Health Committee on Sept. 29th, 2016

[Peter Weltman, Senior Director, Costing and Program Analysis, Office of the Parliamentary Budget Officer, Library of Parliament]

I think I'd just like to back it up, if I have a minute to respond.

What we would be most comfortable providing is, as Mostafa stated earlier, a comparison of examples. We can show different countries that are paying different prices, and we leave it there. I don't think it's within our ability or mandate to suggest areas of savings. We would just leave the opportunity out there in the report, showing what these people are paying, what those people are paying, and what these other people are paying.

I don't think we'd go as far as to say we could save money if we tried this or we tried that. I think that would be better coming back after policy-makers say that they have decided on an approach that they want to take to manage this program and ask us to come back to them with an updated cost estimate.

[John Oliver, Liberal, Oakville, ON]

We heard from the Pharmacists Association. They're quite concerned that we as a nation would lose the full service that a pharmacist provides in terms of not just filling the prescription but also providing advice on drugs and complications and co-issues. Is it possible to make sure, if we were looking at a national pharmacare program, that there would be full coverage and full compensation models built into that for the people who administer the prescriptions along the route?

[Peter Weltman]

Again, I see that as policy direction. If you come back to us and say we want a program managed on this basis, exactly the way it's delivered today, with this change and this change, and ask us to come back to you and cost it, we could do that, but we wouldn't come to you and say, “Well, if you did this, we could do this, or if you did this, we could do that.”

[John Oliver, Liberal, Oakville, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Go ahead, Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

I have so many questions today, Mr. Chair. Thank you very much.

This is excellent, because I think in the scenario that I'm looking at, it appears we're being asked to perform surgery on a very important program in Canada without first coming up with a diagnosis. There's more than one way to get the solution that we would like. I think, Mostafa, you said there still will be private care because the public health care system won't cover everything.

My impression from some of the witnesses is that they don't want a private system. They do want a monopolistic type of system, one system, in which perhaps bureaucrats or different groups of individuals would decide which drugs would be covered. That's one of my concerns.

The decisions we make, first of all, are going to be expensive one way or another, but we do want to make sure at the end of the day that we're actually solving the problem that's out there, and we don't really have up-to-date statistics on it. Do you agree that it's important to gather sufficient data on the number of Canadians who either lack prescription drug coverage or have insufficient drug coverage, in order to properly estimate the cost implications of a universal public national pharmacare program?

[Mostafa Askari]

As I mentioned earlier, part of the modelling we are going to have to do is to look at that and see exactly what the potential is for the demand for prescription drugs, and then what would be the cost.

[Colin Carrie, Conservative, Oshawa, ON]

Yes. I'm concerned that we're jumping in before we have some of the data. I will state that there are a lot of assumptions being made. I believe Mr. Kang said he doesn't think it would cost $17 billion more. We assume there are some savings to be had, but we don't know, and before we make the decision, I'd like to see you come back.

I'm trying to find the best way forward. Again, just to clarify, do you think the best way forward for you guys to give us the information would be if we made an amendment to this motion and we got the two reports to get a snapshot of today? There's going to be more than one way and more than one opinion on how to move forward. I want to get the diagnosis before we perform the surgery.

[Jean-Denis Fréchette]

I cannot make a decision for the committee. You're asking me a difficult question. This committee is master of its own destiny. You decide, but we will work with whatever is the committee's will. I think you know the limits. We mentioned the limits, or what we would like to see, but I cannot comment.

Will it be helpful? If you do it, we will work with whatever motion you will have.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Weltman, I believe you had a comment.

[Peter Weltman]

I think what would be helpful when we talk about defining the problem is knowing that it's not within our purview to do so. If the committee is presented with the problem statement and we are asked to provide an estimate as to the cost of that problem, then we can do that, but to define the problem is beyond our mandate.

[Colin Carrie, Conservative, Oshawa, ON]

You know, I appreciate that. Perhaps a better way to ask for what I'd like to get from you would be to ask you for the data to analyze what's out there today. I think that would be a good way of moving forward, and if, as Mostafa said, you could do two reports, then it would give us that information. You guys can look at it that way before we make a policy decision. Mr. Oliver did say he would be looking at a monopolistic system and a one-payer type of system, and if we are going to go down that route, I want to see what we're getting into before we make those decisions.

[Jean-Denis Fréchette]

If I may...maybe I'll put myself in trouble and maybe I should switch to French, because I'm less in trouble when I do that.

[An hon. member]

You go ahead.

[Jean-Denis Fréchette]

Mr. Chair, here is what we could do, and I'm not suggesting anything; I'm just saying here's a potential scenario.

We took notes of all the discussion from both sides, and remember that we are non-partisan. We are independent of the government and we're non-partisan as well.

We took notes of what was discussed this morning from both sides, and what we could do is come back with our terms of reference. We have the motion that is there. I think we can manoeuvre around that. We took notes of other good suggestions from both sides for models, and also your last suggestion. We will come back with our terms of reference, whether or not we're going to have two reports, three reports, three models, or one model. Those terms of reference will belong to this committee to decide the direction you want the PBO to take. I think it's going to be easier for this committee to go forward on that basis as well, or to amend the terms of reference. It's going to be easier for the committee to decide which direction you want to take.

We'll be honest with you after that. If we say we cannot do that, then it's for whatever reason. If it's helpful, that's the way we can go.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you for that.

Do I have any time? No?

[The Chair, Liberal, Bill Casey]

You're done. Ms. Sidhu is next.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you all for being with us.

What types of challenges are involved in using international comparisons in a costing analysis?

[Peter Weltman]

The challenge is getting appropriate data. That's the challenge we always face in any cost estimate. The process is bringing ourselves up to speed on the situation. This is a new area for us, so we've been busily reading background materials. Then we would reach out to our network that we built up over the years to understand what data exists, and sometimes the data is not very good. We look at how that compares to our particular situation. There's a bit of judgment and experience involved in making sure the data that we are using to benchmark with is relevant to the study that we're doing. The biggest challenge is finding it and then making sure it's comparable.

[Jean-Denis Fréchette]

If I may add something, it's the cost of the data. You remember I mentioned that we have limited resources. It's not only in terms of people; It's also in terms of budget. In terms of buying data, we do have a budget for that, but international data is costly, as you know.

[Sonia Sidhu, Liberal, Brampton South, ON]

In the PBO's upcoming research, is there any way to point to what the most expensive diseases are that are lacking prescription drug compliance? As we heard, 23% of people are not getting medication because of the cost.

[Mostafa Askari]

We would have to go and look to see whether the data is available for something like that. That's an extremely difficult thing to get—exactly how people use prescription drugs, whether they use them properly or not, and whether they actually use the right thing or not. That's extremely difficult.

There may be some survey data, but I'm not sure whether it is very reliable. Anyway, these are things that we have to go and examine.

[Sonia Sidhu, Liberal, Brampton South, ON]

In other reports related to health costs that the PBO has done, were there any barriers you faced in fully examining the cost that the committee can help you with?

[Mostafa Askari]

The work we have done in the past, in terms of health care costs, has been at a very high level, such as total provincial health care costs. Those all used available data from CIHI and other macroeconomic data that was available. There weren't really any issues there.

If we need some help from the committee to get information that we cannot get easily ourselves, then certainly the committee would be helpful in that case.

[Sonia Sidhu, Liberal, Brampton South, ON]

Can the PBO please talk a bit more about how their office analyzes a hypothetical system like this one, where the price is such an unknown and specifications differ province by province?