13 December 2018 13:30
The president of the Québec medical Association, Dr. Hugo Just | Photo : Denis Méthot
The president of theQuébec medical Association, Dr. Hugo Viens, has tackled one of the biggest taboos of the quebec healthcare system the 8 last December in the framework of the 12th Forum of the health care industry that was held in Quebec in raising the possibility of reviewing the basket of services of medications to help control rising costs and to offer a medication for rare diseases.
The revision of the basket of services, both for care covered only for the medications, is a subject highly sensitive to which no quebec government has ever dared to really tackle these last few years. The idea has already been raised by some voices, but had been ruled out, as well as the possibility to impose a copayment. Dr. Come has revived the track during a round table in which took part the president of thecanadian Association of insurance companies of persons (CLHIA), Lyne Duhaime, and the former Health minister of Quebec in the first Liberal government of Philippe Couillard, Dr. Yves Bolduc.
The importance of the drug
Dr. Just, an orthopedic surgeon, has defended the importance of drugs in the trajectory of care that is medically required for a patient. All agree that surgery should be provided by the health system, he said, but if the patient needs medication to his release from the hospital, is it acceptable that they are not covered by the health insurance plan ? It apart so the episode of care into two parts, he says, a component covered and the other may be. Yet, even if the patients are increasingly short stays in hospital and more in community, it is always in the same episode of care.
This is a point that has shared Louis Thériault, vice-president, policy and research, Innovative Drugs Canada. “A drug that is an integral part of health care should be a part of a universal system “, he argued.
Some medicines are free of charge when the patient is hospitalized, but are no longer covered when he returns home so that they could speed up his recovery and enable him, according to the situation, return to work quickly.
Review the basket of services
Dr. Hugo Just is concerned about the increase in the cost of the drugs, but he proposed a few avenues to control this growth : first, review the basket of services and medications to low-value-added. He cited the case of statins used to reduce cholesterol. Many family doctors will prescribe in order to prevent the onset of heart problems and strokes.
It is a choice to use which oppose to many cardiologists because it does not encourage people to change their eating habits and do more exercise to reduce their cholesterol levels and prevent an event that coronary. Of the people, we suggest you take statins in primary prevention will continue bad eating and not to move by saying that they take a pill against cholesterol, say experts. In addition, the value of this drug to prevent really adverse cardiac events is the subject of debate within the medical profession.
Anyway, the cardiologists would like that statins are rather prescribed for people who have already had an event chd or who are at high risk of develop because of their genetics. It was estimated three years ago that one-in-four canadians covered by a drug insurance plan took a medication for the cholesterol and the total bill amounted to $ 500 million per year.
As have cardiologists, the president of the QMA has, therefore, called into question the prescribing of statins on a large scale and said that the money saved could be re-injected in the payment of drugs for rare diseases.
Choices to make
“In the health system, there are treatments that have added value more important compared to the money invested, said Dr Come to the of the insurance Journal on the sidelines of the Forum. When you will start to feel a tightening of resources, there will be choices to make and I believe that we are ready socially to do so. “
There are skincare products with high added value that we are going to cover because they are going to allow people to avoid a disaster. To the opposite, he predicts, it will put into question some of the health problems that we must medicalize and which we prescribe many medications, while the value of these treatments may not be there. There are huge savings to make this side, he argues, and the debate on the basket of services will become inevitable.
In addition to the revision of the basket of services, the Dr Just emphasized that the doctors should also “déprescrire” drugs, what they are not doing enough. From the time he was minister of Health, Philippe Couillard had wanted to have a look at the australian model where a pharmacist and a doctor were a team to review the medication of patients and to reproduce in Quebec, but it never went forward. However, there are health gains and financial-to make this side.
These two measures, or the cancellation of registration and the revision of the basket of services, could allow, according to the president of the QMA, not to pay for the drugs with low added value and to offer a medication innovative for rare diseases with high impact in a few people.