Health Committee on Dec. 6th, 2016

[Peter MacLeod]

For members of the panel, I think the greater concern, as reported to them by members of the insurance industry, was the consequences, especially with small businesses that have small group plans and one employee who then develops a rare disease. Very quickly, the cost of providing those medicines swamp that business's ability to sustain that private insurance.

That is definitely a major concern and I think it's one echoed widely across the small business community and among insurers.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Ms. James, you mentioned that, particularly with cardiovascular medications, there are costs due to non-compliance. A person's morbidity and mortality are higher when they are not taking their meds. Through the Heart and Stroke Foundation of Canada, are you aware of any overall societal costs, like costs to the medical system, or how much a year it is costing our system for people who are not taking their medications?

[Lesley James]

I don't know that figure but there have been studies in Canada and elsewhere in the world, showing that issues with cost quite often lead to non-adherence, which then increases the risk for patients presenting with heart attacks in emergency departments.

We are seeing that, over the long term, the cost of treating cardiovascular disease in the health care system is more costly than it would be to get them on hypertension medication or whatever it needs to be.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

[The Chair, Liberal, Bill Casey]

Your time is up.

Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you very much.

My first question goes to Mr. MacLeod. Mr. MacLeod, you said that this group of individuals who sat on this panel was randomly selected. They seem to be a pretty knowledgeable group if they were able to come up with these recommendations. Can you please explain to me how the random selection was done?

[Peter MacLeod]

Absolutely. It's a process called a civic lottery and it's been used to select members for almost 30 panels across the country at the municipal, regional, and national level. More than 1,000 Canadians, at this point, have been selected, and one in 60 households in Canada received similar invitations to participate: serving on panels, examining health issues like supervised injection sites, but also on municipal planning issues concerning mass transit.

In this case, there were I believe 378 volunteers. They were then entered into a database and it was done in such a way that effectively we were blind to the outcomes of it. We know what the demographics of the Canadian population are, so effectively a computer algorithm sorts through all of those applicants and then randomly selects the series of attributes—the gender, the age, the geography—and in this case we were also looking for what their annual out-of-pocket expenditure was on medicines, and we were also looking at whether or not they had drug coverage.

From that composite of attributes, we would then blindly identify a series of candidates who fit that profile, and from among those candidates, again blindly, one name would be selected. Then they would be contacted and invited to serve.

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay, thank you.

I've been studying pharmacare on this committee for quite some time now. The terminology used within this report, I would say, is about my level and I'm about six to eight months into this study. Now, these folks were only together for five days, so tell me a little about how their discussion was driven in order to come up with the recommendations here. Were they presented with all sides of the argument? Were they presented with what it might look like to advance our private health care system as well as continuing forward with a public health care system, or was just one side of the coin presented to them?

[Peter MacLeod]

Certainly that was a concern for the conveners of this process. That's why we have an 11-member advisory committee. Their names are contained in the appendix of the report. We had lengthy discussions about how we could, to the best of our ability, create a balanced curriculum so that among those 20 invited guest speakers there would be a range of perspectives provided.

I'll leave it to my colleague, a member of the panel, to explain his sense of the fairness and balance of the process. But I would also suggest that, given five full days where you're really in the thick of it with people, with the benefit of all these materials in front of you, frankly, I think we underestimate the capacity of the public to play a more sophisticated and informed role in policy-making.

It's important to note that the report is really in two halves. We wrote the blue pages, but the white pages were exclusively the words of the panel members.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

My next question, then, is going to the Heart and Stroke Foundation, to Ms. James.

You described the fact that prescription drug use, of course, has increased quite drastically over the years in Canada. Can you comment as to why we're seeing that increase in prescription drug use?

[Lesley James]

I think prescription drug use is increasing throughout the world and it is not unique to Canada. It's increasing in cost and it's an increasing proportion of our health care spending. That's the concern for the Heart and Stroke Foundation.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you, but why?

[Lesley James]

I can't speak to that. I think that's a clinical question.

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay.

In your estimation you said there are a number of other countries that you've looked at that are doing a national pharmacare program. Which country is doing it the best?

[Lesley James]

I don't want to say which one is doing it the best and which one is doing it the worst. I think what would work for Canada is looking at our needs and our context, considering the fact that we do have private insurance already.

I think the U.K. has an interesting model where there is coverage of prescription medication available to all people, as well as private insurance available as a top-up. Perhaps that's worth looking into in Canada because it's a quite similar context.

[Rachael Thomas, Conservative, Lethbridge, AB]

In your estimation then, should we also protect private insurers as well as public?

[Lesley James]

I think there needs to be a balance in Canada. Given that we've had this system in place for so long, there needs to be consultation to see what would work best going forward.

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay.

Your reason for drawing attention to the U.K. is the fact that they've preserved their private system in addition, or as a “top-up”, which were the words you used, to the public system. I'm hearing you say that's a positive thing.

[Lesley James]

I'm speaking as an individual. I studied part time in the U.K. I think it's quite wonderful that you access all medications without major service charges to individuals. There is an option to top-up with private insurance through employers.

[Rachael Thomas, Conservative, Lethbridge, AB]

Do you see any disadvantages to the U.K. system?

[Lesley James]

Not that I'm aware of, no.

[Rachael Thomas, Conservative, Lethbridge, AB]

Mr. Lynd, I'd be interested in asking you the same question.

If you were to look at the international context, other countries that have a universal pharmaceutical system, what would your observations be? What country is doing it well and we can learn from?

[Prof. Larry Lynd]

I'm going to speak about the orphan drug environment because that's where I've worked the most. We had a study done out of Ottawa that actually looked at orphan drug or rare disease drug decision-making internationally. What's interesting is that lots of countries have processes, but we haven't been able to.... They have at least frameworks in place to support decision-making, much as we have in British Columbia—

[Rachael Thomas, Conservative, Lethbridge, AB]

I'm sorry, Mr. Lynd. We are short on time. We have about 20 seconds.

Could you draw on a specific country, please?

[Prof. Larry Lynd]

No, I cannot. I'm afraid nobody has a really good process in place.