Evidence of meeting #51 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was system.
A recording is available from Parliament.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
For the generics, especially, yes. It's to a limited extent when it comes to single-source products that are of equal benefit.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you, Mr. Chair, and thank you both for being here today.
I want to direct my first question to Ms. Wallström and talk about the out-of-pocket copayments again. I know that Ms. Sidhu brought up some questions there.
We've got about 10% of Canadians who do skip their medications because of the fact they just basically can't afford to purchase them. According to our notes from the Library of Parliament, about 6% of Swedes are doing the same thing. I'm just curious to know about these out-of-pocket expenses. Have there been increases or decreases in the overall cap on the out-of-pocket expenses for prescription pharmaceuticals over time? If so, what accounts for the changes?
Director General, Dental and Pharmaceutical Benefits Agency
The threshold has been in place for quite some years. I don't have the figures right now, but I would say that for maybe 10 years the threshold did not change at all. Then a couple of years ago, the government decided to increase the threshold so that it's now around 230 euro per year. I would say that the government's motives for that were that it was still at a fairly low level and there was a need to adjust to developments in general.
We have had different governments in the last mandate periods, and the new government, which is more left-wing, has decided on these reforms to lower the threshold for certain patient groups. There is no, I would say, political debate in Sweden as of now targeted toward the pharmaceutical benefit scheme and the copayment by patients in that direction. There are other debates when it comes to dental care, for example, as patients in Sweden pay much more for that. The political focus is more concerned with those areas.
Conservative
Len Webber Conservative Calgary Confederation, AB
I see. Thank you.
I know that my colleague Colin Carrie had a couple more questions, so I'm going to pass the rest of my time to him.
Go ahead, Doctor.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much.
Getting back to Mr. Golja, about moving towards this managed competition model, are there any lessons that were learned from the Dutch when you guys were looking at reforming the health insurance system that Canada should consider if we're going to move to this type of coverage? Could you maybe give us some advice on what steps we could take to facilitate this? It seems you've been through this already.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
Unfortunately, this is not really my expertise. So, unfortunately, it would be very difficult to explain what happened in 2006. I don't really have very specific lessons to hand over.
I would definitely say that if you were to engage in such a system, you should make sure that you find the right balance between the parties and that you keep in touch with whether or not your regulations and the market are still functioning. I think that's an important factor. I'm saying “market”, but it's a controlled system, of course, instead of an actual market.
One example I can give you, if you will allow me, is that of the biosimilars, where we saw that when it came to these out-patient drugs—or at least they are considered external drugs—when the biosimilars came to market, there was virtually no competition in the system at first. By analyzing the problem and seeing that apparently within the system the different parties could reach lower prices, we had to find a way of recreating the balance, which we found by putting it into the intramural sector and allowing for the total budget to be negotiated within the hospital sector.
So, we're really trying to fine-tune that and also allow for mechanisms that shave off the negative effects, you could say—because we were talking about copayments just now. Of course, in one of the debates, especially in our last elections a few weeks ago, many parties said that the yearly copayments should be lowered.
So there is debate about, for instance, vulnerable parties who take up a lot of care and who automatically make their copayments immediately—and that's an actual payment they have to make every year. Then, additionally, there are all sorts of different extra expenditures that they have in their daily lives. I think allowing for mechanisms to mitigate these negative effects is one of the important elements of our system....
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you so much. It was a pleasure listening to both of you. The luck of the draw is that a lot of the questions I had lined up were asked by other members of the panel.
This may have been answered, and forgive me if it has been covered.
Ms. Wallström and then Mr. Golja, you talked about how you have the copayments, and I know you said there are certain drugs that are not subject to copayments, or certain groups, children and that sort of thing. What is the provision for people who are destitute to the point of not being able to make any sort of copayment? Is there a provision to make sure that these people get covered?
Director General, Dental and Pharmaceutical Benefits Agency
In Sweden there is, and there is a social security system that allows grants for these patients. Often it's more than just the pharmaceutical copayment that they need help with, so that is part of it.
Liberal
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
It's the same here. There is a normal fee that you pay, which everyone has to pay every month, but at the same time there is an income-related subsidy for those with lower incomes, so that the monthly premiums go down, but then there is still the copayment issue.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
For these patients or these people who are not able to pay that, there are special provisions. For instance, there are municipalities that are reinsuring the copayments for a very limited group. There are different mechanisms in place.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Okay. Would both of you agree that basically no one is left behind because of their inability to pay? Would that be a fair generalization?
Director General, Dental and Pharmaceutical Benefits Agency
On a general level, I think that is fair to say, but, of course, there are situations in which people tend to get into problems anyway. But on a general plane, I would say yes.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
I would agree.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
To change topics a little bit, there is something that Sweden has in common with Canada. Right now, Sweden has one of Europe's largest elderly populations. This, of course, is expected to continue as birth rates are dropping. Canada has much the same issue. Our population is aging, and we're seeing the diseases that come with age. We're expecting increased health challenges and costs.
First of all, can you tell me if there are any preparations for how Sweden's system for pharmaceuticals and the health care system in general are going to manage these costs?
Director General, Dental and Pharmaceutical Benefits Agency
Yes, there are.
The question is if there are enough and if they are targeting the right issues in time. Of course, there are discussions and preparations. When it comes to the pharmaceutical benefit scheme, I would not say that we do anything differently than we would have done otherwise. Other agencies in Sweden are focused on providing more guidelines, and they're working with issues when it comes to the elderly who use a lot of drugs. There have been governmental reforms targeted at reducing the number of pharmaceuticals that the elderly use, especially pharmaceuticals without good directions for people's health. That work has been going on for some years. We see that it will need to be enhanced further in the coming years.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you so much.
Mr. Golja, do you have anything to add to that?
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
No. I would say the same.
There are programs right now for prescribers when it comes to appropriate use and prescribing guidelines for the elderly, especially, as you said, when it comes to the number of drugs that are interfering with each other, and things like that. Other than that, there is no [Inaudible—Editor].
Liberal
