Week 7: Drug costs and Pharmacare, policy actors Flashcards
True or False: Doctors don’t tell patients the prices of their prescriptions
True
More than what fraction of Canadian’s said they or someone in their household did not take their meds as prescribed because of the cost.
1/3
In the video, what did the woman with breast cancer do
Woman worked while undergoing treatment for breast cancer because she couldn’t financially take the time off and didn’t have insurance
True or false: Canadians spend the most on prescriptions in the world
False, second most
What fraction of households had issues paying for prescriptions
1/4
True or False:Every country that has universal health care also pay for prescription medicine, except for Canada
true
True or false: Pharmacare was part of the initial blueprint for healthcare initially
True
Negotiating lower drug prices with companies is a good strategy, who did this and in what year
NZ did this is 1993
For every 1$ on drugs Canada spends, NZ spends how much
11 cents.
Whats the problem with the Canada Health Act
prescription drugs aren’t covered
True or False: Prescription drug coverage was apart of comprehensive national healthcare proposals discussed in Canada as far back as the 1940s
true
Policy in stages of Pharmacare
first hospital insurance, then medical insurance, then drug insurance
Wait for pharmaceutical spending to plateau before expanding medicare to include pharmacare
Saskatchewan coverage
universal, comprehensive drug coverage from 1975 through 1987 (just in its own province)
True or false; In Canada share of total health expenditure by health spending category
true
What percent of total health expenditure is spent on drugs, hospitals
13.6%
24.3%
True or False: Drugs are the first biggest expense
False: Second
Cost drives in 1998-2007 confused about this
True or false from 1998-2007 there was an increase in the overall use of prescription drugs
true
True or false: in 1998-2007 there was no use of newer and more costly prescription drugs
false there was use
True or false: Canada’s drug prices are the third highest among the 38 organization for economic co-operation and development (OECD) countries, influencing Canadians access to drugs (impacting their health) and sustainability of Canada’s health care system
true
__ million (fraction) Canadians either don’t have prescription drug insurance or inadequate insurance to cover their medication needs
7.5 million, 1/5
how many million Canadian’s do not fill their prescriptions
3 million
All jurisdictions in canada provide public drug coverage for seniors ages __ plus
65
In 2021, seniors make up _% or Canadas population and accounted for __% of public drug program spending
19%, 62%,
True or False: Costs of medicines don’t change dramatically, but source of financing does
true
True or False: Governments may choose to avoid public liability associated with an age-based entitlement to drugs and switch to means-tested or catastrophic drug plans
true
Means tested
we will subsidize your drugs depending on your means, income based.
Social safety net
drug plan, if it isn’t catastrophic you have to pay for it
True or false: Governments may choose to limit public drug expenditures rather than address the societal burden of total drug expenditures
true
Public drug program spending accounted for __% of all prescribed drug spending in Canada in 2021, amounting to $__ billion
44%, 16.2 billion
Ontario drug benefit program
older than 65 less than 25
Living in a long-term care home/special care home
Receiving professional home and community care services
Receiving benefits from Ontario works or Ontario disability support program
Enrolled in the trillium drug program (for people who spend approximately 4% or more of their after-tax household income on prescription drug costs)
ODP covers those people, and covers approx 5000 prescriptions, you can search on the website.
Patented medicine prices review board
an independent tribunal that limits the prices set by patentees for all patented medicines sold in Canada to ensure they’re not excessive
Does not regulate the prices of generics and has no jurisdiction to review the prices negotiated with the federal, provincial, or territorial drug plans
What does the patented medicine review board evaluate
Prices of other drugs form the same therapeutic class in the market
Prices of the same medicine and other medicines in the same therapeutic class in comparator countries (France, Germany, Italy, Sweden, Switzerland, UK, USA)
Changes in the consumer price index
Health economics
a branch of economics concerned with how (scarce) resources are allocated and used in the health system.
Predominately used to evaluate the efficient and effective use of resources to achieve health objectives.
Methods used in health economic analysis
Cost-benefit analysis
Cost-effectiveness analysis
Cost benefit analysis
Compares the monetary value of resources used with the monterey value of resources saved or created
Places a monetary value on lives and quantity of life
Often done using ‘willingness-to-pay’ methodology
Surveys, qualitative work, to say ‘how much would you pay’ for this gain in quality of life or inc of life years? Can put a dollar amount on that specific benefit.
Policy alternatives can be compared by the net monetary benefit
examine the monetary value of all associated costs with the monetary value of all associated benefits
Example: which should we fund with our limited budget to help people quit
Cost-effective analysis
Compares the monetary value of resources used with health effects (e.g., mortality rate, blood pressure, etc.)
