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Pharmacare Implementation in Canadian Health Care SystemTerm Paper

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¶ … Pharmacare in Canadian Healthcare System (Policy and Decision Making)

The Canadian healthcare system comprises of a group of social health insurance plans providing adequate coverage to every Canadian. It is publicly administered and funded territorially or provincially, within federal government-established guidelines (Daw and Morgan 2012). Under this healthcare system, citizens are individually delivered preventative medical care treatments from primary healthcare providers, together with access to good hospitals, qualified dental surgeons and added medical services. With very few exceptions, all citizens are qualified for health coverage, irrespective of their medical histories, personal incomes, or living standards (Morgan, Kennedy, Boothe, McMahon, Watson & Roughead, 2009).

Canada remains the most distinct country on earth with a global public health insurance scheme that doesn't cover prescription drugs. Irrespective of the fact that drugs can help manage, prevent and cure sicknesses, recommendation drugs used in places other than hospitals aren't included in the CHA (Canada Health Act). Provincial drug advantage schemes come in different forms, but lack national standard. It covers a wide range of populations with numerous subsidy arrangement and eligibility requirements (Daw and Morgan 2012). The programs cover about 26%-45% of overall prescription drug expenses, provincially. Nationwide, only 44% prescription drug costs are publicly-funded compared to 90% hospital bills and 99% medical bills (CIHI, 2012).

Canadian healthcare system has remained the subject of significant political debate and controversy. Some don't believe the present system can deliver the required treatments timely, and supports the adoption of a private system like that of USA. However, there are concerns that privatization would usher in inequalities in the healthcare system where only the rich can afford certain types of treatments (Morgan et al.,2009; Morgan and Cunningham, 2011).

Main Policy Issues

The CHA is the federal Canadian legislation regulating all publicly funded healthcare insurance. This Act defines the main objective of Canadian healthcare policy, i.e., helping promote and restore the physical and mental well-being Canadian residents, and facilitating reasonable health service access without any financial, or other, barriers. The CHA creates conditions and criteria relating to all insured and extended healthcare services that territories and provinces must fulfill to get full federal cash contribution under the Canadian Health Transfer (CHT). CHA's major aim is ensuring every eligible Canadian has significant prepaid access to insured health services, without any direct service-point charges for such services (CIHI, 2012).

Canada's national health insurance program (always referred to as Medicare), intends to ensure every resident can easily access all necessary hospital and physician services, on a prepaid condition. Instead of possessing one single national program, Canada has a national program comprising of about 13 interlocking territorial and provincial health insurance programs, all sharing some common features and basic coverage standards. Created by the CHA, the core principles governing the healthcare system are signs of underlying Canadian values of solidarity and equity (Nicolle and Mathauer, 2010).

The federal, provincial and territorial political administrations share the roles and responsibilities in the Canadian healthcare system. Under the CHA, federal health insurance legislation, conditions and criteria are precise and should be satisfied by both territorial and state healthcare insurance packages, enabling them to satisfy their complete share of the federal cash input, available under the CHT. Both territorial and provincial governments are responsible for managing, organizing and delivering health services for their residents (Eaddy, Cook, O'Day, Burch & Cantrell, 2012).

Reason for Pharmacare being a Policy Concern and Relevant Evidences

Two reasons are identified as to why Pharmacare is a policy concern.

First, Pharmacare goals are not well articulated or shared within the general population. According to Eaddy et al. (2012) and Boothe (2012), there is little consensus in the desired goals of Pharmacare by Canadians. While some consider Pharmacare for acute care, others consider it in terms of the people services or under how much procedure waiting times are reduced. There is need for a clear and common articulation of Pharmacare and the goals it is meant to realize. In addition, implementation of the system should seem to focus on the set goals, and not on one aspect as the focus is currently, on acute care.

Second, the function of Pharmacare is not configured for operation in a way that fosters its effectiveness and efficiency. Some have argued that the Canadian healthcare system is locked in a 1960s model characterized by balkanization, and an ideology vested with interests (Morgan and Cunningham, 2011; Boothe, 2012). However, this doesn't mean that clinical procedures haven't changed. While the healthcare needs for the Canadian population have changed with time, the system meant to combat this challenges hasn't changed, hence not suited for the modern day healthcare challenges. For example, for Canadian hospitals, the majority of the patients are elderly people. The healthcare system is misaligned to the health needs of these people, who are losing their overall functionality due to complex set of health conditions. These people are held up in hospitals because they have limited access or no access to the appropriate clinical procedures e.g. geriatric, physical care, etc. (Eaddy et al., 2012).

