um anit o ba.

ca

http://umanito ba.ca/o utreach/evidencenetwo rk/archives/8315

Why, in a sea of pink, are so many cancer patients in the red?

A version of this commentary appeared in the Hill Times and the Toronto Star Like many f amilies, 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 f inancial prognoses. As is the case f or many who come to need it, the Canadian system was there f or 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 f ashion. 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 signif icant f inancial loss on top of the already stressf ul experience of cancer diagnosis. My mother-in-law was not so lucky. Because of the nature of the cancer she has, my mother-in-laws treatments are going to be much lengthier. She is supported by a loving f amily, but she wont be f ully supported by medicare. T his is because Canadian medicare care only covers the costs of medically necessary physician, diagnostic and hospital services. As is increasingly common, my mother-in-laws 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 f or most of the prescription drugs she needs to treat her cancer. She is not alone. Cancer patients of ten need prescription drugs af ter they leave the hospital. T hese drugs control nausea and pain; in some cases, they are an active part of the chemotherapy. T he 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 signif icant f inancial strain f or f amilies that are already experiencing a tremendous emotional burden. T here is, of course, a patchwork of public drug programs of f ered 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 f ace thousands of dollars in personal drug expenses bef ore government coverage kicks in. My mother-in-law is lucky in the sense that, being a retired nurse, she has prescription drug coverage of f ered as part of her retirement package. But many other cancer patients are not so lucky in part because private insurance is an increasingly costly benef it that employers are more and more reluctant to pay f or, especially f or their retirees. T he problem is that too f ew Canadians realize that they dont have much, if any, coverage f or prescription

drugs. And too many Canadians only f ind this out when they get sick and then f ace considerable f inancial burdens or, worse, real barriers to accessing the health care they need. T he solution f ound in most countries is a system of universal coverage f or 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 f or 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. T hus, the next time cancer charities lobby government or the next time that Canadians walk, run, or ride in a cancer f undraiser, I hope they consider advocating f or patients as much as they advocate f or a cure. I am certain we would be marching in protest if our hospitals started charging patients thousands of dollars f or their cancer surgeries. Why shouldnt we protest similar charges to patients every time they have to f ill a prescription outside the hospital setting? Location of care shouldnt matter. Really, shouldnt every cancer patient have access to necessary medications without incurring f inancial 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.