HALIFAX – Canada’s premiers and territorial leaders agreed to buy generic drugs together and standardize certain health-care practices as they try to cut soaring costs amid claims they have been left to manage health expenses in the absence of federal leadership.
The premiers, meeting at the Council of the Federation in Halifax, released 12 recommendations that include a plan to buy generic drugs in bulk and adopt streamlined treatment methods for some medical conditions.
Saskatchewan Premier Brad Wall, who co-wrote the report with Premier Robert Ghiz of Prince Edward Island, said they would identify three to five drugs in the fall and that the provinces and territories would begin buying them next spring.
“Canadian prices on 64 generic prescription drugs are 90 per cent higher than American prices and that’s the gap we’re going to seek to close,” he told a news conference Thursday.
“We’ve got to fix that.”
The premiers have agreed to bulk buying of pharmaceuticals before, and the federal government has even said it was interested in joining, but their commitments have floundered in the face of politics and pressure from the highly competitive pharmaceutical industry.
The generic industry argues that bulk buying would drive down profit margins to the point where some drugs would no longer be made in Canada, forcing governments to rely on sole sources, and leading to possible shortages.
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The Canadian Pharmacists Association praised the recommendations, but also warned that similar efforts by the premiers in 2010 seemed to go nowhere and that the initiative could risk the reliable acquisition of drugs.
“We do caution premiers to tread carefully with respect to drug purchasing to ensure that drug supply … is not negatively impacted,” Jeff Poston, executive director of the group, said in a statement.
The premiers also agreed to examine clinical practice guidelines throughout Canada to determine whether certain surgeries may be unnecessary in a bid to save the provinces and territories money.
Wall cited the standard of care used to treat foot ulcers related to diabetes, saying if the right standards were adopted it would result in fewer hospitalizations and amputations.
In Saskatchewan, Wall said there were 453 hospitalizations due to diabetes and related foot ulcers last year. Of those, there were 118 amputations – 80 per cent of which he said were unnecessary and cost the province up to $4 million.
In Atlantic Canada, Ghiz estimated $15 million could be saved every year if the clinical practices around foot ulcers and diabetes were in place.
Ghiz said it is also key that provinces better co-ordinate the training of health-care professionals to meet the needs of a changing demographic.
He said that despite an aging population and a birthrate that’s been dropping, the number of pediatricians that have been trained across the country has risen by 79 per cent in the last decade while the number of geriatric doctors has stalled.
“That’s a clear indication of an area where we can share information … to make sure we’re training the professionals that we need for the future,” Ghiz said.
Wall said the report is a response to what he characterized as Ottawa’s lack of interest in improving the health care.
“The federal government stated pretty clearly by what they didn’t say and what they did say that they weren’t perhaps as interested in innovation as we like and the premiers very much are,” he said.
Nova Scotia Premier Darrell Dexter also accused the federal government of distancing itself from efforts to improve patient care.
“The federal government decided it was going to absent itself from the decision-making around health care and the premiers at that time decided that we were going to take it upon ourselves to provide leadership in this very important area,” Dexter said.
Federal Health Minister Leona Aglukkaq said the premiers are welcome to come up with innovative measures aimed at improving health care in their jurisdictions.
“It’s within their purview to make decisions of that nature to manage how they deliver health care,” Aglukkaq said while announcing a separate initiative in Halifax.
She dismissed suggestions that Ottawa hasn’t been interested in looking at ways of making the health-care system more efficient.
“I think we have played a huge leadership role,” she said. “One size fits all is not a solution. Jurisdictions are investing in areas that are their priority.”
Quebec Premier Jean Charest said later in the day that he would have to determine whether any plan for the provinces to jointly buy drugs in bulk would conflict with his provincial pharmacare program. He said if it did, it may mean Quebec would not participate in the program.
The Canadian Medical Association, which had a hand in drafting the report, hailed the measures and downplayed concerns that the provinces might pay lip service to them now and not implement them because they are not binding.
“This is the first step after 50 years of medicare where we’ve got a process that might actually hold out some hope of having a pan-Canadian standard,” said John Haggie, president of the association.
“We’re very pleased that they’ve actually got this far. The support is unanimous. We are committed to the process.”
The plan would also harmonize different approaches to treating cardiovascular disease, which costs almost $3 billion a year for hospitalizations. Haggie said 70,000 people die of cardiovascular disease every year – roughly the equivalent of the population of Prince George, B.C. – and that many of those could be prevented with a common strategy.
“If you can reduce that even by 10 per cent, you’ve got a few more 45-year-old dads who will spend more time with their kids,” he said.
The report comes months after federal Finance Minister Jim Flaherty announced a new health care funding formula late last year that would take effect in 2014, leaving some premiers fuming that Ottawa imposed the scheme without consulting them.
The formula calls for current spending levels of six per cent annually until 2017, followed by increases tied to the rate of economic growth. Those increases are expected to be about four per cent annually, but Flaherty has said they will never drop below three per cent.
The federal government has defended the new formula as generous.
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