A national catastrophic drug plan is long overdue, according to the Canadian Diabetes Association (CDA). Such a plan would benefit all Canadians and help renew our publicly funded healthcare system. Still, the challenge lies in sorting out the details. In this case, the definition of catastrophic and what the proposed national plan might cover are major concerns. All requests from the CDA to meet with officials designing the plan have been rejected. We are told that no one from the public will be consulted, even though our expertise and advice might be useful in making decisions.
Depending on where you live in Canada, the cost of managing a chronic condition like diabetes can indeed be catastrophic. Typically, Canadians living with diabetes spend $5,000 or more a year out-of-pocket to buy diabetes medications and supplies.
Over two million Canadians have either type 1 or type 2 diabetes. Each week, more than 4,500 Canadians learn that they must deal with diabetes for the rest of their lives. By 2010, over three million Canadians will be living with this serious condition.
Few of us think about what it means to be diagnosed with diabetes. It’s much more than a little problem with blood sugar. Diabetes is a serious disease that can lead to life-threatening complications.
Over 50 per cent of Canadians living with diabetes have developed serious complications as a result. Diabetes is a leading cause of heart attacks, stroke and kidney disease, blindness and limb amputation. One in ten hospital admissions lists diabetes as an underlying factor. Nearly 40 per cent of heart attacks being treated in hospital are the result of the condition. More than 50 per cent of dialysis patients developed kidney disease thanks to diabetes.
All Canadians pay the direct cost of treating diabetes-related complications which cost Canada’s economy more than $13.2 billion in 2002. Canada’s three western provinces paid nearly $1.5 billion in 2005 for doctor services, hospitalizations and day surgeries to treat people with diabetes. By 2016, the direct cost of treating diabetes in British Columbia, Alberta and Saskatchewan will jump an astonishing 74 per cent!
Diabetes-related complications add to Canada’s growing hospital and surgery wait lists and to spiralling costs in our healthcare budgets. Yet diabetes is one condition where science shows serious complications and hospitalization can be prevented with aggressive treatment. The Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada reviewed the best available scientific evidence. In these guidelines, aggressive treatment of diabetes, including healthy eating, physical activity and appropriately prescribed medications, were all recommended.
By managing their diabetes well, people can live full and productive lives, supporting their families and contributing to their communities and our economy. Yet two significant obstacles remain. First, Canadians with diabetes and their doctors do not have access to all of the medications and supplies needed to effectively manage diabetes. Second, those with diabetes frequently cannot afford the medications that are available.
If you have diabetes, it matters where you live in Canada. The Canadian Diabetes Association publication, Diabetes Report 2005: The Serious Face of Diabetes in Canada, shows why. A 22-year old Canadian with type 1 diabetes and no other health complications, earning $15,000 a year, can pay nothing in Nunavut. In Newfoundland, the same person could pay up to 25 per cent or $3,639.33 of pre-tax income annually for medication and supplies.
A 52-year old Canadian with type 2 diabetes and no complications, with an annual pre-tax income of $30,000, would pay $290.15 in Yukon, $1,733.61 in Alberta, and $1,897.49 in British Columbia. In addition, $3,945.68 or 13 per cent of pre-tax income could be spent on diabetes medication and supplies each year. If serious complications develop, the personal cost of prescribed medications can skyrocket. Those living with diabetes are then faced with a very difficult situation.
Those who cannot afford the cost of prescribed diabetes medication often cut corners on critical parts of daily diabetes management. The end result is that more than 50 per cent of Canadians with diabetes do not have their diabetes under control. Complications of poorly controlled diabetes carry not only a high personal cost, but add to the cost of healthcare paid by all Canadians and increase the numbers waiting for surgeries and hospital beds.
In December 2005, the Canadian Diabetes Association called for a national catastrophic drug plan. Under the Association’s proposal, all Canadians would be covered, and would spend no more than three per cent of their annual family income for prescribed medications and supplies. All medications approved as safe, effective and for sale by Health Canada and prescribed by a physician would be covered. All provinces would receive financial support to fully participate, allowing all Canadians the same level of coverage and access. Our Association believes in the long-standing Canadian principle that need - not cost or where you live – should determine ability to manage a disease like diabetes.
The idea of a national catastrophic drug plan is not new. Four years ago, both the Kirby and Romanow studies reviewed the future of health care in Canada. They recommended that government implement a national catastrophic drug plan as a necessary part of renewing our healthcare system. Today, Canada’s Health Ministers are working behind closed doors to decide how a catastrophic drug plan might work. A report to the public is expected by the end of June this year.
While a national catastrophic drug plan might help end current gaps in services and medications available across Canada, we just don’t know what our governments are planning. While their proposal may be very good, those Canadians who will be directly affected by the creation of a catastrophic drug plan should be included in discussions about what the plan should include.
Without the practical advice of those who will rely on this plan, any proposal runs the risk of not working as well as it could. We may implement a program that will not supply everything we need to sustain our publicly funded healthcare system.
The Canadian Diabetes Association urges federal and provincial governments to include Canadians now in creating a national catastrophic drug plan. We encourage you to ask your federal Member of Parliament or your local member of your provincial legislature for support. There is no need to wait. All Canadians will benefit from the creation of a plan that will ensure healthcare services are there when we really need them.