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Audience Comment / Edmonton Town Hall

Well good evening. My name is Dianne Dyer. I'm the President Elect for the College and Association for Registered Nurses here in Alberta. I first of all want to thank CMA and I certainly want to thank Maclean's for hosting this tonight. It's just a wonderful event.

When we talk about good value in healthcare this I think means that people receive the care they need when they need it from the right provider.

Our population is aging rapidly and there is a growing burden of chronic illness which is really taxing our healthcare system. There are new drug therapies, new technologies and shorter hospital stays meaning that people are receiving more care in community settings. "Do they receive the care they need when they need it?" is really the question. When we need a healthcare system we ask ourselves: "Are we getting equal value on the areas of health promotion and treatment of chronic illness?" Effective treatment by interdisciplinary primary care and primary healthcare teams in the community can help people avoid expensive care in hospitals.

In order for a team-based care model to be effective however, in terms of service delivery and cost, we need to remove the barriers and the unnecessary steps to seeing the right provider. Patients (or clients) must have access to services when they need them and access to all members of the interdisciplinary team in order to make decisions about their care and their treatment. We cannot expect the patients, the clients, to make decisions, be responsible for their health, if we don't provide them the education and the supports that they need.

Now a national pharmcare program would also contribute to chronic disease management in communities. Since medicare began it's costs have remained stable while the costs of prescription drugs have soared. Prescription drugs are a major driver of healthcare costs. Canada's per captita drug costs are higher...

Ken McQueen: Stops Dianne Dyer from continuuing: "Can we keep this short please because we've got alot of people to get through." [Editor's note: Please see Michael McBain's comment from the Toronto Panel which completes thought and also read this media release from the College & Association of Registered Nurses of Alberta]

Dianne Dyer: Sure. Ok. And then from a long-term point of view we need to remember that we promote health, injury prevention, illness prevention in the community to minimize the severity of the chronic illness and disabilities in later life. Stops the audience member from continuuing: "Can we keep this short please because we've got alot of people to get through." [Editor's note: Please see this audience member's comment from the Toronto Panel which completes thought].

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Audience Comment / Toronto Town Hall

My name is Michael McBain. I'd like to start just by thanking Dr. Turnbull and The Canadian Medical Association for calling on federal leadership in healthcare. We're gonna lose the system without federal leadership. We're not just a bunch of provinces. We're not just a bunch of regions. We're a country and the system is splintering because there's no guardianship -- there's no building for the future -- without federal leadership.

You're asking a really good question. We're not getting value for money and I think the 800 lb gorilla in the system is the pharmaceutical industry. Now it's interesting that nobody talks about that but that's the biggest cost driver. How can you say you're concerned about sustainability and rising costs and not address what the cost driver is -- the primary cost driver. Pharmaceuticals has gone up 73% in 10 years per capita inflation adjusted. Nothing comes near that. But worse than that we're spending 30% more than the international average on new drugs. We're not using them properly. Over prescribed. Drugs are dispensed based on marketing tactics not on evidence. Even with children! If we're concerned about children's health we should be concerned about physicians who are prescribing dangerous anti-psychotics to 2 year olds. That's a huge problem and that's a marketing problem. That's something the medical association needs to consider. This is a moral issue. Medicine's not about commercial marketing. And that's the biggest challenge in terms of value for money.

And I think the solution is a universal public pharmacare plan. Not a private plan, not a hybrid like Quebec has because Quebec's drug plan is out of control. It cannot control it's costs because it partnered with the private insurance industry. You have to have a public plan. So I think it's a very good question. I think we have to address the cost drivers and I think we're not getting value for money, particularly with new drugs.

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Why are people with long-term illness/diseases required by some doctors to make an appointment when they need refills on their prescriptions?
We could save a TON of money if there were 'classes' of prescriptions for illness (already diagnosed) that doctors should be mandated to fill over the telephone - or pharmacies could fill without need to see a doctor.

We're probably wasting millions on prescriptions filled by doctors who are just looking for a five minute cash-grab.

http://sitelife.theglobeandmail.com/ver1.0/gocomm?ck=CommentKey%3ab1aac751-a0fa-4a93-a0ec-117366bf6d68

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This is a troublesome road to go down, because it cements and increases the role that large pharma has on our health care system.

It is critically important for everybody to understand that large pharma has no interest in making being healthy; the financial incentives in this system encourage drugs to be created that manage symptoms of illnesses, without actually curing the underlying problem. If the treatment has another side effect that requires further treatment, that's even better from a corporate financial bottom line POV.

Research into true cures need to be publicly funded without corporate interference so as to make sure they are as widely available as possible. Natural treatments that are easily accessible to all should be researched first, as opposed to artificial and expensive pharma drugs.

The most important part of any observation/revamp/examination of the health care system is keeping people healthy in the place, not treating them with drugs when they start to get unwell.

And there are so many, many things that need to be addressed in our society in order to keep people healthy:
- encourage physical fitness through proper urban planning and creating walkable communities, largely serviced by superb public transit and alternatives like biking and cycling
- discourage the ingestion of unhealthy food-like products through financial incentives (the more a food is processed and has unhealthy salt, sugars, chemicals added to it, the larger the tax on it - these taxes could be used to subsidize healthy, unprocessed foods)
- hard limits on the garbage they add to food like salt, fructose, refined sugar, etc
- improved nutritional teaching in schools, including preparation of healthy meals
- full support for physical fitness in schools, with lots of after-school sports, gym, etc.
- only serving healthy options in schools.
- adopting a precautionary approach when it comes to chemicals, pollution, radiation in our environment - if the company can't prove it's safe, then it shouldn't be used/ingested.
- helping people understand that health does not start with a pill, and how important it is to control what we take into our bodies and the effect that it has.
- teaching parents how important nutrition is for children in every aspect of their life. I see so many parents giving their kids complete junk as lunch and snacks, not having any idea how much damage they're doing to their children.
- ensuring companies that create huge social costs, like cancer and obesity, pay the price and that we don't subsidize them at the cost of the average person's health.
- changing the way doctors treat patients in order to give them enough time to holistically understand someone's health picture and help them get healthy, and identify potential issues at the earliest possible time. Right now, 7 minutes per patient visit, one at a time, only perpetuates a system of treatment with drugs, and having serious illnesses routinely missed until they become quite serious.

These types of changes will have a more profound and lasting effect on our society, at an overall lower cost, than lining the pockets of big pharma for expensive illness treatments for problems that other industries, and our own collective ignorance, have created.

The bottom line is that we have a finite amount of resources. I would greatly prefer to invest those in the front line of keeping people healthy, rather than at the back end where big pharma has a goal of keeping people not quite sick enough to die, and on as many medications as possible.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-3