Thank you, Mr. Chair.
Thank you to the members of the health committee for the invitation to speak today.
I'm here today not just in my role as chair of Canadian Doctors for Medicare, but also as a family doctor in Toronto, with an inner city downtown practice that runs the spectrum from those struggling to make ends meet on social assistance, to the working poor, to those solidly in the middle class, and yes, even a few bankers and consultants from Bay Street. My waiting room is always a lively space.
Founded in 2006, Canadian Doctors for Medicare provides a voice for doctors from coast to coast to coast, advocating for evidence-based and values-driven reforms to our public health care system.
As a background to my remarks today, I will submit copies of a brief report that was published by us, Canadian Doctors for Medicare, in partnership with the Canadian Centre for Policy Alternatives, in advance of the recent PBO report on the cost of pharmacare. In that document we provide an overview of current public and private spending on prescription medications and some of the potential savings that Canadians could expect to see with the introduction of a universal pharmacare program.
We have the benefit today of hearing from some well-known economic experts who have deep expertise on this issue, and while I'm happy to talk dollars and cents, I also want to focus my remarks on the positive health impacts that such a program would bring.
I've been very lucky to have been born, raised, and trained all through university in Canada. Now I'm very fortunate to practice as a family doctor in our universal public single-payer system. As Canadians, it's something that we are sincerely proud of, and rightly so. Unfortunately, as a family doctor who works within a very diverse practice and set of patients, I also see first-hand how that same public system doesn't go far enough. Every day that I'm in the clinic I see how gaps in coverage and gaps in medicare mean many Canadians are falling through the cracks in our incomplete system.
At Canadian Doctors for Medicare, we're of course proud of our system; it's why we work tirelessly, not only to defend the principles on which it was based and on which it was founded, but also to find ways to improve it. That of course means seeking innovations that will make it more efficient and more accessible, and ensure it achieves the best outcomes for Canadians. When we talk about pharmacare, we talk about it as one such program. We talk about it as the unfinished business of medicare.
When I'm with a patient, in my role as a physician there is nothing worse than being able to make a diagnosis, have a conversation with my patient, develop a treatment plan that makes sense for them and for me as their family doctor—which often includes prescription medications—only to realize that they're ineligible for a means- or age-tested public plan, they have no job-linked insurance, and that their ability to fill those prescriptions means having to dip into their savings account for medically necessary care.
In fact, this happens so often that I include questions about insurance status whenever I meet a new patient in my meet-and-greets. I ask these questions because I need to be cognizant of this situation, of how it serves as a barrier to treatment and how it influences the care I either can or can't deliver. When a patient's only option is to pay out of pocket, the cost of drugs also begins to influence other budget decisions, including rent, healthy food, hydro, and, of course, medically necessary prescriptions.
This is particularly true for the working poor and people who are precariously employed. It means that patients experience a phenomenon known as “cost-related non-adherence”, resulting in unnecessary hospitalization and a downstreaming of disease. It means that chronic medical conditions like hypertension or high cholesterol go untreated until acute complications develop, creating an unnecessary burden on patients themselves, their families, their loved ones, and our health care system as a whole.
It's estimated that between 5% and 6% of hospitalizations in Canada are a result of non-adherence to prescriptions, costing us approximately $1.6 billion per year. While we don't know the percentage of these cases that are due to the financial burden of filling prescriptions, we know it is frequently reported as a problem, not just by doctors, but by patients. For example, cost-related non-adherence was reported by 9.6% of respondents to the 2007 Canada community health survey who received a prescription. Financial barriers to accessing medically necessary prescriptions are felt especially acutely by low-income Canadians, with 20% of these respondents reporting issues with cost-related non-adherence.
Here in Ontario, where I practice, if you're old enough or poor enough, you're entitled to a comprehensive public drug plan. However, for Ontarians working in contract or precarious jobs who might have the very same diseases as their means-tested or age-tested peers, access to drug treatment depends entirely on their private insurance plans or the balance in their bank accounts.
For example, in 2015 the Wellesley Institute reported that if you were an Ontarian earning $100,000 or more a year in income, there was a greater than 90% chance that you'd have access to a job-linked drug program. However, if you were earning less than $10,000 a year, that fell to less than 20%. We know from the medical literature as well that health is tied to wealth and income, and of course the folks who are least likely to have a drug plan are also the folks who are most likely to need a drug plan.
If we instead look at disease not by employment income but by disease itself, another recent study estimated that the disparity in access to treatment among working-age Ontarians with diabetes resulted in 700 premature deaths a year. That's 700 premature deaths each year in one province for one disease due to a lack of access to treatment. That doesn't begin to capture the cost or social impact from complications of diabetes, such as chronic kidney disease, issues with vision, impaired wound healing, peripheral neuropathy, and an increased risk of heart attacks and strokes.
When I speak with my colleagues in other countries about why I am proud to be a doctor working in Canada, I cite the relief of knowing that cost is not a factor when patients access medically needed hospital or physician services. Medical bankruptcies such as those we hear of in the U.S. are thankfully rare here, but we cannot ignore the significant financial burden that comes with a diagnosis when we do not have access to medically necessary prescription drugs.
I was happy to see in the recent PBO report an acknowledgement of the potential savings that a national pharmacare program could bring to Canada, especially as I saw the $4 billion in estimated savings that were determined despite prudent, conservative estimates of administrative and drug price reduction savings.
You've heard from economists and experts in the PBO about the number of factors that go into determining potential costs of implementing a single-payer universal prescription drug program here in Canada. As well, of course, you have heard of the potential financial savings that would result from expanding access to everyone.
What I and my colleagues at Canadian Doctors for Medicare, as well as doctors across the country, can convey to you with a high degree of confidence is how such a program will have a tremendous and positive impact on the health of everyday Canadians, the patients we see in our offices every day. It will ensure that when any Canadian goes to the doctor, the care doesn't end when they go out the door, and that the medically necessary prescriptions they leave the clinic with are the most appropriate and best available medications based on need and not on ability to pay.
It's time to close this glaring gap in medicare.
Thank you.