Fraser Forum

Improvements in health-care services must accompany any increase in federal money

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Provincial and territorial health ministers met recently in Toronto to discuss “several key areas” including the affordability and accessibility of pharmaceutical drugs. Dr. Eric Hoskins, Ontario's minister of health and long-term care, who chaired the meeting, is quoted as saying "Provincial and territorial ministers are united in their commitment to strengthen health care for Canadians in the face of emerging challenges."

The ministers are also reported to be reaffirming their commitment to work together and with the federal government, which joined the pan-Canadian Pharmaceutical Alliance (pCPA)―the pCPA conducts joint provincial and territorial price negotiations for brand name drugs―last year, to address difficult decisions, including the need to have a more consistent assessment of drug coverage within the provincial public drug plans.

At the same time as the health ministers were meeting, attendees at a conference on population-based therapeutic research, policy and practice also held in Toronto were discussing how the siloed approach to the delivery of health-care services in Canada negatively impacts patients, how government decision-makers do not make optimal use of new approaches designed to reduce uncertainty in health technology assessments of the value of new pharmaceuticals, the challenges in accessing health data in Canada to evaluate the benefits and risks of health-care innovation, and proposals for a national drug formulary.

If the health ministers had been at this conference, they would have clearly heard that the system fails many patients in terms of integrated care provided by health professionals, hospitals and other related services and that there’s a looming potential for Canadian patients to be denied new innovative drugs and other health technologies emerging for the treatment of several chronic diseases such as cancer.

When the provision of health services is divided among many branches―for instance, the Ontario Ministry of Health has more than a dozen―it’s perhaps not surprising that patient care is not as seamless as it should be. In addition, when each branch handles its own budget in isolation, no account is taken of a large saving in one branch resulting from a small increase in expenditure in another (i.e. an increase in the prescription drug branch budget that leads to a significantly greater reduction in hospitalization costs is merely seen as additional expenditure for the drug branch and a windfall for the hospitalization branch) even though there’s an overall cost benefit to the government and an improvement in patient health.

A more holistic approach to the assessment of the economic benefits of innovations in health care is required.

The health ministers noted that the introduction of the pCPA has resulted in more than $712 million in combined savings annually from drug bulk purchasing. It’s unclear whether the savings were ploughed back into the health system or disappeared into general revenue.

Moreover, the policies and practices of the pCPA continue to have limited transparency. If the health ministers had been at the population therapeutics conference, they would have also learned that Canadian patients do not want to change the provincial public drug plan systems into a single cost-containment lowest-common-denominator national drug formulary like New Zealand’s, which provides fewer drugs to patients. They want the present provincial systems enhanced to provide the right drug for the right disease at the right time.

The lack of access to data on health-care utilization is of further concern. The health ministers should ensure that access to data is widely available to all bona fide researchers, subject to appropriate privacy and confidentiality policies, so that the effectiveness of the system can be evaluated and situations identified where improvements are required.

Demands for more funds from the federal government must be accompanied by concrete plans for improvements in health care, not more of the same.


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