The study, Pharmacare: what are the costs for patients and taxpayers?

TORONTO, Sept. 28, 2015 /CNW/ – New research suggests that a national single-payer Pharmacare program is unnecessary and will be costly for Canadian patients and taxpayers. The study was published at Canadian Health Policy the online journal of Canadian Health Policy Institute (CHPI).

Since 2013, several academics, activist groups and unions have been vigorously advocating for the establishment of Pharmacare. Several papers have been published that advocate for Pharmacare. Most recently, the Canadian Medical Association Journal published a study (Morgan et al 2015) that estimated the cost of establishing Pharmacare.

Pharmacare is proposed as a national universal publicly-funded single-payer system that would entirely replace Canada’s current pluralistic system of federal-provincial-territorial publicly-funded drug plans, and employment-based private drug plans. Pharmacare advocates infer that this will be either a federal program or a federal-provincial-territorial intergovernmental cooperative program in order to achieve national scale and standards.

“Pharmacare advocates propose to establish a government-run monopoly over drug insurance,” said Dr. Brett J Skinner lead author of the report. “Our study examined what that will mean for patients and taxpayers.”

According to co-author Kimberley Tran, “We asked several important questions about Pharmacare that have not been adequately addressed by its advocates like, how many Canadians are insured, uninsured and under-insured for their prescription drugs? How will access to prescription drugs be affected and what are the health implications for patients? Under realistic assumptions, how much cost will be shifted from private plans onto taxpayers? What are the indirect economic costs from a government take-over of private insurance? How do other countries achieve universal drug insurance coverage?”

The CHPI study examined the evidence and concluded that there are at least four reasons why Canadians should be skeptical about Pharmacare.

Fist, according to the study, Canada’s actual experience with public drug plans strongly suggests that Pharmacare will reduce access to the most innovative medicines for the 24 million Canadians who currently have employment based private drug plans, without improving benefits for the 11 million Canadians who are currently eligible for public drug plans.

“Forcing 24 million Canadians with private drug plans to accept the inferior coverage provided by public drug plans could have profound health and economic implications,” said Dr. Skinner.

Second, assuming realistic prices and no changes to the drug benefits currently enjoyed by Canadians, the study calculated that Pharmacare will shift $13.2 billion in direct prescription drugs related costs onto taxpayers. If implemented entirely as a centralized federal program, Pharmacare would shift $25.5 billion off the provinces and the private sector onto the federal budget. In both cases, additional indirect economic costs resulting from the government take-over of the private drug insurance industry could total at least$4.1 billion in the first year.

Third, the study argues that a government monopoly is not needed to achieve universal drug insurance coverage: under the current pluralistic public-private system, Canada already has universal drug insurance coverage for catastrophic expenses, and near universal insurance coverage for ordinary prescription drug costs. Neither is a centralized national program needed:  provincial/territorial/federal governments already have the authority to autonomously implement any kind of drug insurance system they wish within their respective jurisdictions.

Fourth, the study suggests that international experience proves there are other ways to achieve universal drug insurance coverage. Several advanced countries have mandatory universal private drug insurance systems supported by means tested public subsidies. Some aspects of Quebec’s drug insurance system are similar to these countries and Quebec has consistently provided the best access to innovative prescription drugs among all of Canada’s publicly funded drug plans.

According to Dr. Skinner, “The evidence suggests that the real problem with drug insurance in Canada is that existing public drug plans are grossly under-insuring patients compared to the coverage provided by private insurance plans. Public drug plans simply provide much fewer treatment options for patients, leaving 11 million Canadians with uninsured drug costs whenever their prescribed and preferred treatments are not covered under the public plan.”

Ms. Tran summed up the study’s recommendations by saying, “drug insurance reforms should focus on helping more Canadians gain the health advantages of the better coverage offered by private drug plans. We can learn a lot from mandatory universal private health insurance systems in other countries. In the meantime, governments should work to improve coverage for new medicines across existing public drug plans in Canada to match the patient health options provided by private drug insurance plans.”

