Thursday, July 16, 2009

Seniors drug costs

In preparing for a presentation I'm doing at a local seniors home tomorrow, I had to research the upcoming changes to provincial drug coverage for seniors in Alberta. Basically, drug costs are rising, and the new changes will save THE GOVERNMENT $20-30 million per year, so you can imagine where the difference is going. Low income and mid-low-income seniors will benefit as the lowest income will pay nothing for prescriptions and the next step up will pay less. However, the mid-high income seniors will take on significantly more costs of drug therapy. At first, I thought this seemed rational, given that those more able to pay should bear more of the cost. But then I wondered whether this rule should apply to those who have served their country and communities for so long. Shouldn't WE be taking care of THEM and not vice versa by unloading our costs onto them? Then it got me thinking: which country has some of the highest health expenditures in the world? The United States. Who off loads most of their health spending onto citizens instead of covering it publicly? The United States.

I started to wonder whether we might be going about this the wrong way.

I dug up the comparative drug spending for all 20 OECD nations for the most recent years available, that being 2005. The United States has the highest per capita total expenditure on drugs of all 20 OECD nations. However, they have the second lowest % of that expenditure covered by public programs, second only to Mexico. The US only publicly funds 24% of all drug expenditures. The lowest developed Western nations in terms of total drug expenditure are Denmark, New Zealand, and Norway. Their public coverage of that cost ranges from 55.8-66.2%. Where is Canada? We have the second highest total expenditure and fourth LOWEST public expenditure. So much for universal healthcare.

Now, the thought entered my mind: is there any correlation between the following:

1. % of drug expenditures covered publicly and total drug expenditure
2. % of drug expenditures covered publicly and health system performance
3. % of total drug expenditures and health system performance

A presentation I came across concluded that public funding of healthcare does seem to improve health system performance but a good deal of this performance is tied to lifestyle choices and socioeconomic status as well. Furthermore, the WHO rankings of health care systems are contested by many respectable authorities, but they're all we've got for now. So let's test our theory.

1. The correlation is so close to 0, it might as well not exist. So based on the data I have, it looks like the amount of drugs that are covered publicly does not impact total drug spending. Thus, other factors must be at play like lack of price protection on marketed pharmaceuticals, lifestyle, etc. etc.

2. There seems to be a weak correlation that the less a country spends publicly on drugs, the more poorly their health system is ranked. But this certainly does not prove cause and effect and the relationship is weak.

3. Here a weak correlation would suggest a relationship between increased drug spending and increased health system performance. Again, no causation proved, but food for thought.

Taking all these together, it seems we may be headed in the wrong direction. It seems clear that there is no relationship between offloading drug costs to individuals and the eventual total drug costs of a society. And regardless of whether the government pays for them, those costs will be borne by someone. If it is individuals, they will then have less disposable income, meaning less money to "stimulate" the economy.

Maybe we have to rethink our whole approach to controlling costs. Also in the process of researching this presentation, I came across a study that showed that if used properly, pharmacists could save the Canadian healthcare system $103 million a year. That's just one member in the healthcare team. Think of what we could accomplish if we restructured our system to fully utilize the skills of each of our allied health professionals, with the patient in the centre of the team? Think what we could accomplish if instead of only pushing pharmacotherapy we also focussed on healthy living and preventative medicine? Think what we could accomplish if instead of always thinking about dollars and cents, the government put some consideration into the greater factors at play in rising drug costs? Think what we could accomplish if for a moment our legislators and administrators would do just that....think.

1 comment:

Stephanie Gour said...

Ha! Politicians thinking.... You should write for Leno.