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Pressing Health Issues in the Federal Election: Pharmacare

by Alex Kilian, Student Leadership Team Logistics and Evaluations Coordinator

THE ISSUE

The World Health Organization (WHO) has declared that all nations are obligated to ensure equitable access to necessary medicines.1 To this goal, pharmaceutical policies should work within and be compatible with broader systems of universal health coverage.2

Spotlight on Canada: Canada is the only country with a universal heath care system that does not provide universal coverage of prescription drugs1. Voluntary, private drug plans vary across Canada, often require out-of-pocket payments for plan deductibles and co-payments, and are dependent on income, workplace and province of residence but not on medical needs. As a result of high out-of-pocket costs, certain medications are not affordable for some Canadians, and these individuals are often forced to make the choice to decrease or forgo the use of prescribed medications. This may lead to worsening of health problems and additional costs to the health care system.

BY THE NUMBERS

  • In Canada 500 million prescriptions/year, $30 billion total cost.3

The problem

  • Public drug plans cover 42% of all prescription drug costs in Canada4
  • Private drug plans cover 36% of prescription drug costs in Canada4
  • Canadian patients pay out-of-pocket for $6 billion in prescriptions, or 22% of all prescription drug costs in Canada.4

The support for a solution (Based on a July 2015 poll by the Angus Reid Institute)

  • 91% of Canadians support “Pharmacare” and universal access to necessary medicines5
  • 89% believe Pharmacare should be a joint effort involving provinces and the federal government.5

A POTENTIAL SOLUTION

  • Pharmacare: a plan that would provide safe and fair access to, and coverage for, prescription medication for Canadians, with the best economic value.

THE EVIDENCE/FEASIBILITY

Pharmacare 2020 was a report produced through collaboration with various stakeholders.6 This initiative aimed to promote an evidence informed dialogue on the possibility and future of prescription drug coverage in Canada. This report proposed a 25% contribution from the federal government, using funding mechanisms such as corporate taxes, income taxes, GST, and/or premiums.6 This federal contribution would come at no greater costs to provinces and territories and would not be redirected from other essential services. The report emphasized the need for a single payer implementation to increase purchasing power and a transparent budget to meet to goal of efficient delivery and long-term sustainability.6 The economic analysis indicated that a national plan could save the private sector up to $10 billion.6 The recent report also project decreased administration costs compared to the cost of the current financing system. With the evidence pointing to the feasibility of the project, it will certainly be exciting to watch the project unfold in the coming years, particularly with the pending status of our country’s government.

References

  1. The Selection of Essential Medicines. World Health Organization. 2002. http://apps.who.int/medicinedocs/en/d/Js2296e/1.html
  2. See discussion in Medicines in Health Systems: Advancing Access, Affordability and Appropriate Use. World Health Organization. 2014. http://www.who.int/alliance-hpsr/resources/FR_webfinal_v1.pdf
  3. The Canadian Rx Atlas, 3rd Edition. University of British Columbia. 2013.  https://circle.ubc.ca/handle/2429/50349
  4. Drug Spending in 2014. Canadian Institute for Health Information. 2014. http://www.cihi.ca/web/resource/en/nhex_2014_infosheet_en.pdf
  5. Prescription drug access and affordability an issue for nearly a quarter of all Canadian households. Angus Reid Institute. 2015 http://angusreid.org/prescription-drugs-canada/
  6. Morgan, S.G., D. Martin, MA Gagnon, B Mintzes, J.R. Daw, and J. Lexchin. (2015) Pharmacare 2020: The future of drug coverage in Canada. Vancouver, Pharmaceutical Policy Research Collaboration, University of British Columbia.
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Student Perspectives: Evidence-informed Policy Workshop

Priyank Bhatnagar is a fourth year student in the Bachelor of Health Sciences program (Global Health Specialization) at McMaster University. Bianca Bantoto is a third year student in the Integrated Sciences program at McMaster University. 

From access to essential medicines to pandemic control, health systems are critical to providing cost-effective programs, services, and drugs to those who need them. While a solid grasp of the policy-making process is important for understanding efforts to strengthen or reform health systems, the concept often seems ambiguous and intimidating to students who do not possess a political science background. To facilitate our understanding of health policy, we attended the McMaster Health Forum’s Evidence-informed Policy Workshop on strengthening health systems in Canada and low- and middle-income countries. Facilitated by Dr. John Lavis, director of the McMaster Health Forum and co-director of the WHO Collaborating Centre on Evidence-informed Policy, and Cristina Mattison, a Health Policy doctoral student, the workshop served as a comprehensive introduction to the assessment of evidence to supplement policymaking. With similar workshops delivered to governments and international agencies globally, this event provided an informative look into the field of policy development.

Overview of the Event

From the round of introductions facilitated by Dr. Lavis, it became apparent that the group of attendees was diverse, with participants coming from undergraduate, graduate, and professional programs. Since the workshop encouraged multi-disciplinary collaboration, each attendee gained exposure to alternate viewpoints as well as a holistic understanding of how research evidence can be used to inform health system decision-making.

Following introductions, Dr. Lavis taught us the importance of identifying a problem, considering the options to address the problem, as well as potential barriers and facilitators for implementing policy options. The workshop focused specifically on how to efficiently search for relevant data and research evidence from appropriate sources, and the role of research in each stage of the policy-making process. Each participant also received a copy of a Health Systems Learning – Finding and Using Research Evidence summary sheet, a valuable resource for future online evidence searches. In small groups, we then focused on refining questions and potential policy solutions for health system issues in Canada and abroad, including emergency room wait times and prevalent diseases in hard-to-reach populations. This exercise provided us with experience in the framework presented by Dr. Lavis for applying research evidence to inform important health systems issues. Throughout the workshop, we received valuable feedback and guidance from Dr. Lavis and Ms. Mattison regarding our ideas, which further solidified our understanding of the concepts that were taught.

Student Perspectives

Bianca: “As an undergraduate student with little health policy background, my experience in this workshop was nothing short of informative and insightful. The simulated policymaking exercise was dynamic and engaging, and has certainly instilled in me a greater appreciation for what is needed to find and use research evidence to inform the policymaking process. It has reshaped the way that I view healthcare issues, which are inherently more complex than what is perceived at first glance.”

Priyank: “My interest in understanding policymaking began after I took a Health Policy course with Dr. Lavis. I was drawn to the event held at the Health Forum to learn more about the factors that need to be recognized when developing policy. Through interactive activities that challenged students to define a problem and develop possible solutions, I gained first-hand experience in evaluating the options available to combat the health systems problems at hand. The first step, however, is clearly and correctly defining the problem. Throughout the session, it was emphasized that this first step is the most time consuming because health-system problems are driven by many complex and interrelated factors. The workshop demonstrated that an understanding of each factor is required to make an informed decision. If a problem is defined inadequately, the subsequent policies developed to address the problem could be rendered ineffective, ultimately resulting in wasted resources. Thus, I walked away from the workshop with newfound appreciation for the importance of defining a problem and the corresponding considerations. Overall, I was intrigued to discover that while coming up with solutions is necessary to resolve issues, a careful examination of the issue is equally important in order to select the most appropriate and effective solution.”