Get the Study
The study, Pharmacare: what are the costs for patients and taxpayers? It was authored by Brett J Skinner (Ph.D.), Mark Rovere(Ph.D. candidate), Neil Mohindra (M.B.A.), and Kimberley Tran (M.A.). It is available online at: www.canadianhealthpolicy.com orwww.chpi.ca.

About CHPI
CHPI is a crowd-funded, consumer-driven, independent think-tank dedicated to conducting, publishing and communicating evidence-based research on the health system performance and health policy issues that are important to Canadians.

SOURCE Canadian Health Policy Institute

For further information: Kimberley Tran, Economist and Media Spokesperson, CHPI. Email: kimberley.tran@canadianhealthpolicy.com, Managing Editor, CHPI. Email: managing.editor@canadianhealthpolicy.com

Alberta bolsters programs that help women, children, affected by family violence

Alberta is spending $15 million to bolster programs that support women and children affected by family violence.

The money is to improve services in emergency and second-stage shelters and to hire 124 outreach workers and youth counsellors, Human Services Minister Irfan Sabir said September 23, 2015.

“Nobody has to live in fear. Nobody should be subject to violence,” Sabir said in an interview.

“When those unfortunate incidents happen, it is the role and responsibility of the government to provide people a way out of that tragedy, to provide people with the support they need to deal with the violence.”

Last fall, the Alberta Council of Women’s Shelters issued a report that said 8,427 women and 8,012 children were turned away from shelters due to lack of space.

The report said during the same time period _ the fiscal year 2013-2014 _ the shelters admitted 5,710 women and 5,612 children.

Jan Reimer, the council’s executive director, said the new money will improve the overall effectiveness of shelters and reduce the number of women and children who are turned away due to lack of space.

She called it the most significant funding increase shelters have had from the provincial government in about 10 years.

“I think this is a huge change and a big step forward,” Reimer said.

“Having sufficient funds to manage the program will make a huge difference and I think will help more women to be served.”

Reimer said the increase will mean second-stage shelters that provide apartments for woman and children as they transition to living more normal lives will now have secure funding.

Women and kids who move to the secondary units free up space in emergency shelters.

The new outreach and youth counsellors will mean that children of women who flee family violence will get the help they need, added Reimer.

“To be able to work with the children and to deal with their traumas can have a health impact for the rest of their lives.”

The council represents 42 shelter organizations in the province.

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Managing Stress in Turbulent Times

CNW: Press Release

If the dark clouds of debt are hanging over you, chances are you’re not leaving them at the door when you come to work.

Money worries not only keep us awake at night and unproductive on the job, but also contribute to rising stress levels and increased risk of developing chronic conditions such as diabetes, cardiovascular disease and mental illness.

A 2014 study conducted by Manulife Financial and research firm Ipsos-Reid documented a direct link between our personal financial wellness, physical and emotional health, and workplace productivity1.

“There were two things we were observing inside our business that made us take on this research in the first place, and they’re symptomatic of what’s happening across the country,” says Nancy Campbell, assistant vice-president of market development at Manulife.

“The first was the percentage of short and long-term disability claims that are related to mental health – at one in three, it’s becoming absolutely epidemic. Ninety per cent of mental health issues in the workplace are stress related. The leading cause of that stress is related to personal finance.

“The second was that our employers were expressing real concern that their employees were unable to get ready for retirement because of all the immediate financial concerns they were facing.”

The report found that those who struggle financially are 16 per cent less productive on the job – for an employee earning $50,000 annually, this translates into $8,000 of lost productivity per year. They also take 25 per cent more sick days than their financially prepared counterparts.

Every challenge can lead to an opportunity and during lean economic times the opportunity exists for staff at all levels to learn resilience and mental fitness strategies.

Dr. Karen MacNeill, a Registered Psychologist at Copeman Healthcare and an expert in performance psychology has worked with clients in a variety of high pressure environments including Olympic athletes and executives leading organizations during difficult times.

“Stress is really the imbalance between perceived demand and perceived resources,” says MacNeill, who facilitates a corporate health workshop at Copeman entitled, “Mental Fitness for High Performance.”

“Battling stress effectively is about self-awareness. Two people going into the same economic situation may react differently – it is important to understand how you are likely to respond. Financial volatility can either be viewed as a threat that can impact performance, or it can be seen as an opportunity to engage the workforce and get more out of them in turbulent times.”

