A version of this commentary appeared in the Hill Times and the Toronto Star
Like many families, mine has been touched by cancer. Most recently, and in a cruel coincidence, both my mother and mother-in-law were diagnosed with cancer this summer. Relatively speaking, my mom was lucky in terms of both clinical and financial prognoses.
As is the case for many who come to need it, the Canadian system was there for my mom when she was sick. Yes, there are aspects of her care that could and should be improved. But on the whole she received quality care in a timely fashion.
Because of the nature of the care she received – a combination of medical care, diagnostic tests, and surgery — virtually all of the cost of the care my mom needed was covered by “medicare” as we know it. She did not have to bear significant financial loss on top of the already stressful experience of cancer diagnosis.
My mother-in-law was not so lucky.
Because of the nature of the cancer she has, my mother-in-law’s treatments are going to be much lengthier. She is supported by a loving family, but she won’t be fully supported by medicare. This is because Canadian medicare care only covers the costs of medically necessary physician, diagnostic and hospital services.
As is increasingly common, my mother-in-law’s cancer care will primarily be delivered at home. So, while our medicare system will cover the cost of her surgeries, tests and inpatient chemotherapy, it will leave her paying out-of-pocket for most of the prescription drugs she needs to treat her cancer.
She is not alone. Cancer patients often need prescription drugs after they leave the hospital. These drugs control nausea and pain; in some cases, they are an active part of the chemotherapy. The problem is that medicare only covers prescription drugs used in hospital — as if no prescription drug used outside a hospital could be considered truly medically necessary.
For cancer patients, the drug bills can add up. In some cases, thousands can be spent each month, adding a significant financial strain for families that are already experiencing a tremendous emotional burden.
There is, of course, a patchwork of public drug programs offered by provincial governments. But that patchwork has gaping holes. In some provinces, patients receive no public coverage unless they are elderly or on social assistance. In BC — where my mother and mother-in-law both live — patients face thousands of dollars in personal drug expenses before government coverage kicks in.
My mother-in-law is lucky in the sense that, being a retired nurse, she has prescription drug coverage offered as part of her retirement package. But many other cancer patients are not so lucky — in part because private insurance is an increasingly costly benefit that employers are more and more reluctant to pay for, especially for their retirees.
The problem is that too few Canadians realize that they don’t have much, if any, coverage for prescription drugs. And too many Canadians only find this out when they get sick — and then face considerable financial burdens or, worse, real barriers to accessing the health care they need.
The solution found in most countries is a system of universal coverage for prescription drug needs. In the Canadian context, the best way to achieve this is to expand medicare to cover medically necessary pharmaceuticals.
Limits would be needed to ensure that only medicines of proven value are covered. And the system would need to leverage its purchasing power to achieve low prices — the way every hospital in Canada does for drugs they provide to patients. But such a system would ensure that everyone would get the medicines they truly need, when and where they need them. Canadians should demand no less.
Thus, the next time cancer charities lobby government or the next time that Canadians walk, run, or ride in a cancer fundraiser, I hope they consider advocating for patients as much as they advocate for a cure. I am certain we would be marching in protest if our hospitals started charging patients thousands of dollars for their cancer surgeries. Why shouldn’t we protest similar charges to patients every time they have to fill a prescription outside the hospital setting?
Location of care shouldn’t matter. Really, shouldn’t every cancer patient have access to necessary medications without incurring financial hardship on top of the burden of disease?
Steve Morgan is an expert advisor with EvidenceNetwork.ca and Associate Professor and Associate Director of the Centre for Health Services and Policy Research at the University of British Columbia.
See the poster based on this commentary