A bet­ter way to fill the gaps in health care

Toronto Star - - WORLD - COLIN BUSBY AND AKE BLOMQVIST

With much fan­fare, On­tario’s 2017 bud­get an­nounced the in­tro­duc­tion of uni­ver­sal drug cov­er­age, start­ing next Jan­uary, for those un­der age 25. True, drugs are an im­por­tant part of the prob­lem in gaps in pub­licly funded health care. But even with an an­nual start­ing cost es­ti­mated at $480 mil­lion, “OHIP+” looks like a poor ap­proach to clos­ing the phar­ma­care gap while tak­ing up lim­ited fis­cal room to close health gaps else­where.

Much of the money for OHIP+ will pay for the drugs of peo­ple who didn’t have any ac­cess prob­lems in the first place. A more tar­geted ap­proach could have a much larger ef­fect on ad­dress­ing the many un­met health care needs of On­tar­i­ans.

On­tario’s current patch­work of pub­lic drug plans cov­ers so­cial as­sis­tance re­cip­i­ents and their de­pen­dants, those who qual­ify for dis­abil­ity sup­port, and those aged 65 and up. In­come-tested cov­er­age is also avail­able for all who spend more than 4 per cent of their in­come on drugs in a given year. Pri­vate em­ployer-based plans cover most work­ers and their de­pen­dants. Most of those with­out suffi- cient cov­er­age are the so-called “work­ing poor” — peo­ple in low-wage oc­cu­pa­tions with­out drug ben­e­fits — and the self­em­ployed.

Most young peo­ple who will be cov­ered by OHIP+ al­ready have cov­er­age through their par­ents’ in­sur­ance. Among those whose cov­er­age will im­prove are mainly chil­dren of low-in­come par­ents with­out em­ployer-based in­sur­ance and post-sec­ondary and high school grad­u­ates who no longer qual­ify as de­pen­dants un­der their par­ent’s plans.

The share of OHIP+ costs that is at­trib­ut­able to these groups is rel­a­tively small: The ma­jor­ity of the $480 mil­lion will be spent to move youth de­pen­dants un­der pri­vate drug plans onto a pub­lic plan.

Given the lim­ited pub­lic ap­petite for tax in­creases and high pro­vin­cial debt, there are other ways we can spend tax­pay­ers’ money that would more ef­fec­tively ad­dress un­met health needs.

Alack of drug cov­er­age is not the pri­mary health con­cern for many On­tar­i­ans. In an in­ter­na­tional health sur­vey, about 11 per cent of On­tar­i­ans said they may not fill a drug pre­scrip­tion due to cost, but roughly three times that many say they skip den­tal ser­vices for that rea­son. Fur- ther, far too many young peo­ple end up in emer­gency rooms for se­vere men­tal health is­sues; oth­ers walk around with im­proper pre­scrip­tion eye­glasses or rely heav­ily on fam­ily care­givers for home sup­port.

In­stead of a plan pay­ing for the drugs of all young peo­ple, we could of­fer com­pre­hen­sive drug cov­er­age for chil­dren of low-in­come par­ents with­out pri­vate in­sur­ance, and for high school or univer­sity grad­u­ates for a four-year pe­riod as they look for per­ma­nent work. This would free up money to ex­tend more den­tal care ser­vices to low-in­come On­tar­i­ans and train more coun­sel­lors in par­tic­u­lar com­mu­ni­ties and schools where men­tal­health needs are the high­est, while com­ing in un­der the OHIP+ price tag. That would be a more ef­fec­tive use of funds.

Fur­ther trou­bling about On­tario’s nar­row ap­proach to plugging drug gaps is that the prov­ince staked a Pollyan­nish hope that greater fed­eral in­ter­ven­tion will ex­tend OHIP+ into a uni­ver­sal phar­ma­care plan na­tion­wide. This is an ex­ten­sion of the age-old po­lit­i­cal game played in Cana­dian health care. By clam­our­ing for more fed­eral fund­ing, pro­vin­cial politi­cians are try­ing to make peo­ple be­lieve they can save money by pay­ing more taxes to the fed­eral gov­ern­ment and less to the prov­inces.

On­tario de­serves credit for try­ing to im­prove the ac­cess of needy On­tar­i­ans to pre­scrip­tion drugs. But in­sist­ing that all im­prove­ments in ac­cess must come through uni­ver­sal pro­grams that pay for all kinds of health care costs for ev­ery­one, even those who can af­ford to pay for them on their own or from pri­vate in­sur­ance, is go­ing to make these im­prove­ments costly for gov­ern­ments — and risks leav­ing On­tar­i­ans with other se­ri­ous health needs be­hind.

A more ef­fec­tive ap­proach would be to cre­ate new, or ex­tend ex­ist­ing, pro­grams that tar­get those who need ac­cess the most.

John Boyn­ton PRES­I­DENT & CHIEF EX­EC­U­TIVE OF­FI­CER DIRECTORS: John A. Hon­derich Chair Camp­bell R. Har­vey Martin E. Thall Elaine B. Berger Daniel A. Jauernig Al­nasir Samji Paul Weiss Linda Hughes Dorothy Stra­chan Daryl Aitken John Boyn­ton Toronto Star News­pa­pers Ltd. is a wholly owned sub­sidiary of Torstar Corp.

Ake Blomqvist is ad­junct re­search pro­fes­sor at Carleton Univer­sity and Health Pol­icy Scholar at the C.D. Howe In­sti­tute.

Colin Busby is As­so­ciate Di­rec­tor of Re­search at the C.D. Howe In­sti­tute.

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