Election 2015: National plan needed for Canada's aging population

While the main political parties are shying away from an evidence-based national seniors strategy that would include a country-wide pharmacare program to pay for prescription drugs, two U of T professors are passionately advocating for a plan on behalf of older Canadians.

Dr. Samir Sinha, an assistant professor of medicine, and Dr. Danielle Martin, an assistant professor in the department of family and community medicine, are regular members of a CBC television news panel that discusses health care issues. Other members are Dr. Jacob Udell of the Faculty of Medicine and Dr. Peter Lin, who was the medical director at the Health and Wellness Centre at U of T Scarborough for seven years.

When asked on air what the most important issue is in the federal election campaign, Sinha said a national seniors strategy. Martin's choice was pharmacare. The two are intertwined.

In an interview with U of T News, Sinha explained the need for the national strategy. Martin responded via email to questions about pharmacare.

Read more Election 2015 coverage from U of T News

Sinha, director of geriatrics at Mount Sinai Hospital, received a grant from the Canadian Institutes of Health Research (CIHR) to examine a national seniors strategy. He is also working with the Ontario government on seniors issues.

“When you travel around the province you quickly realize that not enough is being done to meet the needs of an aging population, and not just in health care,” Sinha said. “Seniors are concerned about finances so they don’t age in poverty. They are concerned about community care, appropriate housing and transportation.”

Ontario is implementing many of the reforms advocated by Sinha and organizations such as the Canadian Medical Association. But what is needed is a pan-Canadian approach.

“This is not something each province can do on its own,” Sinha said. “We have to do this collectively as a country.”

The federal government has taken a “hands-off” approach to health care, Sinha said. Whoever forms the next government could play a significant role not only in managing the Canada Pension Plan, the Old Age Security program and the Guaranteed Income Supplement but also take a leadership role in major infrastructure projects that would benefit seniors.

Martin, vice-president of medical affairs and health systems solutions at Women’s College Hospital, said implementing a national pharmacare program “will require courage and some up-front investment to put in place the mechanisms to build a national formulary and engage in price negotiations with the pharmaceutical industry.”

She noted that a recent poll showed that one in five Canadians – either themselves or someone in their household – had not taken medications as prescribed because of the cost. “In my practice, I see health conditions worsen over time when people do not take their medications.”

The federal government and the provinces could commit to establishing a single-payer system within four years, she said, along with a publicly accountable body to administer it. “It’s completely doable.”

The NDP announced a $2.6-billion, four-year program in support of a transition to a national pharmacare plan on Sept. 18. The federal government’s purchasing power would be used to negotiate better prices for drugs, which could save on average 30 per cent on prescriptions.

The Liberal Party has “made vague statements about wanting to include pharmacare on a list of items to be negotiated with the provinces,” Martin said. “The Conservative Party has not yet articulated a policy on pharmacare, although the current minister of health [Rona Ambrose] has said the federal government would like to participate in bulk purchasing of drugs with the provinces.”

The latest federal budget included income splitting and allowing people to put more money in Tax Free Savings Accounts (TFSAs). “It sounds really good politically,” Sinha said of these measures, “but from a policy standpoint it doesn’t address the fundamental issue of poverty for older Canadians. Many of them don’t have enough money to put much in TFSAs.”

Sinha agrees with Martin that a new program would have to focus on “bulk buying” and the elimination of co-payments, which many seniors face when buying prescription drugs.

“Co-payments do more harm than good,” Sinha said. “Many seniors simply choose not to fill their prescriptions because they can’t pay even low co-payments.” This in turn adds to health care costs.

One of the reports produced through the CIHR grant concludes that while older Canadians account for 15 per cent of the overall population, they account for 60 per cent of the total spending within provincial and territorial medication programs. About 40 per cent of older Canadians are taking one inappropriate medication. An additional 12 per cent take multiple inappropriate medications.

Sinha said the Liberals, the NDP and the Green Party are all generally supportive of a national seniors strategy. Nevertheless, he said, details are lacking.

“We want to be non-partisan about this,” he added. “We just want to make sure that any program is based on the evidence and good policy.”

Green Party Leader Elizabeth May has been the strongest advocate for a national seniors strategy, arguing that it needs to include not only a pharmacare plan but a policy to deal with dementia and Alzheimer’s and a respite program for caregivers.

In Martin’s view it is the social determinants of health – income, education, employment, housing and food security – that shape our wellbeing. “Income in particular determines access to all of these other determinants of health,” he said. “A commitment to reducing or ending poverty is needed federally.”