Pros and Cons, and Policy Decision

The national Pharmacare scheme has numerous benefits: fair citizen access to prescription drugs essential for ensuring uniform protection across Canada; decreased prescription drug-related expenses in overall healthcare bill via public management of Pharmacare, enhancing more bargaining leverage with producers and more efficient cost control; and the likelihood of gathering data on drug use, to serve both public decision-makers and healthcare providers (Daw and Morgan, 2012).

In evaluating performance, Pharmacare has proven quite efficient in providing financial protection to Canadians against all high-cost hospitals and medical care. Simultaneously, the thin scope of universal services, covered by Medicare, has created relevant coverage gaps. In case of dental care and prescription drugs, for instance, depending on province/territory of residence or employment, PHI fills these gaps, and in drug therapy-related cases, by provincial programs focusing on old and poor residents (Boothe, 2012).

While Canadians are thoroughly satisfied with Medicare's financial coverage, they are far less satisfied with easily accessible healthcare. Most importantly, since the 1990s, they were dissatisfied with doctor- and emergency department- accessibility, together with unending waiting periods for non-urgent surgeries. Based on 2010 Commonwealth Fund survey results of patients, for instance, Canada came behind Australia, France, Sweden, UK and USA, with regards to patients' experiences with long waiting periods for physician-directed medical care and non-urgent surgeries (Schoen, Osborn, Squires, Doty, Pierson & Applebaum, 2010).

Nevertheless, implementing nationwide Pharmacare raises several concerns: what role would the federal government play? Should Pharmacare agree to CHA's terms? Should other principles like affordability and sustainability guide Canada in considering its national Pharmacare approaches? What drugs would Pharmacare choose, and on what criteria? Should a nationwide scheme be built step-by-step (by, say, previously covering catastrophic expenses), or should wholesale reforms be introduced for quicker implementation? What are the short-term costs for this scheme? Would the government afford these costs easily? Would it be possible to implement national Pharmacare without patient charges?

How would these added costs be divided between the federal government and the territories and provinces? How would current provincial drug insurance programs be integrated into national Pharmacare? What provincial compensation plans exist for provinces refusing to participate? What is the compensation plan for private insurance companies? and How would national Pharmacare affect drug prices? Physicians' drug prescription practices? What about consumer's compliance and available program utilization (Schoen et al., 2010; Daw and Morgan, 2012)?

Summary and Conclusion

The current Canadian method for prescription drug purchase is a somewhat hybrid system of both private and public plans. It is totally dysfunctional, for numerous reasons. Drug plan diversity implies that Canadians enjoy drug coverage, depending on their province of residence, employment, but not necessarily on their medical care requirements. Patients with insufficient coverage, mostly unemployed or self-employed workers, are mostly unable to benefit from maximum treatments. Over three million Canadians admitted to not filling a prescription last year owing to unaffordability (Nicolle, and Mathauer, 2010; Morgan, and Cunningham, 2011).

Canada remains the world's second most expensive country in terms of prescription drugs' retail prices. Among the Organization for Economic Cooperation and Development countries, Canada has the fastest increasing drug costs: above 10% per annum. Countries with universal Pharmacare (e.g., France, Sweden, UK, Australia and New Zealand), pay far less for their drugs and the increase in their drug costs are much lower. Private insurer importance is responsible for high prescription drug costs in Canada. This is a totally inefficient private coverage, and administration fees are excessively higher for private than for public schemes (8%, compared to 2%). Public schemes have the needed resources for pharmaco-economic evaluations to ensure that, once a drug has been reimbursed, patients will get some bangs for their money (Morgan, and Cunningham, 2011; Schoen et al., 2010).

A public drug insurance scheme should be an important part of any nation's pharmaceutical policies. The scheme must bring together all social programs created to provide the minimum possible level of well-being for every citizen, health policies created to enhance public health, industrial… [END OF PREVIEW]

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