Canada - World Health Organization Regional Office for Europe

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108 Health systems in transition Canada 1. The man goes directly to the ED (the vast majority of ED patients come without a GP’s referral). He is taken to hospital by a household member or by an ambulance. 2. Once at the ED, he provides his provincial health card and briefly describes the problem. He is then referred to a triage nurse who estimates the urgency of the complaint after further inquiry. The waiting time for admission into an ED room for further tests and examination depends on the level of urgency. 3. The man is then examined by an emergency physician and told about the diagnosis and the recommended surgical procedure. 4. A medical team performs the required surgery or procedure. 5.6 Pharmaceutical care Inpatient drugs are dispensed by hospitals without charge to patients as part of medicare. Outpatient pharmaceuticals, the cost of which may be covered in whole or part through public or private drug plans, are prescribed by physicians and in rare cases by other health providers who have the right to prescribe certain classes of drugs. Individuals obtain their prescription drugs at retail pharmacies. Almost all pharmacies, whether they are independent or part of a chain, sell a host of products beyond prescription and over-the-counter drugs. Pharmacies in large chain grocery stores now compete directly with traditional stand-alone pharmacies by selling prescription and over-the-counter drugs. Provincial and territorial drug plans vary in terms of the extent and depth of coverage, and these variations are most pronounced for expensive drugs (Menon, Stafinski & Stuart, 2005; Grootendorst & Hollis, 2011; McLeod et al., 2011). Unlike all other provincial plans, the Quebec drug programme is a mandated social insurance plan in which the private sector plays a key role (Pomey et al., 2007). To add further complexity to these provincial and territorial differences, eligible First Nations and Inuit patients are covered through the federal non-insured health benefits programme. The one exception is inpatient drug therapy: since prescription drugs provided in hospitals are considered part of universal coverage, they are provided to all provincial and territorial residents, including First Nations and Inuit, free of charge, by P/T governments. In terms of public and private insurance coverage for prescription drugs, there is an east–west gradient in Canada, with residents living in the four Western Canadian provinces as well as Ontario and Quebec having noticeably
Health systems in transition Canada 109 deeper coverage than residents living in the four Atlantic provinces (Romanow, 2002). In response to this policy problem, some experts have long argued for a single national drug plan and formulary as well as a single agency to regulate pharmaceutical pricing. However, such an approach is challenged by two opposing imperatives: that of provincial governments, especially Quebec, which wish to retain control over provincial drug policies including prescription drug plans, and that of the federal government, which has resisted assuming the financial burden and future fiscal risk of a federally financed and administered pharmaceutical coverage programme (Marchildon, 2007). With the exception of Quebec, governments agreed to allow CADTH to establish a pan-Canadian process to review the clinical and cost-effectiveness of new prescription drugs the CDR, which began in 2003. However, the CDR makes only recommendations, and provincial governments ultimately decide whether or not to consider CDR analyses in determining whether or not to include specific pharmaceuticals in their respective formularies. In 2004, as part of the 10-Year Plan to Strengthen Health Care signed by first ministers, all P/T governments, except for Quebec, established a task force of ministers of health to develop and implement a “National Pharmaceuticals Strategy” that encompassed the following nine action items (CICS, 2004): • in response to ongoing concerns about the financial insecurity caused by poor and inconsistent coverage of expensive drugs (Phillips, 2009), to develop, assess and cost the options for catastrophic coverage; • establish a common national drug formulary for participating jurisdictions based on safety and cost-effectiveness; • accelerate access to breakthrough drugs for unmet health needs through improvement to the federal drug approval process; • strengthen evaluation of drug safety and effectiveness; • pursue purchasing strategies to obtain best prices for Canadians for drugs and vaccines; • enhance action to influence the prescribing behaviour of health care professionals so that drugs are used only when needed and the right drug is used for the right problem; • broaden the practice of e-prescribing through accelerated development and deployment of EHRs; • accelerate access to non-patented drugs and achieve international parity on prices of generic drugs; and
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Health Systems in Transition Gregor
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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List of abbreviations Abbreviations
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List of tables and figures Tables p
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Abstract Canada is a high-income co
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The European Observatory on Health
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Canada - World Health Organization Regional Office for Europe

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