Health committee  Could I just add, just so you know, in 2013 the British Columbia Pharmacy Association reviewed literature on the financial impact of access barriers because of cost in the Canadian health care system, and as Marc-André suggested, there's not a great deal of literature, but they found estimates that range between $1 billion per year and $9 billion per year.

Health committee  I'll take that on because of the study that we published in the Canadian Medical Association Journal about how much it would cost to provide a reasonably comprehensive drug benefit for the community in Canada. That's not including hospitals and long-term care, but in retail pharmacy we estimated that the direct increased cost to governments was $3.4 billion, if I recall correctly, $2.4 billion of which would be recouped in some sense by reduced cost of the taxpayer-financed extended heath benefits for public sector employees, including, likely, all of you and myself.

Health committee  Thanks for the question. In fact, we've just completed a study on this that is under peer review and we hope will be published relatively soon. In that study we looked only at family physicians, including family physicians who practise emergency medicine, but I suspect that the data for specialists will not be all that different.

Health committee  I'm sure we all have probably a half dozen we can send you over the course of the coming months.

Health committee  Yes, every province is responsible for its own drug benefits. We have no binding commitments between the federal and provincial governments around national standards, and so provinces run their own programs, which are very different. Ontario, which is where that study was conducted, offers relatively comprehensive—in fact, “Pharmacare 2020”-like—coverage for persons age 65 and older.

Health committee  Thanks for the question. There has been quite a lot of study done on what influences the prescribing decisions made by physicians, and also what influences the demands patients make. In fact, one of the most powerful forces in prescribing in present-day North America is the influence of industry.

Health committee  I strongly disagree with means testing of a universal drug benefit. If a drug is deemed to be safe and effective at addressing legitimate health care needs and it represents value for money from a public health care system perspective in how we address those health needs for a Canadian, it shouldn't matter where they live, where they work, and what their income is in terms of their accessibility for that medicine.

Health committee  I'll respond to the developments there. First of all, if you've got a citation for the patients in the veterans administration dying on wait-lists for particular medications, I'd appreciate seeing that. It would be nice to look at it. On the issue with respect to accountability, we do want publicly accountable bodies that are making coverage decisions.

Health committee  I would like to add something to that. A thoughtful question was asked about the political role here. I would implore this committee to consider that what you're doing right now is a tremendously important politically. You are thinking not only about what the end state should look like, but also about the hurdles involved in the transition .

Health committee  Actually, the Angus Reid survey asked a number of questions about support for the system and then asked people what their support would be with different instruments, not just the GST. Canadians want a universal public program. I will be clear: I helped Angus Reid design that survey and was responsible for some of the analysis.

Health committee  Yes, if I may. I have a couple of things to highlight in terms of the probability or possibility of moving forward. We can learn a bit from countries that have reorganized the way they cover medicines in their countries in recent years. New Zealand created this purchasing agency referred to as PHARMAC in 1993.

Health committee  Thanks. I actually chose not to respond to their work, in part because it wasn't peer reviewed. It's not credible research.

Health committee  Our paper is a peer-reviewed research paper in the Canadian Medical Association Journal. It's been out for over a year now, so other academics have had plenty of time to try to replicate, critique, or tear it apart in a formal and disciplined way, and no one has. That paper has recently won a national prize for its scholarship and its importance in helping policy in the country.

Health committee  We know from repeated studies, literally dozens of studies conducted in Canada, the United States, and elsewhere in the world, that even relatively small costs borne by patients can be a barrier to filling prescriptions. It's important that we understand that patients don't act the way that we as managers of a health care system might wish them to act.

Health committee  Well, no. I mean shortages are not a function of coverage decisions, per se. In markets that we would compare ourselves to, governments do make decisions about what will and what will not be covered under the universal drug plans. In a few of them, you can buy supplementary private insurance to cover those sorts of things.