According to their self-congratulatory communiqué, the "quality and sustainability of Canada's health care systems are being improved" by the efforts of the premiers of the 13 provinces and territories.
In the year since the Council of the Federation (the name given to the premiers' confab) appointed a health-care innovation working group, it has "achieved a number of successes," according to the release. These include lowering the price of prescription drugs, reviewing the appropriateness of seniors' care, and examining opportunities to expand the roles of paramedics and pharmacists.
Let's give the premiers credit for correctly identifying three key areas that need urgent attention in Canada's health system: improving access to and affordability of prescription drugs; bolstering the long-term care system; and creating some kind of coherent health human resources strategy so that we have the work force we need in the future.
But they have hardly earned an A for ambition with their timid efforts.
Take long-term care: The time for talking is long past. In every province and territory, there are long and ever-growing waiting lists for beds and nursing homes and long-term care facilities and, if you do get a spot, it can be costly. Home-care services in most provinces focus their efforts on surgical patients who need short-term care, not patients with chronic health conditions who most desperately need assistance to remain in the community and out of hospital.
Canada's fastest growing demographic is so-called senior seniors (those over 80). They and their caregivers – most of them working moms with children – need help and they need it now. There has been plenty of reviewing of situations and very little implementation of solutions.
The same can be said of health human resources. There has been much talk of interdisciplinary teams and getting various health professionals to work to their full scope of practice, but implementation has been slow and sporadic. The principal health human-resource strategy in Canada is to poach workers from other jurisdictions, a self-defeating practice that drives up wages. Labour accounts for nearly two-thirds of health spending, or about $135-billion a year. This is where the premiers should be making a big effort, not just agreeing to consider vague nickle-and-dime measures like giving pharmacists and paramedics more responsibilities.
So let's turn our attention to the one area where the premiers have actually taken concrete action – prescription drugs.
Last year, participating provinces and territories (some opted out) agreed to set a common price for the six most commonly prescribed generic drugs. That initiative saved $100-million a year. Now they have agreed to join forces for bulk purchases of 27 brand-name drugs, a measure that is expected to save up to $70-million a year.
Publicly administered drug plans spent $12.3-billion last year on prescription drugs (and private drug plans another $15.4-billion), so savings of $170-million is a pretty modest effort.
But the real lingering question is this: If the provinces and territories can agree to purchase 33 prescription drugs together to benefit from bulk purchasing, then why can't they do so for all drugs?
In fact, why can't they just have a single formulary – the name given the list of drugs that are reimbursed by an insurer – that applies to every province and territory and administer it centrally instead of creating separate (but almost identical) formularies for the public drug plans in each of the provinces and territories?
Hold on. All this actually does exist – almost – at least in theory. Way back in 2004, the premiers agreed to a National Pharmaceuticals strategy. They signed a commitment to act in five major areas:
- Establishing a national formulary;
- Implementing drug pricing and purchasing strategies to obtain the best prices for drugs and vaccines;
- Strengthening the evaluation of real-world drug safety and effectiveness;
- Using technology for e-prescribing to reduce waste and help avoid dangerous adverse reactions;
- Improving the prescribing behaviour of health professionals.
Nearly a decade later, the premiers are still taking baby steps on implementation. And, sadly, that is all too typical of our approach to health reform in Canada: Many promises made and so few fulfilled, the touted improvements illusory.