December 11, 2018 10:15
Photo : Freepik
Canada likes to boast of his public system of universal health care to Americans, but yet, it is missing a major component to this system : a national system of prescription drug insurance. This is not that we have not thought of. The idea is in the air since the 60’s, it has been taken up by new governments, but to date, none is passed to the act.
However, all studies on the health care system in canada over the past 50 years have concluded that the lack of insurance plan for prescription drugs was a major shortcoming. The royal Commission on health services had said in 1964, and the national Forum on health in 1997, the Commission on the future of health care in Canada in 2002 and the report of the standing senate Committee on social affairs, also in 2002.
Another primer latest is on : April 18, 2018, the standing Committee on health tabled a report which recommended that Canada establish a public system of universal single-payer to include prescription drugs provided outside of hospitals. The current government of Justin Trudeau is expected to decide in 2019 if he goes ahead with this old dream and could even decide strategically to make it an electoral issue in the next federal election next year.
But Canada and Quebec have-they really need a public prescription drug insurance plan ? The question has been the subject of a panel discussion at the 12th Forum of the industry of the health of Québec, which was held in Quebec on 5 and 6 December last year in front of an audience, bringing together a very large number of insurers. The chair for Quebec of thecanadian Association of insurance companies of persons (CLHIA), Lyne Duhaime, the former provincial minister of Health, Dr. Yves Bolduc, and the president of theQuébec medical Association (QMA), Dr. Hugo Viens, participated in the exchanges.
Inequities between provinces
Access to a drug insurance system in Canada varies considerably from one ocean to the other. All recognize that, Quebec has without doubt the best in the country and serves as a model elsewhere in the country. Moreover, it is the only province that requires all residents to be covered coverage for prescription drugs, whether through a private plan offered by insurers or by the public plan.
The coverage provided by the provinces varies a lot according to the groups. The workers are covered by a private plan, the seniors and recipients of social assistance by government-sponsored plans, the military, members of First nations, federal inmates and some of the refugees are from schemes financed by the federal government. The left behind, are self-employed, part-time employees, or have a low income, but the segment of the population most adversely affected by the absence of such a regime, the national public is that of women.
A study dated 2018 has concluded that nearly a million Canadians have reduced their spending on food and heating to be able to pay for their medications, and almost two million have said that they have not been able to pay at least one drug during the last year. Another recent report estimated that hundreds of people die prematurely each year among working-age Canadians because they did not have the means to buy their prescription drugs.
“Canada, Health Canada, is lagging behind several countries around the world on the plan costs and health outcomes obtained by the system of insurance schemes, public and private drug disparate. Canadians pay some of the highest prices and spend more for prescription drugs than the citizens of almost every other country in the world. “
It is far from the idyllic image that the Canadian system of universal healthcare.
A real need
In the face of these iniquities provincial penalize hundreds of thousands of people, all of the participants in the round table of Quebec have agreed that there was a real need for a health insurance plan national. No one has questioned his need.
“100 % of Canadians should have access to their medication, a summary Lyne Duhaime. Is this justified that you can have access to a medication in one province and not in another ? It is a legitimate question to ask. And there’s also an issue of society about drugs very expensive. This is probably the most complex and the most difficult to resolve : who will pay for these drugs to ensure that patients who need it have access to ? “
The representative of the insurance industry has taken advantage of this forum to bring to the defence of private insurers and their contribution. Access to medicines has an emotional stake in, and people have the impression of not having fully access to the medication or that the insurers do everything they can to reduce the coverage, she said. However, it is a false perception, corrected Lyne Duhaime : 95 % of claims are accepted by insurers, but the remaining 5% non-eligible can be found in the media. However, a company will never manage to fill all the needs in health care and medicine : we could always do more, she took care to clarify.
The private, a benefit for the Quebec
According to the president of the CLHIA Quebec, even if the system can be improved, the mixed regime in quebec has demonstrated that the competition between the employers and insurers has led to regimes that are more generous. In Quebec, 8 000 medicines are covered by the public plan and the private insurers are more than what is required in the vast majority of cases.
“We are deeply convinced that it is the best alternative, she said. The experience of the past twenty years has demonstrated that the involvement of the private, when it is well-framed as in Quebec, has increased the access to medicines in contrast to what one may see in the United States. “
She said she did not understand the position of the FTQ and the CSN, which call for a single scheme with a single-payer, which would, of course, the State. She believes that it is an ideological debate and that their members would lose immediate access to an array of drugs if they had the single public plan.
Lyne Duhaime had an ally with her : Dr. Yves Bolduc, who believes that the presence of private insurers adds healthy competition in the system. “It is important to have alternatives, he commented. In Quebec, if the insurance companies are forced to offer more in their coverage of drugs, it is that they are forced at the outset to offer everything that the government offers. It is, therefore, an advantage of having a dual system to improve accessibility. “
Maintenance of the system of mixed quebec
Dr. Bolduc, who returned to the practice of family medicine after its passage in politics, defends him also the need for a national scheme : “Every Canadian should have a drug insurance plan. This is a must have, and Quebec has shown that it is able to make costs reasonable “, he insists
The real question in the eyes of Dr. Bolduc is not whether Canada should put in place a national scheme, but what form should it take : a public plan that covers all, or a mixed regime, like that of Quebec, which works very well ?
A fear arises : the creation of a public plan canadian prescription drug insurance is about to sound the death knell of the regime in quebec ? Not at all, if it is to the former minister. He showed himself to be firm on one point : we do not touch and the abolition of the mixed regime in quebec. The health, he insisted, is a provincial jurisdiction, it does not believe a new war federal-provincial on this issue and it calls for an approach on a province by province.
“If the federal government wants to put money into a national scheme to cover the entire population of the country, it is necessary that each province decides its own plan and the coverage it will provide, he argued. We will host in Quebec, but there will no condition which could go with this money. “
The question of costs
The president of the Québec medical Association, Dr. Hugo turn, raised another key issue : that of cost. Who is going to pay the note of a national system ? It is, moreover, expressed concern about the foreseeable increase of the invoice in the future and is afraid of an open bar. He would be in favour of public plans, which would cover the essential and which would be supplemented by private pension supplementation.
Lyne Duhaime, however, responded that it was unrealistic to think that a public plan would provide the basic needs, and that the insurers would cover the excess. “As you mutualiserais the risks are high, she says, you would create an accessibility problem. “
Inequalities continue to
Even the creation of a national insurance scheme drugs would not eliminate inequality between the provinces, should be Dr. Yves Bolduc, as each of them could decide the coverage that it offers. In the end, he decides that everyone would come out a winner with several models, including a mixed system where private insurers have a big role to play, rather than with a central system, unique decides of all.
“I do not think that the solution would be to flusher insurers and pharmacists also want the flusher, he said. It should be just that in the end, everyone is a winner, a winner at the access level. “