Waiting lists not pharmacare main issue: feds
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* Barbara Sibbald

*   © 2004 Canadian Medical Association or its licensors

The federal government, Roy Romanow and Dr. David Naylor all purport that waiting lists — not pharmacare — should dominate the agenda at this week's (Sept. 13–16) First Ministers' conference on health care. 

Federal Health Minister Ujjal Dosanjh says governments must provide catastrophic drug coverage so Canadians don't face financial ruin over the costs of their prescribed drugs, but he maintains that reducing waiting times are the meeting's main deliverable. “A lack of timely access is eroding the system,” says Dosanjh. The Liberals campaigned in June's election to significantly reduce waiting times over 5 years in 5 key areas: cancer treatment, cardiac care, diagnostic imaging, joint replacement and sight restoration. 

The proposed national pharmacare program is sketchy on details, but would basically see the federal government pay all the costs for drugs now covered in the provincial and territorial formularies. This could run to between $7.5 to $12 billion annually. The premiers maintain that this would free up provincial funds to devote to reducing waiting lists. 

A national pharmacare plan should be established “eventually,” says Romanow, the former head of the Royal Commission into the Future of Health Care in Canada, but it “must be integrated into a series of reforms that have been neglected for too long….” It must also operate under the auspices of an independent body that links costs with health outcomes “so Canadians can make an informed decision.” 

Naylor, dean of medicine at the University of Toronto, dismissed the pharmacare scheme as “the political theme of the moment,” during a speech to CMA's General Council on Aug 16. Waiting times must first be addressed, he said. This involves setting benchmarks for acceptable waiting times, measuring waiting times for specific procedures and targetting initiatives to deal with bottlenecks. “There is a lot of misinformation,” he said. More money and health care professionals are also needed, Naylor maintained. “The devil will be in the details … in our fractious federation.” 

Dosanjh hopes to soothe that political beast by negotiating a formal dispute resolution procedure with the premiers that “would give the provinces a voice and enable an independent panel of experts to assess if the Act has been breached and, if so, to recommend appropriate action.” Such a proposal will “keep the politics — and by that I mean the bickering — to a minimum, making it more transparent and impartial.” Canadians “want their government to fight for medicare, not over medicare,” he concluded. 

Dosanjh's stated priorities for the meeting include defending the Canada Health Act, addressing waiting times, improving access to health professionals, ensuring coverage for catastrophic drug costs, providing accountability in the health system and ensuring the financial sustainability of the health care system. — *Barbara Sibbald*, CMAJ