Calls for a national drug insurance program, commonly referred to as Pharmacare, can regularly be found in Canada's media. While access to prescription drugs is an important component of any well-functioning healthcare system, there's little evidence that an expanded government-run single-payer program is either necessary or ideal.
When it comes to concerns about access to medical goods and services, it makes sense to first examine those groups that are most vulnerable such as low-income and chronically ill Canadians.
Interestingly, a review of provincial drug programs reveals that such Canadians already have comprehensive prescription drug insurance coverage. While the levels of coverage vary by province, lower-income Canadians have access to at least catastrophic insurance for prescription drugs (limiting out-of-pocket costs to a small percentage of income), while those on social assistance have coverage at very low or zero cost. Coverage under current plans also tends to be more generous for lower-income children and seniors than for non-senior adults, particularly those without children.
Faced with these realities, and limited government resources, the case for expanding public drug insurance loses steam. This is especially true when we consider the fact that middle and higher income Canadians more likely have effective private insurance through employment or direct purchase.
That being said, it's certainly possible that some groups of Canadians may be slipping through the cracks. In such cases, public policy should focus on identifying and supporting these individuals, instead of subsidizing those who don't need it.
However, some may still point to public drug plans in other countries and say "Well, if they have it, why don't we?" Aside from the major questions of cost and efficiency, it's vital to understand how drug plans in other countries actually work. For example, take a look at Switzerland and the Netherlands -- two countries with well-respected universal healthcare systems.
Neither country has opted for a government-run insurance scheme for pharmaceuticals (or, incidentally, for health care in general).
Instead, they both provide universal access for all health care services (including pharmaceuticals) through private insurers in schemes which involve health insurance premiums as well as some cost-sharing in the form of co-payments or deductibles. Low-income citizens and those exposed to high drug costs still have access to pharmaceuticals, however, through premium discounts, cost-sharing exemptions, and other public-safety nets.
So, while there is merit in pursuing policies to expand access to those legitimately in need, the Dutch and Swiss models demonstrate that several avenues exist between a government-run single-payer program and the current decentralized approach in Canada.
Importantly, before we get into hypothetical estimates of how much a national drug insurance system will cost, it's critical to understand the status of current coverage already available to low-income Canadians. If, as research suggests, these groups are already well covered, we should focus on whether further expansion of government drug coverage to all Canadians (whether they need it or not) would be a sound use of taxpayer dollars.
As with the case of surgery, this is likely a situation where it's prudent to use a scalpel instead of a baseball bat.
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