MacNeill says now more than ever, organizations need to invest in their key talent and develop their capability to lead under pressure.

“The approach we take at the Copeman clinic is to empower our patients with a variety of tools and techniques to manage stress and promote wellbeing. When looking at tools for managing work pressures, think of it as a mental fitness golf bag. You wouldn’t use the driver for every shot, but you’d have a variety of clubs for the situation at hand, whether managing conflict, getting perspective, or building confidence.”

MacNeill also suggests that in high pressure environments it is not only important to monitor stress and anxiety but also to keep an eye on physical health as patients struggle to keep up in times of adversity.

“Under periods of stress, people will often shut down or go inward when what we know is best is to go towards, and get support from, psychologists, physicians, financial planners, your manager, or whomever can help with the challenges that are overwhelming you.”

In addition to managing physical health through regular exercise, nutrition and annual assessments, MacNeill counsels her patients to tackle their finances and take advantage of health coaching and stress management workshops.

Federal government should invest $3.3B into health care for seniors: Report

A new report has put a price tag on aging in Canada.

The Conference Board of Canada study, commissioned by the Canadian Medical Association (CMA), says that it would cost the federal government $3.3 billion in the next year to implement three strategies to cope with the wave of aging baby boomers.

In the next five years, the price would jump to $17.5 billion as boomers put an ever-increasing strain on the Canadian health-care system.

“The reality (is) that it costs more to look after people who are aging,” said Dr. Cindy Forbes, president of the CMA. “There are at least three items that are doable and will make a difference to Canadians in the next budget cycle.”

The first strategy recommends giving provinces and territories additional money for health care based on the age of their populations.

That would require the federal government to boost funding to the Canada Health Transfer (CHT), the country’s largest handover of cash from the federal government to provinces and territories. Money sent through the CHT must be used for publicly provided health care.

The money is currently provided solely based on population, which the report calls uncommon and impractical, because an elderly population has higher health-care costs.

According to a recent study in the journal PLOS One, the average cost for care in a patient’s last year of life is $54,000.

The Conference Board report says countries like Belgium, Germany and Switzerland all top up their health-care transfers based on age.

Prime Minister Stephen Harper has said he’d renegotiate the terms of the CHT when it expires in 2017 so that increases would be tied to population and economic growth.

Liberal Leader Justin Trudeau said if elected, he’d negotiate the terms of an adjusted CHT with the provinces come 2017. Tom Mulcair, leader of the federal New Democrats, has said an NDP government would reverse Conservative cuts to provincial health transfers.

The second potential reform laid out in the report is coverage of the entire cost of medications for all households that are currently spending at least $1,500 per year, or three per cent of their annual income on drugs.

A July study by Angus Reid showed that 14 per cent of Canadians have neglected to fill a prescription due to cost.

Mulcair recently suggested a similar strategy that would see the creation of a universal pharmacare program. He said that if elected, he’d contribute $2.6 billion to the project over the next four years.

Forbes said she’s heartened to see pharmacare being discussed on the campaign trail.

However, the Conference Board report says funding a national pharmacare plan would cost $8.4 billion over the next five years. In 2016 alone, it would cost $1.5 billion, more than half of Mulcair’s proposed four-year budget.

The report also lays out the costs of making two key caregiver tax credits refundable.

According to Statistics Canada, there are currently eight million “informal caregivers” in Canada _ people who look after aging or ill loved ones without financial compensation.

Those caregivers may be eligible for the non-refundable Canada Caregiver Tax Credit (CCTC) or Family Caregiver Tax Credit (FCTC), which offer a tax return on expenses incurred during the course of caring for a dependant.

A refundable tax credit could reduce a tax bill to below zero, essentially refunding some of the money spent on caregiving. It would cost $90.8 million in 2016 to make the credits refundable.

While the report doesn’t detail the cost of making the credits refundable past next year, the Conference Board’s Matthew Stewart said the price tag is only expected to grow by about one per cent each year, bringing the total cost to $500 million by 2020.

