Many Canadian snowbirds may soon be grounded.
As the federal election approaches, many people will also be making plans for their winter vacation. Yet due to inaction by the federal health minister, some people may be forced to remain in Canada if drug shortages now cause them to fail to qualify for private travel insurance.
Each fall, a number of patients come to my office to fine-tune their medications. Often, when I am about to increase the dose or add a new medication for better control of diabetes mellitus, hypertension, etc., patients will remark that they plan to leave for a southern destination in a month or two.
Even a change in dose of medications could invalidate private travel insurance, and certainly a substitute to a “close cousin” in the same drug family would do so. Thus, a large group of people who have been stable for years on various medications face the possible loss of insurability.
For many months, well-established drugs have been suddenly placed on “back order” for an unknown period of time. This involves drugs used in cancer therapy as well as several medications for hypertension, heart failure, diabetes mellitus, heartburn, tuberculosis and seizures. Is this due to increased global demand, a lack of active ingredients, contamination issues, vague manufacturing problems or simply a decision to stop making an unprofitable drug? No one will say. According to Kelly Grindrod, associate professor of pharmacy at the University of Waterloo, 1,800 of 7,000 prescription drug products are shorted. A substitute drug in the same family may still have quite-different side effects and re ed efficacy. Moreover, a forced change in medications within three months of travelling can make patients “unstable” in the eyes of insurance companies.
The Canada Health Act states that “if insured persons are temporarily out of the country, insured services are to be paid at the home province’s rate.” Yet for hospital care outside Canada, British Columbia still pays only $75 per day. Alberta, Saskatchewan, Quebec and New Brunswick pay $100. Until Jan. 1, Ontario will pay $200 to $400 per day. Most provinces, recognizing that these mere token amounts, advise people top chase private travel insurance; this will become increasingly difficult for people whose drugs are changed due to back orders, making a real catch-22 situation.
The CHA Annual Report 2017-2018 states: “For all jurisdictions except Prince Edward Island and the three territories, the per diem rate for out of country services appears lower than the home province or territory rate, which is contrary to the requirement of the portability criterion of the CHA.”
Financial penalties for violations of extra-billing and user fees are “mandatory” whereas those for other violations such as portability are only “discretionary.” The report admits that “to date the discretionary penalty provisions of the Act have not been applied.”
Canadians should demand that Health Minister Ginette Petitpas Taylor investigate the cause of worsening drug shortages and find solutions. In addition, after many years of inaction, she should finally ensure that all Canadians receive at least the health coverage outside their country that is clearly required by the Canada Health Act.
Enforcing the CHA will likely cause provinces to demand increased federal health transfer payments. Hence, when the health ministers next meet, updating and amending the act should be on the agenda so as to make health delivery more fiscally sustainable.
By the October election, the SNC-Lavalin affair, promises on balancing the federal budget, voting reform and avoidance of omnibus bills will probably seem less important than health access issues. The problems described above will become more relevant as winter approaches and — quite likely — even more drugs are suddenly placed on back order. The result? Many people may be deprived of spending a few weeks in the south due to lack of adequate health coverage outside Canada
Politicians should remember that most of these affected people do vote.
Dr. Charles S. Shaver
past chair of Section on
General Internal Medicine
Ontario Medical Association.