Sure. There are two areas, and I'll touch on them briefly.
One of them is that we're one of the few nations with universal health care that does not have pharmacare or medicine included in that definition of “comprehensive”. When I was going door to door in my riding, I ran into many people who were now in jobs that were temporary or part-time or contract, and I saw that the historic pattern in Canada, where people were employed and had pharma insurance through their employers, is changing. The cost of pharma when you're unemployed is quite significant. In the case of twentysomethings who are living with their parents—and my riding is Oakville—if a child with diabetes returns to the home, the cost could be $1,000 a month that nobody in the family was anticipating.
There are varying stopgap measures. There are some programs that can be applied for when you can prove you're destitute, bu those are variable across Canada. Different provinces have different rules, so we don't have a universal application for pharmacare, particularly for those who are unemployed and need assistance. I think looking at that would be a very worthwhile study.
We could look at prescription medicine, to start with. What would a national drug formulary look like? How would we go about controlling costs? How would we manage it? Could we make it affordable? I think there are several ways we could study it to look at affordability. There have been a lot of recent studies about the cost of licensed drugs in Canada. Can we, by more competitive negotiating processes, lower those costs to make licensed drugs more affordable?
Finally, there are issues around people misusing some drugs because they can't afford them. They'll take antibiotics for a few doses and then go off them to save them for the next time, and that's leading to inappropriate use of antibiotics. Some people don't use the drugs they're supposed to be using at all because they can't afford them. It would also give us, I think, a national picture of prescription practices, so we could look at over-prescribing, under-prescribing, and how drugs are being used effectively across Canada.
That's one area.
My second one—and these are my top two—is that I really do feel it's time for a comprehensive seniors care strategy. The CMA is calling for it. Most of the medical community is calling for it. It's looking at how we link acute care, primary care, home care, and community services together to provide a comprehensive basket of services focused on seniors.
I have a really good quick story that I'll share with you just to give you an idea of how that might work.
About 12 or 15 years ago, I was down in Rochester, New York. There is a program down there that delivers all-inclusive care for the elderly. It links all of those services together for clients or residents who would be in long-term care facilities here in Canada. These are quite frail, quite compromised people. We went down there in the morning. A call came in from a caseworker—not a nurse—who was working with a woman who was clearly in distress, with trouble breathing. She had chronic obstructive pulmonary disease as a diagnosis, and she couldn't breathe. It was late August and it was about 85 degrees, and she was living in an apartment with one bedroom and no air conditioning. It was a stifling environment. The call came in, and within about an hour a nurse was dispatched to see her in her home. The nurse confirmed the COPD was worsening, and about three hours later—I'm trying to remember the sequence of this—the woman had an air conditioner. A community team came out and installed a $600 air conditioner. By the time we left at around 4:35, a call came back in from the caseworker, who said the woman was fine. Her lungs were clearing up. She was restoring and she was back on track, and they signed off on her for the day.
In other words, for them it was the cost of a caseworker, a nurse's visit, and some calls to some doctors and others at the main headquarters. They averted a very major acute COPD episode for about $600 and maybe another $600 of staff time for the people who were there in the residence with her.
In our system, that woman would have been left on her own and could have had a very serious COPD crisis. When the COPD exacerbated, she would have had to call 911 to have an ambulance bring her in to the emergency room. Usually after an ER stay and an ICU stay, those kinds of elderly, fragile people need time in the in-patient unit to recover before they're sent home. In our system, it would be hundreds of thousands of dollars, but that acute episode was resolved by that interaction as it was happening, through a community team and a home care team.
How do we get that kind of flexibility and responsiveness to seniors, particularly the very frail seniors, in our system? I think that's worthy of study as well for us.
Those are my two thoughts.