Health Committee on Dec. 1st, 2016

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I'd like to focus a bit on costs and how much a switch to a single-payer system would cost. I'm concerned, because even as this study goes on, it seems that our data is insufficient. It's older data, and from a practical standpoint, we also have the complexity of federal coverage, provincial coverage, and private coverage.

Apparently, there are 24 million Canadians who have private coverage through work. If the government makes a decision that's going to force 24 million Canadians to take government coverage— and in some cases, we've heard it can be inferior coverage and won't cover the drugs a private plan would cover—then what kind of effect are we going to have on our population from an outcome basis, with the whole kit and caboodle?

I don't have a lot of time, but what I would like to ask the Auditor General, Mr. Ferguson.... Health care delivery is pretty much a provincial and territorial jurisdiction. As a conservative cost, the program would be about $35 billion. Do you have the jurisdiction to audit a provincial and territorial program, and what do you think the costs would be just for your department to audit something of that size from a process standpoint?

[Michael Ferguson]

If it was a national program run by the federal government, then it would be something that would fall within our mandate. Of course, taking on a very large additional program in our audit world would have some impact on us, but we have the authority.

As for doing an audit on the way the system is structured now, we already do audits in the three northern territories. We have access to what's going on in the territories and what's going on at the federal level. With the provinces, we'd have to bring the provincial auditors general in to look at that, but that's based on the structure as it exists now.

If the structure was a national program run by the federal government, then we would have the ability to audit that. If it was some sort of a national program that was set with all of the jurisdictions being part owners, as we see with something like the Canadian Blood Services and other things like that, then there would be a question about whether we would have access or not. That would have to be sorted out in the way that organization was established.

[The Vice-Chair, Conservative, Len Webber]

Thank you.

We will have a final question, for five minutes, by Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much.

I wanted to come back to the Auditor General's recommendations around making sure this is patient-centred and works for patients. Let's assume that we have a robust formulary that's evidence-based and that we have good cost-management strategies in that formulary. In the rest of the health care system, the primary relationship is between a caregiver, usually a physician or a nurse practitioner—but it could be somebody else—and the patient. The physician-patient relationship allows access to hospital services and specialists, and that's how our current system stays patient-centred. Patient-focused is that primary relationship.

In terms of the national pharmacare plan, do you see a model where that relationship is the primary relationship in prescriptions? Is there any other role you can see for a bureaucratic overlay that would interfere with the decision between a doctor and a patient to have a prescription issued?

For example, I heard Veterans Affairs say that the veteran must demonstrate that a lower cost drug doesn't work. It sounds like you have an administrative process that tests whether a generic is as effective as the original drug. I would argue that probably is an important decision made between the patient and the doctor, and there isn't a bureaucratic process involved in that.

[Michel Doiron]

Thank you for the question.

In our situation, the relationship between the doctor and the patient is the main point. That said, often a doctor may prescribe something, and there is a generic drug on the market that is cheaper and gives you all the same attributes. Unless there's contradictory evidence, we go to the generic. If you had a national health care—and I never really thought about it, so I want to be careful what I say—I still think you would need that to ensure that you're getting the best cost for your dollar or bang for your buck. Therefore, you go to a generic first, and if it doesn't work, you go to the second or third order, and you get into what is best. I think my colleagues were talking about it earlier; they have the same thing in aboriginal.

I think any health care system, and even in pharmaceutical, the main point is the relationship between the doctor and the person. When you hit the pharmacy, you need checks and balances to ensure that if there is something more cost-effective...especially if we're talking $35 billion a year.

[John Oliver, Liberal, Oakville, ON]

That's a good example. Generics is what I was going to come back to next. For instance in our Government of Canada plan, I'm on a prescription and my doctor wrote the brand name. I pay more for that at the counter whereas if I have the generic, I don't pay more. It's really a consumer choice then at the end between the two. As long as the physician has confirmed with me that they are equitable, then this is my own decision around that cost point.

Are you satisfied generally that the introduction of generics is happening efficiently in Canada? As the patent protection falls off and you see them coming on, are adequate generic processes in place and are those drugs being substituted in efficiently for Health Canada?

[Sony Perron]

We've been very aggressive in the financial benefit in implementing generic substitution and paying for generic, first, as an option. To answer your question, technology may bring some of the solution you're looking for. It's not necessary to have a plan or an individual between the physician, the patient, and the pharmacist. Technology can do a lot.

I was mentioning earlier that 96% of our claims go through directly, and a lot of controls are built into the technology. We can think about pushing that. Whether it's a national or local plan, we can think about using more technology so that when the physician prescribes something, the criteria are already made available to the physician up front and he or she can submit the reason why it is preferable to go to the second-line therapy right away, or whatever kind of information is needed.

We can simplify the life of the physician, the patient, the pharmacist, and the plan administrator as well. There is potential there and I think we are making some progress.

[John Oliver, Liberal, Oakville, ON]

That efficiency is so important. We heard from the pharmacy association that there are hundreds of third-party private insurers. Every time a patient comes in to fill a prescription, there are hundreds of different processes that have to be looked at, different plans, different percentages, different copays. It's an incredibly complex system, let alone those who can't afford the drugs. They don't even show up in the pharmacy because they can't afford to fill their prescription, or if they do get it filled, they save some of it for the next time they get sick because they can't really afford it. There are tonnes and tonnes of clear advantages for Canadians to move towards a national pharmacare model.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Mr. Oliver. Your time is up, and our round of questioning is completed.

I'd like to thank all our witnesses from the Department of Health, from the Auditor General's office, and all the way from Prince Edward Island, our friends from Veterans Affairs. Thank you sincerely for being here. Safe travels home.

[Michel Doiron]

Thank you very much, Mr. Chair.

[Colin Carrie, Conservative, Oshawa, ON]

Could we have unanimous consent to do a bit of committee business before we end this, or maybe after the next meeting if we can't have unanimous consent?

[The Vice-Chair, Conservative, Len Webber]

Because of the fact that it is not on the agenda, Mr. Carrie, we would have to get unanimous consent as to whether or not we can go into other business.

Do we have unanimous consent around the table to go into other business?

Yes, sir.

[Don Davies, NDP, Vancouver Kingsway, BC]

On a point of order, Mr. Chair, I find that hard to vote on. It would depend on what the business is. There's usually unanimous consent to discuss a particular issue. I can't vote on it until I know what it would be.

[The Vice-Chair, Conservative, Len Webber]

Okay. Certainly, we can find out.

What would you like to bring to the table, Mr. Carrie?

[Colin Carrie, Conservative, Oshawa, ON]

It's basically that with all the witnesses and the testimony we're getting, could we maybe submit a few more witnesses?

[The Vice-Chair, Conservative, Len Webber]

You're looking at putting extra witnesses moving forward. Is that something that is copacetic with everyone around the table to discuss in other business? Are there any comments?

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'd be happy to entertain that. One thing that I think we'd have to revisit is the actual schedule we have for the pharmacare study. I don't have it firmly in my mind right now how many more meetings and how many more witnesses we have.

I actually think that maybe we should schedule some committee business time next week for that. I don't think this is urgent. I think we can take some time to do that. I'd like to know who the witnesses are and what the category of testimony is to determine whether or not the committee would need to hear from them.

[The Vice-Chair, Conservative, Len Webber]

All right. I guess if we can get that on the agenda for the next meeting, you can bring it up at that time.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Okay.

The meeting is adjourned.