Stewart, the associate director of national forecasting at the board, said it’s up to politicians to decide whether they’re willing to invest the money in these three strategies to cope with ballooning health-care costs as Canada’s population ages.

“To me, the most interesting thing in this report is the cost of aging,” he said.  “Rarely have we actually put that into dollar amounts.”

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Stung by costs, some of Minnesota’s medical marijuana patients back to buying on streets

Just two months after Minnesota launched its medical marijuana program, some patients turned off by high costs say they are back to buying the drug illegally because it’s the only way they can afford it.

State officials and the companies hired to make marijuana products trumpeted the program’s medical approach _ pills and oils, no leaf products _ when it launched in July. But some patients say the highly restricted and regulated system is costing them hundreds or even thousands of dollars a month_ none of it covered by insurance.

Company executives defend their prices _ a small vial of marijuana extract can run nearly $130 in Minnesota, more than double the cost of a similar product in Colorado, where recreational marijuana is legal and they’ve sold it medically for more than a decade _ and say costs will fall over time. But they’re also taking steps to help some buyers, including raising money to cut the price for lower-income patients.

According to state data, nearly one in five of the 491 registered patients hadn’t returned to buy more medication in the last month, though state officials stress there are many possible explanations.

Patrick McClellan, who suffers crippling muscle spasms from muscular dystrophy, told The Associated Press that his monthly tab for oil for vaporizer pens _ one of the legal state-sanctioned treatments _ runs $264. He can get a month’s worth of marijuana buds on the street for $80, and mixes it in with as much of the state-approved medicine he can afford.

“That’s a car payment,” he said of his state bill. “What we’re talking about is an expensive designer drug that only the rich can afford right now.”

He’s not alone. Faced with an estimated $2,000 bill, Jonathan Holmgren is back to using the raw plant that the state still deems illegal to treat his Crohn’s disease. Darrell Paulsen can’t afford to pay up to $700 a month for a legal supply _ he, too, is relying on the black market to make the muscle spasms from cerebral palsy bearable.

Two other patients registered with the state told the AP they’ve reverted to buying marijuana on the streets because of cost, but asked that their names not be used due to fear of arrest.

There’s no shortage of success stories in the program’s first two months _ from parents saying they’ve watched their children’s epileptic seizures abate to patients talking about lives restored, free of pain.

But the return to illegal sources underscores some broader problems for Minnesota’s program.

Faced by stout opposition from law enforcement, state leaders approved one of the nation’s most restrictive guidelines: Leaf products aren’t allowed and the range of qualifying conditions is narrow. Oils and pills cost more to make, and the customer base is small. One manufacturer has already announced delays in opening some of the distribution centres outside the Minneapolis metro area and raised its prices.

State officials are weighing whether to allow people in chronic pain to register for medical cards next year _ a move that could trigger a massive wave of new patients and allow manufacturers to mass produce more cheaply.

Part of the price discrepancy with other states’ offerings is due to simple competition: Just two companies are allowed in Minnesota; Colorado has no such limit.

Dr. Kyle Kingsley, chief executive at manufacturer Minnesota Medical Solutions, acknowledged Minnesota’s prices are higher than some other states and said he sympathizes with the “small minority” of patients who have reverted to the black market.

“It breaks my heart that there are folks that are not able to access the program financially,” Kingsley said. “We’re busting our hump to make that right. It will improve over time.”

Both companies are setting up charitable arms to buy down patients’ medication, and already offer discounts to low-income patients.

But the prospect of future price cuts hasn’t come fast enough for Holmgren. After weeks working with Minnesota Medical Solutions to find the right treatment, the 33-year-old was left with a vial of oil that didn’t work as well as his illegal $400-a-month source _ and would have cost him $2,000 each month.

Holmgren said he’d much rather use the state-approved medicine than risk arrest, but the costs have to come down.

“It wouldn’t be as much distress in my life or other’s people lives. We could be legal,” he said.

The federal government might someday relax its stance on marijuana, meaning insurers could decide to cover it as medicine, but patients don’t expect that any time soon. And Sen. Scott Dibble, a sponsor of the law, said there’s likely no appetite in the Minnesota Legislature to reverse the law’s prohibition on allowing raw leaf.

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