Imaginative Changes Can Modernize Health Care
As a pharmacist, now retired, who practiced my profession for 45 years, most of the time as president of a small chain of prescription pharmacies called Vanguard Drug Mart, I can unequivocally state that the Ministry of Health and Long Term Care under the leadership of George Smitherman, has completely caved in to the research-based pharmaceutical companies known as Big Pharma and the Ontario Pharmacists Association. His original Bill 102, which in my opinion was inadequate, has now been completely gutted. The Ontario Medical Association was not targeted for any changes. The Minister probably felt that taking on the pharmaceutical manufacturers, the pharmacists and the doctors at the same was not a good strategy.
Let me make one thing clear at the onset. The health care system operates more or less reasonably well at this time. The problem is that costs of maintaining the system at this level are skyrocketing and the Liberals do not have the guts to make changes to keep the system effective but at prices the Ontario taxpayer can afford.
There are no health-care angels in Ontario, only interests. The public would like to get the most innovative solutions to health problems using all the hi-tech developments available and pay nothing, or nearly nothing. The pharmacists, the doctors and Big Pharma want to maintain the status quo or to make more money, if possible. Nobody has an interest in cutting costs unless costs are cut in areas that do not affect them. No profession or industry will act on its own in the public interest.
What is to be done? As a person with many years of practice interacting with the players involved, and with no financial interest, I propose that we need nothing short of revolutionary changes in the parameters of operation of medicine, pharmacy and Big Pharma.
Let me begin with the doctor. The cost of pharmaceuticals is increasing at an alarming rate. The general practitioner and the specialists prescribe many new medicines at inflated prices that are at times only marginally better than the old, because they are bombarded by drug salesmen extolling the benefits that are non-existent or, at best, similar to the benefits of the drugs now in use.
Chronically ill patients, taking the same medicine over many years, are often asked to make an office visit to repeat the prescription, at a cost to the taxpayers. There are many patients going to see general practitioners for simple ailments that could easily be diagnosed by other trained professionals (pharmacists and nurse practitioners) who would charge much less for the service. Some of the simple work done by specialists can be given to other professionals as well. I refer, as an example, to optometrists who can do refractory work and test for common eye ailments, leaving the more complicated areas for ophthalmologists. In remote communities these changes have occurred on their own, due to the lack of doctors, and seem to be working very well.
Pharmacists and nurse practitioners would be given specialized training to do the diagnosing which would be expected of them. The pharmacists, whose fee for dispensing has not appreciably increased in years, would not need the kick-backs (renamed professional allowances), to continue in practice, as they would be paid by the government for this service. Pharmacists would take their proper place as drug specialists to advise doctors on the right drug at the best price. They would also be allowed to repeat the doctor’s prescriptions for long-term care patients, under certain controls.
Pharmacists have the legal right to substitute less expensive generic drugs for drugs listed in the Drug Benefit book. This allows the government to pay less for these drugs as would private payers. There are many drugs not listed in the book that have generic equivalents, but the pharmacist cannot legally substitute for them. Why not allow pharmacists to substitute all drugs that have generic equivalents, thereby saving the government and private payers money? The answer, of course, is that Big Pharma pressured the government to not allow this extra substitution.
Big Pharma exerts big pressure. With election money for politicians and the threat of taking their manufacturing facilities out of the province, they intimidate politicians into accepting their formula for doing business. The cost of drugs is rising world-wide and very soon it will be impossible for them to sustain this modus operendi. Another method will have to be found to fund research to find new medicines.
The above changes cannot be realized with the present political system. Health care is too important to be left in the hands of intimidated politicians worried about being reelected. An act should be passed to set up committees to reevaluate all the jobs done by health professionals. These committees should include educators, retired pharmaceutical manufacturers, retired physicians, retired pharmacists, retired nurses, hospital administrators and people who do not have a financial interest in the status quo. The terms of reference should include the following: “provide excellent health care at sustainable cost and do not interfere unnecessarily in the proper care for the Ontario public”. This would free the politicians from any blame for the disruption which has to occur to make the necessary changes.
The changes required are monumental but necessary to accommodate the baby-boomers reaching the age where their needs will bankrupt the system.
