Consumer Participation and Access to Health Care

According to the results of a new study, consumers and patients in Canada are eager to become involved in health technology assessment - a process which helps determine what new treatments, procedures and technologies should be covered by health plans. Health technology assessment (HTA) is defined as ‘the rigorous assessment of any medical intervention utilized in health treatment and maintenance across a whole spectrum of medical and health practices, including drugs, vaccines, materials, as well as medical and surgical procedures and systems.”¹

Health policy makers need to assess the impact of access to new medicines on health outcomes and overall health costs when determining levels of coverage for low-income patients. A study of the impact of supplying prescription drugs at no cost to low income Americans with cardiovascular disease reveals the effect of drug access on the control of their disease and future hospitalization rates. During the course of the study, a total of 163 low income patients with heart disease were given access to cardiovascular medication which they could not afford on their own (nor were they eligible through medical coverage).

The ageing population has lead to an increase in the prevalence of chronic diseases in Canada. At the same time through medical research and innovation effective new treatments are being developed that can delay and avoid disability and hospitalizations associated with chronic illness. Restricting access to new medicines does not necessarily lead to more cost-effective health care.

Newer medicines can be more effective, have fewer side effects and may treat conditions for which no existing effective treatment is available. A recent study that analyzed health spending data from over 23,000 patients and researchers examined the replacement of older drugs with newer drugs in terms of reduced mortality, reduced morbidity and reduced spending on other medical services such as inpatient stays and emergency room visits.

Hospitalization rates in Canada have been steadily declining for nearly three decades. In fact, during the past decade the number of hospital bed days utilized annually declined 55% from 1990 to 2000, further demonstrating the impact of the shift from inpatient health services to outpatient services and prescription drugs.

The discovery and development of new drugs that can save lives and improve the quality of care for patients is a long and complicated process that can take up to 15 years. A timely and efficient review and approval process is important to ensure that patients can benefit from these new medicines as soon as they are available. In Canada there are two review processes for drugs that are reimbursed by provincial drug plans. Before a new drug can be sold in Canada, Health Canada must evaluate every new drug for safety and efficacy. In 2002, the average time taken by Health Canada to review and approve new medicines was just under two years.¹ Then, before a new medicine is made available under a provincial drug plan it is reviewed by each province to determine if it will be covered by each province’s drug plan – a process that takes more than a year.

Nearly 8 million Canadians depend on provincial drug benefit programs for their prescription drug coverage. In 1999 this included 3.2 million seniors, 3.2 million people with low incomes, and 1.5 million others.¹ An examination of provincial drug plans shows that there is significant disparity among the provinces in terms of products that are provided to residents.²

Many countries including the U.K, Australia and the United States involve patients/consumers in assessing new treatments for the purpose of determining the extent to which they should be made available by health plans. Because patients have intimate experiential knowledge about disease and its effects, they have an important contribution to make to the process of healthcare decision making. Numerous studies on this issue are clear in demonstrating the advantages of involving consumers yet Canada continues to lag behind other countries that are far more progressive in engaging patients in assessing treatment options.