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Whither catastrophic drug pledge?

DR. NUALA KENNY and Dr. Alex Gillis have part-time jobs: keeping politicians honest about health-care promises. Perhaps these should be full-time jobs Ė especially during federal and provincial budget season, which we are now entering.

Dr. Kenny and Dr. Gillis are prominent figures in the Nova Scotia medical establishment. She is a former deputy minister of health who now teaches at Dalhousie Universityís bioethics and pediatrics departments. Dr. Gillis was chief of surgery at the IWK Health Centre for almost 30 years and now serves as vice-president of professional and academic affairs at the hospital.

In addition to those duties, the two sit on the Health Council of Canada Ė a watchdog created by Ottawa and the provinces four years ago, at a time when two separate accords pumped $78 billion into the health-care system. The councillorsí core mandate is to report directly back to Canadians on whether they are getting value for their money. Their latest summary, Health Care Renewal in Canada: Measuring Up? was issued in February and scrutinized a broad cross-section of the system.

In some areas, the progress report, in fact, documents a lack of progress. Such is the case with catastrophic drug coverage. "The pharmaceutical strategy is of particular importance to Atlantic Canadians because there are 600,000 people in these four provinces with no coverage. Zero," Dr. Gillis recently told The Chronicle Herald editorial board.

While the media spotlight often falls on patients who cannot get access to rare or expensive drugs because the latter are not covered by MSI outside a hospital setting, the problem is much larger than that. "Thatís not what the 600,000 is about. The 600,000 is those people who have to struggle to pay for regular prescriptions," Dr. Gillis said.

Ideally, a patient should qualify for catastrophic coverage based on need and ability to pay relative to income Ė as in Quebec, Ontario and Western Canada. But the reality is that medicare provides slim drug coverage, catastrophic or not, in Nova Scotia. Unless you are on welfare, or make less than $16,000 a year, unless you are a senior or in hospital, then public drug coverage is not for you. That leaves many vulnerable people. Most folks rely on a patchwork of employer-sponsored insurance plans, which are hardly uniform or comprehensive in terms of medications and conditions which they will reimburse you for.

"Close to 90 per cent of Canadians are reasonably well covered," Dr. Gillis said. "A little over three million Ė 3.5 million Ė are weakly covered. Thereís probably one or two per cent Ö who have none."

No doubt, Atlantic Canada accounts for a disproportionate number of those due to poverty and the precarious nature of employment here. However, contained in the 2003 health-care renewal accord was a commitment that Canadians, regardless of where they live, get reasonable access to catastrophic drug coverage by the end of last year. That deadline has come and gone with no sign of implementation. "There is little of substantive progress to report," the council says.

The first ministers are probably beginning to rue the day they made this pledge. Pharmaceutical costs are ballooning by an average of six per cent a year, second only to hospital costs. Provincial Finance Minister Michael Baker recently warned in one of his pre-budget addresses that overall health costs are climbing by 8.6 per cent a year and that something must be done about it.

Next January, the province plans to add to those costs by introducing a "working families" Pharmacare program at an estimated annual price tag of $75 million. Itís still not clear who will qualify and how much participants would pay out of their own pockets. But itís already clear the catastrophic drug coverage gap is bigger than even this programís ability to address it.

Nevertheless, as Dr. Kenny pointed out to our editorial board, itís counterproductive, and also costly, not to provide catastrophic drug coverage. Think of heart attack patients of modest means who are treated at great expense in the hospital, she said. They are released, and then "they canít get blood thinners paid for Ö So you do all this intervention, (and) if they canít get what they need in the long term, youíre setting them up for all kinds of secondary consequences."

Sometimes governments make ill-advised promises. But basic catastrophic drug coverage is not one of those. Dr. Kenny and Dr. Gillis are right to insist that this one be kept.