Categorized | Global Health Matters

“Pharmacare is the unfinished business of Canadian Medicare”The Historical Context

Posted on 23 November 2015 by Jessica Bryce

“Pharmacare is the unfinished business of Canadian Medicare” says a new report by Pharmacare 2020, an organization comprised of a number of prominent physicians, health policy workers, and researchers.

How did we get here? Why are prescription drugs not covered by Canadian medicare? Why don’t we need to show our health card when we go to the pharmacy? To answer these questions, we must delve into the history of Canada’s health care system.

Since the early days of medicare, many have argued that medications are a necessary part of a comprehensive coverage system. In 1945, the Federal government made the first proposal to the provinces regarding a national medical insurance system that, notably, suggested inclusion of drug coverage. In 1964, the Royal Commission on Health Services (informally known as the Hall report), recommended that the federal government assist the provinces in establishing a comprehensive, universal program for ensuring medical services (which was based on Saskatchewan’s system that was already implemented). This influential report also recommended that the plan include coverage for prescription drugs. Drug coverage was discussed at the federal level, but “was shelved because the government did not perceive sufficient public demand to make it a political win” (http://irpp.org/research-studies/study-no50/). Thus, it was not included in the 1966 Medical Care Act, a precursor of the 1984 Canada Health Act. Without federal direction, each province formed its own public drug coverage insurance plan for specific sub-populations. Most of these programs target seniors, low income families, and individuals with disabilities.

The idea of universal pharmaceutical coverage was not formally revisited at the federal level until 1997, when former Prime Minister Jean Chretien chaired the ‘National Forum on Health’. The forum identified two key problems with drug benefit plans:

  1. Having multiple bodies purchase drugs (i.e. private insurance companies, hospitals, provincial drug plans) reduced the purchasing power that could be had by a larger collective organization
  2. Seniors were under-insured for many necessary medications

Yet again, it was recommended that drugs should be included “because pharmaceuticals are medically necessary and public financing is the only reasonable way to promote universal access and to control costs.” (National Forum on Health 1997). In 2002, the Romanow commission recommended starting with federally-initiated catastrophic drug coverage. Then, incremental reforms could ultimately lead to complete drug coverage for all Canadians. This report lead to the formation of the National Pharmaceuticals Strategy in 2004. Unfortunately, funding decreased and progress was hindered due a change in the federal government in 2006.

Although not government sanctioned, a number of reports since 2002 have recommended a Universal Pharmacare Coverage program. However, a quick glance at the authors of these reports demonstrates considerable overlap. Although well written and researched, there are a limited number of groups and individuals researching potential pharmacare reforms in Canada, and even less ambassadors for it at the provincial and federal government level. However, as pointed out in the recent Pharmacare 2020 report ‘The Future of Drug Coverage in Canada’: “a July 2015 poll by the Angus Reid Institute found that 91% of Canadians support the concept of having “Pharmacare” to provide universal access to necessary medicines; 88% believe that medicines should be part of Medicare; 80% believe that a single-payer system would be more efficient; and 89% believe Pharmacare should be a joint effort involving provinces and the federal government.” Public demand for pharmacare reform is there, the research supports it, and yet there are no government initiatives and virtually no incentive for the government to do so. What should be done?

….. stay tuned for more!

 

References:

  1. Are Income-Based Public Drug Benefit Programs Fit for an Aging Population? http://irpp.org/research-studies/study-no50/
  2. Pharmacare 2020: The Future of Drug Coverage in Canada http://www.pharmacare2020.ca/
  3. 2014 Lobby Day Delegate Backgrounder https://drive.google.com/file/d/0B9cM-RadOUW2RzR5YW01UHNuZUk/view?usp=sharing

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