Cracks showing in health system

Canada’s health care system has been the envy of much of the world, but two issues are showing chinks in the armor.

Cracks showing in health system
Most Canadians like to brag to the rest of the world about the country’s health coverage, but according to the CLHIA cracks are starting to show in the system.

“Generally it works well,” said Stephen Frank vice president of policy development and health at the CLHIA. “People are getting the drugs they need and the system hasn’t bankrupted us yet. There’s no real massive groundswell of problems there but there are cracks that are starting to come and it’s around access. You’re getting different levels of access depending on where you live.”

Right alongside access, drug pricing is increasingly rearing its head, with biologic and specialty drugs increasingly disrupting plans. “These are problems that are starting to happen and we can address them if we get ahead of it a little bit,” said Frank. “Our view as an industry is that we do need to have a standardized approach to drug coverage.”

The CLHIA sees that happening in two respects: a formulary and standardized pricing.

A formulary or a minimum list of drugs would ensure access for everyone in every province or if they’ve got public or private coverage. “We think everyone should have a baseline,” said Frank. “But we think there should be room for differentiation over and above that.”

The CLHIA’s proposal for a formulary is supported by Great West Life as it would ensure a baseline of coverage for all Canadians and reduce some of the existing complexity in the system. “This would offer consistency across jurisdictions and coverage, and help reduce costs associated with complexity in the system,” said Loretta Kulchycki, vice-president of group marketing at Great-West Life. “Such a formulary would need to include drugs that treat chronic and rare diseases, so that provinces, plan sponsors or individuals who want additional coverage can have it.”

As big an issue as access is, pricing is still perhaps the biggest issue facing plan sponsors in Canada, especially with the rise of big drug claims.

“Pricing is also quite problematic,” said Frank. “Prices vary across the province; they vary by employer. We really need to tackle that and get to a more standardized pricing level for everybody and we think we can do that collaboratively with government and within our industry. On both fronts we think there’s room to standardize a lot more than we currently have.”

The provinces have started to collaborate on negotiating for drug pricing. ”The challenge is they have not extended that pricing to employer plans and individuals. So if you’re covered provincially then you get the price they’ve negotiated and if you’re not you don’t. We think the provinces should be negotiating on behalf of all and sharing those prices with everyone.”