If you ask Canadians what they think defines us, what we are proud of, one of the most common answers will be our health care.
The Canadian Health Act, established in 1984, outlines five core values guiding the distribution of healthcare for Canadians.
It is universal so all citizens may have it, it is portable so they may take it anywhere they want in the country, it is accessible so that every citizen has equal opportunity to reap the benefits of it, it is publicly administrated so it is accountable and it is comprehensive, so it covers everything that is medically necessary within a hospital.
While these tenets do serve as a good guide, they are unfortunately not realized effectively in actual practice due to the changing nature of medical care.
Specifically, we will address the ways that two of these values, comprehensiveness and accessibility, have fallen. Following the meeting of these values, we will explore the how we can increase our social efficiency in spending for health care, or the ways that we can get the most value for the money that we are spending.
Over the past decades there has been an endless wave of new technologies for health care, whether in vaccinations, in imaging machines or in genetic research we have seen biomedicine expanding its tools for combating diseases, old and new.
Coinciding with this, we have also seen what is known as an epidemiological shift, wherein the types of diseases that were most common have changed from acute illnesses to chronic illnesses.
An acute illness is that which is diagnosed, treated and is dealt with promptly; the typical pattern we may expect from a visit to the doctor.
Across the Western world as we gain a handle on old menaces of contagion and viruses, we don’t see sweeping waves of polio or leprosy, as medicine has advanced to treat these acute illness.
This turns our attention instead to chronic illnesses, those that can’t simply be cured in medicine’s traditional style and will require treatment likely for the rest of the person’s life.
Here the person’s care is not based in the hospital or in the doctor’s office, but in their everyday world.
We see not waves of acute diseases, but waves of diabetes, of ADHD or depression and anxiety.
Accompanying this is the fact that chronic care is increasingly being treated with pharmaceuticals of some sort, and being outside of the hospital, even if you have a private insurance plan, you are still going to be paying out of pocket for your medications for the rest of your life.
One concern that is being addressed is that of the aging population and the fear that this will greatly increase the burden on our budget for health care.
We can examine how this fits into the epidemiological transition we have addressed. It is estimated that the elderly population in Canada can be expected to have between one to three chronic conditions that they must attend to.
With this in mind, it is clear to see why addressing the needs of chronic care are only going to be increasingly important.
Here we see how the value of comprehensiveness has become out-dated. Canadian healthcare isn’t just based in the hospital, and drugs are not only administered by doctors in hospitals; they are administered by individuals in their own homes.
At this point, let us review some statistics regarding the costs of our healthcare and where our money is going.
In 2005 Canada, spent an estimated $35 billion on chronic care directly. The indirect costs were an estimated $77 billion.
This additional $77 billion is said to reflect the nature of chronic illnesses, wherein the person will also be subject to complications of their conditions, and the extra care, as we see, does add up to a sizeable sum.
Since 1985, the cost of pharmacare out of the total health care budget has increased from 9.5 per cent to 16.4 per cent in 2009.
Additionally, the proportion that is paid by the public has increased, while the proportion paid by private insurance companies has gone down.
In a comparison of the amounts people in other countries pay for prescription and over-the-counter medicine, between 2008 and 2010, Canadians paid more compared to a breadth of European nations, and only Americans consistently paid more than us.
In 2009, the average Canadian’s yearly costs out of pocket for their pharmaceuticals was $893, ranging from $714 to $1,057 between provinces.
The same report from 2009 stated that $25.4 billion was spent on pharmaceuticals, with $11.4 billion from the public budget, and $4.6 billion from out-of-pocket costs.
Sadly, it was also found that 10 per cent of Canadians reported that the costs directly forced them to not fill out their prescription, or to skip doses. The immediate health detriments from not being able to take one’s medications are plain, but we must also consider the additional costs that this produces.
If we recall the $77 billion spent in indirect costs for chronic care, this is one of the situations that contribute to it, being that not taking medications can lead to more complications requiring expensive immediate treatment.
To further address this impeding of accessibility, there are those Canadians who do fill out their prescriptions, but do so at the considerable depletion of their income.
I think we have all seen the commercials for people needing to choose between buying food and paying for electricity; well sadly the case can be the same with medication. This is especially true for those with fixed incomes, such as the growing retired population.
Unfortunately this problem is so common; I can speak to this from my own experience. About 10 years ago, my father had an accident while working and the prescriptions to care for this for the years since required hundreds of dollars to fill. Without the aid of an income or worker’s compensation, the stress this can induce is obvious.
Now why is this treatment not funded? Simply because it was not done by doctors in hospitals, but everyday in our home. Such situations can be found in millions of homes across the country.
The Potential To Adapt
Here I would like to introduce potential solutions to this issue that Stephen Duckett and Adrian Peetoom present in their book ‘Canadian Medicare: We Need It and We Can Keep It.’
They propose that we must establish a national buyer for all medications at the federal level, as well as a robust evaluation board to ensure the thorough testing of all pharmaceuticals that will be prescribed to Canadians; too often they have rubber-stamped drugs, resulting in unforeseen long term side effects, which require even more treatment.
This idea is not revolutionary and has been implemented in many European countries. We have seen that they do indeed pay less.
This is due to the simple fact that a national buyer has much more bargaining power, and the mass quantity purchased results in a lower price.
With national public coverage, the premiums paid to private insurance companies, a sum of $9.4 billion, would then be transferred to provincial budgets, though at a price adjusted for the needs specific to each province.
They additionally suggest that for those with difficulty meeting the reduced prices there can still be a funding of co-payments to ensure Canadians receive the care they need, regardless of their income.
With accessibility to their medications facilitated, families that need the savings the most can have more room to breathe and the ability to access healthy options for food and activities. This is not to mention that they will not need as much acute treatment, and we again have reduced the cost to our health budget.
To finish, I would like to present a final suggestion by these authors for getting these ideas moving.
They suggest that we write our representatives if they have any plans to update coverage to include outside-of-hospital pharmaceuticals, and if they have a plan to investigate practical ways to establish a national coverage plan.
Should you like to read the book by Duckett and Peetoom, there is a copy available in the stacks at Bata, and I got my copy used from the bookstore for a very fair price. I plan on looking up the contact address of our provincial and federal representatives and writing them; after all, we are supposed to be making policy based on evidence and the evidence states that our health care is not comprehensive or accessible.
On top of all of this, imagine if billions were saved on pharmaceuticals and how this could then be used to pay the wages of doctors and nurses, rather than downsizing and firing them.
Or consider how the reduced amount of acute treatment can ease the burden on those working at our hospitals, and only at the cost of reducing the profit made on Canadians by insurance and pharmaceutical companies.
After all, they can’t afford to ignore the money that we will still be paying them, and they have settled for less with other countries before us. We won’t be demanding that we pay nothing to them, but we will be demanding that Canadians pay fair prices, and that getting the care they need doesn’t depend on how much money they have.
It seems incredible that we haven’t established a national plan and buyer when the evidence for its effectiveness is already found and is likely due to the lobbying on the behalf of the industries to secure their profit.
So, if we want to see this happen we are going to have to lobby on behalf of ourselves, especially if we are going to claim that comprehensive and accessible healthcare is something we value as Canadians.