I don’t normally write about Canada, usually because it is always blissfully uneventful back home. But it looks as though I missed out on a couple of pieces of news the past week that might have suggest almost certain changes in the Canadian healthcare system for the foreseeable future (h/t to my mom!).
First off, facing steep demographic declines and consecutively higher spending on health care for the past decades, the government of Quebec has proposed a $25-per-visit charge for doctor’s visit.
While I am not all that familiar with Quebec’s health-care system, as each province has the mandate to run its own, the concept of paying (somewhat) for healthcare is no longer new to the rest of the country. A number of provinces, including Ontario, for the past few years, has put in place an income-based healthcare contribution, usually paid at tax times. The amount is income-tested, and does not exceeds more than a few hundred dollars even for the richest. However, the idea of a per-visit co-pay rings a bit too American to most Canadians, but that’s really the least of our worries here.
What it does signify is a shift in practice from the ideals of universal healthcare, so troubling to some that some claim it contravene the Canada Health Act. Whether that will be challenged in a court of law once the law comes into place is still to be seen. But what the proposals do reflect is the economic realities of our times – more pensioners supported by a healthcare system buckling under its weight.
The rest of the country is watching this development with keen interest and little smugness, knowing fully well that despite appearance of healthy budgets, we are all going down that road of re-visiting the feasibility of free health care, with Quebec leading the pack.
The second piece of news has to do with the Ontario government’s attempt to cut the price of generic drugs sold in the province, by eliminating a middle-men fee between the generic drug makers and the pharmacies.
While the government claims the fee – where drug makers pay pharmacies to stock their products in the stores, and thus inflate the price of generic drugs that the government must cover under its public drug plan, pharmacists insists that it pays for services like home deliveries and free advice dispensed at the counter.
Ontario’s pharmacists say these professional fees add up to $750 million a year in funding for them and help pay for home deliveries, advice and other services.
The province says the fees simply inflate the price it pays for generic drugs, noting the same drugs cost a lot less in other jurisdictions.
The noose is tightening around businesses that previously relied heavily on government subsidies as part of its business model. So much that the largest drug chain store in the country, Shopper’s Drug Mart, took a 9% plunge in its stock price when the report came out last week.
The government is most likely counting on the fall in generic drug price (previously allowed to be 50% of brand-name products, now no more than 25%) to lower both its public drug program bill and work-place benefit plans, and make room for all three parties – the government, work-place, and individuals to take on additional contribution costs in order to maintain the “free” healthcare program for the foreseeable future.
In other news, the Dutch are also revisiting their concept of affordable health care, which has grown increasingly expensive in the past half a decade.
From my own experience, the low-cost nature of the Dutch system has a lot to do with its healthcare system focusing more on treatment, and less, if any, on preventative care, and where a cultural aversion to medication (if you are sick, stay home and drink tea) and hospitalization (home birth is the rule rather than the exception, and asking for epidurals during labour means you are a wimp) also keep the cost low. I will try to write about those another day.
But all in all, we are all moving in the direction of higher health care costs. Now the race is on to see which country is best able to contain the cost without sacrificing the care.