How much will it cost to achieve particular health benefits?
Can we spend the same amount on another intervention to achieve more health benefits?
Different health effects common across diseases (ex. Life expectancy), how much life expectancy is increased and how much this is worth
Monetary value and which health benefits it creates, health benefit that is a metric and can be compared across we can see which is most effective
Ex. Should we add the HPV screening program to current Canadian screening practices?
Gathering information for policy analysis RPSM
Research evidence
Magnitude of the problem
Effectiveness of policy options
Stakeholder support for policy options
Policy documents
Current policies, including policy objectives and means to achieve policy objectives
Values, assumptions, guiding principles
Policy approaches in different jurisdictions
Framing
Media/ social media
Problem framing
Stakeholder interest and support for policy options
Surveys/ interviews/ focus groups with stakeholders
Key stakeholders’ interests, positions, and levels of commitment
Policy actors
The people who are involved in policy; those making it, down to those caring about it.
Who should make, or have the greatest influence on, health policy decisions?
Governments (which kind? Democratic; participatory; technocratic, etc.)
Street-level bureaucrats (civil servants, people who work for government, policy analysts usually, common in hospitals)
Subject matter experts (e.g., physicians)
Health organizations (hospitals, NGOs)
Patients/ the public
True or false: If its our health we deserve a right to decide about it
true
Interest group
Any group outside the state including the market and some civil society groups that attempts to influence policy to achieve specific goals.”
Voluntary
Aim to achieve some desired goal(s)
Do not attempt to become part of the formal government machinery
Cause group
“interest or pressure group whose main goal is to promote a particular issue or cause.”
Ex. Dying with dignity, group advocating for euthanasia
Sectional group
“interest group whose main goal is to protect and enhance the interests of its members and/or the section of society it represents”
Ex. canadian medical association, formed to protect physicians interests, representing doctors
Imagine the government is considering expanding the eligibility for medical assistance in dying (i.e., euthanasia and physician-assisted suicide) to patients with primary psychiatric conditions as well as allow patients to provide advance consent for MAID
What’s an interest group who you think would attempt to influence policy in this area?
Doctors involved in diagnosis of psychiatric conditions
Psychiatrists
Canadian mental health association
People who have had family members who used MAID or couldn’t
People affected with those conditions, usually have the loudest voices, people who are ineligible
Religious groups
Legal experts
Statement on medical assistance in dying (MAID)
Policy statement from canadian mental health association
Disappointed that the government supports allowing those with mental illnesses to seek medical assistance in dying
“Until the healthcare system adequately responds to the mental health needs of Canaidans, assisted dying should not be an option.”
What does the Council of canadians with disabilites think about MAID
MAID makes some lives seem to have more value than others
“CCD opposes government action to decriminalize assisted suicide because of the serious potential for abuse and the negative image of people with disabilities that would be produced if people with disabilities are killed with state sanction.
View this as infringing on views that people with disabilities have less worth and consider those lives expendable
What does the Alzheimers society believe about maid from 2016
because we cannot predict future suffering, providing advance consent for MAID should not be possible for people with dementia.”
Government
“the institutions and procedures for making and enforcing rules and other collection decisions.”
Politicians, bureaucrats, policy elites, etc.
Governance
all processes of governing, whether undertaken by a government, market, or network…”
Government actors + civil society organizations, interest groups/ pressure groups, organizations/ corporations, etc. ex. Pharmaceutical companies
Lobbying
the process through which individuals and groups articulate their interests to federal, provincial or municipal governments in order to influence public policy or government decision-making.”
Professional lobbyists are paid to assist others, like pharmaceutical companies or nonprofit companies.
Experts at communicating
Provide a ‘dating service’ between interest group members and policy makers/ decision makers
They know inner workings of governments, tell interest groups how to proceed/get governments to care about what they’re doing
Lobbying act
Describes how to lobby in Canada
Under this act, must register with the lobbyist regulator (the government)
Must report all meetings with public officers and report subject matter of those meanings (when, with whom, and subject matter).
Distinction between two types of lobbyist:
Two types of lobbyists, explain each
Consultant lobbyists
Firm, interest group, non profit, hires them
External
In-house lobbyist
Works within a corporation whose sole job is to lobby for that corporation
Internal
NGOs, university, doctors without borders,
Members of government or staff not considered lobbyists
Diplomat, UN member, etc not lobbyist
People who talk to governments all the time don’t need to register as lobbyists
People (private citizens) who aren’t paid aren’t lobbyists
How many lobbyists in Canada
7000
CONFUSED ABOUT THE END OF THIS LECTURE and LOBByists
