drug plan manager there years ago. One of the challenges is that they technically have a plan that any Albertan can join. It has a premium, and any Albertan can join. If you were to take the survey, about 25% of Albertans would say they have no drug coverage—yet they actually have access to that coverage. Mr. Webber would know it very well, for example.

Would you say they're uninsured? Do they have access or not? This is where it gets into the area.... In Ontario, where they have the Trillium drug program, you may not have a private coverage plan, but you may be fine. At a certain percentage of your income—it's around 4%, which you absorb in drug costs—you can make an application and the Province of Ontario would cover that. So, are you uninsured or underinsured? I think this is part of the definitional challenges that occur.

I think the secondary and related question is, what drugs are you covered for or not covered for? That's highly variable from jurisdiction to jurisdiction as well. You may find in one province that you could apply because that drug is an eligible benefit in that circumstance, and in another province it might not be. It's a very, very difficult number to go....

The number of people who have access to some form of assisted coverage on a catastrophic basis is actually very high in Canada. However, that doesn't mean—taking in the survey data—it's easy for many Canadians to afford to get to that catastrophic coverage.

I would say, and Brett has done some work on this as well, that it's certainly lower than the 20%, but the exact number is hard to put a figure on.

June 6th, 2016 / 4:45 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Yes, it is.

When you ask some of these questions, it kind of depends on how you ask the question, because there can be other variables involved. I think Ms. Kurl would say that it's difficult to take all of those variables into account.

There are a couple of things you said that I want to see if you could clarify. You said that gaps needed to be addressed and then you mentioned public assistance for those in need. Those were recommendations of yours. I think if you look at the value statements that Ms. Kurl talked about, we'd like to see Canadians covered. We don't want to see any Canadian losing their home because of improper coverage.

How would you suggest we address these gaps, and how would you define and address providing public assistance for those in need?

4:50 p.m.

Vice President, Innovation and Health Sustainability, Innovative Medicines Canada

Glenn Monteith

Gaps can come in two forms. One can be a financial gap that you have to bridge. Ontario Trillium is an example of where you have to absorb a certain amount of out-of-pocket expenditure of your family income before you have coverage. The second gap, going back to my previous answer, is which drugs might be eligible for that gap. When the provinces generally offer something, they relate it to their own benefit plan, so that can be variable. Some consistency across that would help solve that type of gap issue.

With respect to the financial gap, it really is to understand.... For example, Quebec uses a premium system for the members of public plans, whereas Saskatchewan and British Columbia use an income-deductible system. There will always be some people, when you pick a line of that sort, who will struggle for whatever reason—or in a particular year, their income may have gone up and down. In order to address that, if you talk to most folks who are familiar with that space, there are ways to adjust for that, using their health card back to the pharmacy, etc., but it's a much more active management than the traditional drug plan design is currently functioning under.

4:50 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Yes: it's how you define need. Ms. Kurl put up a slide showing that 16% of people making over $100,000 self-report or at least say that they are having problems funding these things. It just seems to be very difficult to try to figure out all these variables.

Ms. Kurl, I know you may have to leave, but if you have time now, perhaps you could talk about the sample you chose of the 1,556 Canadian adults from the Angus Reid Forum. Who are these people? Do they represent average, everyday Canadians, or are they a special club? Who are these guys you talk to? What are their demographics?

4:50 p.m.

Executive Director, Angus Reid Institute

Shachi Kurl

Briefing people on the ins and outs of survey methodology, and particularly online methodology, can be about a 40-minute process, but I'll give you the Coles Notes version.

4:50 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

You have four seconds.

4:50 p.m.

Voices

Oh, oh!

4:50 p.m.

Executive Director, Angus Reid Institute

Shachi Kurl

I have a little longer than that.

They are drawn from an online panel of approximately 130,000 to 140,000 Canadians. These are people who, yes, self-select into the panel, but that doesn't necessarily mean that they will all be asked all the same questions or be invited to participate in every survey. There is an element of randomness to the way selection is done.

We are able to control to ensure that the sample is drawn from and balanced to census data. On income levels, on age, on gender, on region, on first language, on education levels, and all the main basically census demographics we are able to balance the sample to ensure that the people we're speaking to and those who are responding to us do represent and reflect the Canadian population as a whole. When we talk to people who are dealing with income levels lower than $50,000 or higher than $100,000, they are reflective of the actual totals within the population.

4:50 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Did you actually ask them if they knew if they had coverage or not? I think we've heard research that many individuals interviewed will say they have problems getting coverage, but they don't even realize they have coverage. As Mr. Monteith was saying, with Trillium and things along these lines they have access.

Do you take that variable into account when you're asking your questions?

4:50 p.m.

Executive Director, Angus Reid Institute

Shachi Kurl

That's one of the first questions we ask: are you covered and do you have access? Again, we're able to tell you that coverage, the level of coverage, is a big driver of whether or not people are struggling with their costs and dealing with barriers or not. Obviously, those who have no coverage or the least amount of coverage have the highest propensity to report that, yes, they are struggling.

To your point around whether you are covered or even know if you're covered, again, that requires a deeper dive into this subject that would certainly benefit from further investigation. We can only ask questions: Are you covered? Are you fully covered? Are you partially covered? Are you not covered at all?

Whether or not people realize they have access to it but haven't themselves gone out and gotten it, that represents a gap. I would suggest that where coverage exists and people are not taking up that coverage is something for those providers to speak to. We can only speak to what people think they have.

4:55 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

I'm covered.

4:55 p.m.

Voices

Oh, oh!

4:55 p.m.

Liberal

The Chair Liberal Bill Casey

You're covered.

4:55 p.m.

Liberal

The Chair Liberal Bill Casey

At this point, I understand you have to catch a plane, Ms. Kurl, so thank you very much for your input. We appreciate it very much.