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# Canadian doctors call for major transformation of healthcare system

BMJ 2010; 341 (Published 10 August 2010) Cite this as: BMJ 2010;341:c4283
1. Barbara Kermode-Scott
1. 1Ottawa

Canada’s healthcare system needs urgent overhaul so that access to essential medical services, including prescription drugs, is improved and sustained across all provinces, the Canadian Medical Association has said.

In 2008 and in 2009 the Euro-Canada Health Consumer Index ranked Canada 30th of 30 countries (the United States was not included in the sample) in terms of value for money spent on health care. Canadians deserve better, says the association.

Anne Doig, the association’s president, said, “Our system needs to be massively transformed. As physicians we’re worried . . . because with its current shortcomings, such as long wait times, the present system will not be able to meet future needs.

“We need a sustainable healthcare system that actually meets the needs of patients. We need healthcare transformation. We need it now. The Canadian Medical Association is engaging Canadians to discuss and debate the hard choices we will need to make as a nation to move our system forward.”

On 3 August the association published an “ambitious but realisable road map” to prepare Canada’s health system for the future. The document proposes action for universal access to prescription drugs; a charter for patient centred care; incentives for enhancing access and improving quality of care; better adoption of health information technology; and improved accountability.

Prescription drugs are the fastest growing item in the Canadian health budget and the second largest category of health expenditure in the country. It is estimated that in 2008 less than a half of the costs of prescription drugs were paid for from the public purse. Furthermore Canada doesn’t have a nationally coordinated policy in the area of very costly drugs used to treat rare diseases.

The authors of the road map point out that public drug plans vary widely across Canada in their coverage. Canada’s 13 provinces and territories have begun to establish public programmes of prescription drug coverage that varies with people’s incomes. Quebec was the first, starting in 1997, and it remains the only province to make universal coverage compulsory (whether public or private).

The deductible—the amount that people have to pay towards the cost of their prescription drugs—varies across provinces in amount and in the basis for calculation. For example, in Manitoba the maximum deductible, paid by families with incomes above $C75 000 (£46 300; €46 000;$73 600), is 6.08% of total family income, whereas in Newfoundland and Labrador the ceiling on drug costs is set at 10% of net family income.

The burden of out of pocket expenditure on prescription drugs also varies widely across Canada. In 2006 the proportion of households spending more than 5% of net income on prescription drugs varied fivefold, with the percentage being 10% in Prince Edward Island but only 2% in Ontario.

The Canadian Medical Association is now using the new policy document to fuel a national discussion on how to improve the healthcare system and put it on a path to sustainability by the time that Canada’s federal, provincial, and territorial Health Accord expires on 31 March 2014.

## Notes

Cite this as: BMJ 2010;341:c4283

## Footnotes

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