Health Committee on Oct. 19th, 2017

[Prof. Steven Morgan]

I think the best estimates are that we'd save about 30% of what we're spending at that time, and at the time we did the Canadian Medical Association Journal study, that was about $7 billion of the drugs eligible for coverage. By the time Canada rolls such a program out, it will be a different number. It will be bigger than $7 billion or around $7 billion, depending on whether or not we're able to keep the spending levels constant right now under the pressures we're facing.

[Don Davies, NDP, Vancouver Kingsway, BC]

Approximately how long will it take, do you think, before we start realizing net savings?

[Prof. Steven Morgan]

I think, particularly under an essential medicines list, you could realize it within a year, because it's inherently feasible to start running a program of that kind, and then it will take a couple of years to move forward on a larger formulary. Just bear in mind that our comparator model in North America might be the USVA. They nationalized their system of drug benefits to a national formulary with national purchasing strategies. Initially they were able to roll out savings in the very first year, and then it took a few years for them to determine how far they were willing to go together as regional—

[Don Davies, NDP, Vancouver Kingsway, BC]

Is there any reason we should wait?

[The Chair, Liberal, Bill Casey]

Sorry: time's up. We have 19 minutes until the vote.

Go ahead, Mr. Eyolfson, for three minutes.

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

To Dr. Raza, you were asked a question before. Here's something that Mr. Van Kesteren and I agree on, which doesn't happen very often.

We know we could decrease costs if illnesses were better controlled, if people's weights were controlled, if their diets were controlled, if they had better exercise, and if they didn't smoke.

What economic strata do people fall into who don't have these things well controlled? Are rich people more likely to be obese, or poor people?

[Dr. Danyaal Raza]

These sorts of factors are more prevalent among people who have a low income.

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

Smoking?

[Dr. Danyaal Raza]

Low income.

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

Uncontrolled diabetes?

[Dr. Danyaal Raza]

Low income.

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

Lack of exercise?

[Dr. Danyaal Raza]

Low income.

The other thing I will add is these are some, but there are also many underlying issues besides income, as people such as racialized Canadians and women face systemic barriers to education. There are a whole host of these social factors, these social determinants of health, that result in Canadians getting sick and in different types of Canadians getting sicker than others.

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

Professor Morgan, this has been a big interest of mine, as you know from previous meetings. I'm an emergency physician. I would see these people first-hand who couldn't afford their medications. A patient would come in with diabetic ketoacidosis and end up in the intensive care unit. You could have a $50,000 admission. Every patient on dialysis costs our system about $70,000 a year. All these examples add up.

What would be your best estimate, based on your research, as to what the annual cost is due to cost-related non-compliance?

[Prof. Steven Morgan]

The estimates that are available for Canada are not great. We don't have gold standard science at present, so they range from $1 billion to $9 billion, depending on which study you look at.

In using studies that have been done in the United States about the effect of getting access to preventative medicines for patients insured in the U.S., they actually find that you save as much money in the rest of the system as you spend on the coverage. That would also put this in the range of billions of dollars. We're not talking about small amounts of money in terms of health system savings, or at least, in reality, it's reduced pressure on an already overburdened health system.

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

Thank you. I have no further questions.

[The Chair, Liberal, Bill Casey]

Thanks very much. We have 17 minutes before the vote.

I want to thank our witnesses again. This committee must have the best, highest-quality witnesses of any committee in Parliament.

On behalf of the whole committee, I want to thank you all for sticking with us. Some of you have been here for 18 months, as we've been going through this process, but it's a great process. We have different perspectives and our witnesses do not always agree, but we get the very best perspectives. We're lucky to have that.

This is the last committee meeting on pharmacare. The next thing will be our report.

I also want to thank all the committee members for doing a great job. It's an important issue, perhaps the most important one being talked about on the Hill. Again, thank you very much to the witnesses.

The meeting is adjourned.