Much of the money for Ontario’s OHIP+ plan will pay for the drugs of people who didn’t have any access problems in the first place.
With much fanfare, Ontario’s 2017 budget announced the introduction of universal drug coverage, starting next January, for those under age 25. True, drugs are an important part of the problem in gaps in publicly funded healthcare. But even with an annual starting cost estimated at $480 million, “OHIP+” looks like a poor approach to closing the pharmacare gap while taking up limited fiscal room to close health gaps elsewhere.
Much of the money for OHIP+ will pay for the drugs of people who didn’t have any access problems in the first place. A more targeted approach could have a much larger effect on addressing the many unmet healthcare needs of Ontarians.
Ontario’s current patchwork of public drug plans covers social assistance recipients and their dependants, those who qualify for disability support, and those aged 65 and up. Income-tested coverage is also available for all who spend more than 4 per cent of their income on drugs in a given year. Private employer-based plans cover most workers and their dependants. Most of those without sufficient coverage are the so-called “working poor” – people in low-wage occupations without drug benefits – and the self-employed.
Most young people who will be covered by OHIP+ already have coverage through their parents’ insurance. Among those whose coverage will improve are mainly children of low-income parents without employer-based insurance and postsecondary and high-school graduates who no longer qualify as dependants under their parent’s plans.
The share of OHIP+ costs that is attributable to these groups is relatively small: The majority of the $480 million will be spent to move youth dependants under private drug plans onto a public plan.
Given the limited public appetite for tax increases and high provincial debt, there are other ways we can spend taxpayers’ money that would more effectively address unmet health needs.
A lack of drug coverage is not the primary health concern for many Ontarians. In an international health survey, about 11 per cent of Ontarians said they may not fill a drug prescription due to cost, but roughly three times that many say they skip dental services for that reason. Further, far too many young people end up in emergency rooms for severe mental health issues; others walk around with improper prescription eyeglasses or rely heavily on family caregivers for home support.
Instead of a plan paying for the drugs of all young people, we could offer comprehensive drug coverage for children of low-income parents without private insurance, and for high-school or university graduates for a four-year period as they look for permanent work. This would free up money to extend more dental care services to low-income Ontarians and train more counsellors in particular communities and schools where mental-health needs are the highest, while coming in under the OHIP+ price tag. That would be a more effective use of funds.
Further troubling about Ontario’s narrow approach to plugging drug gaps is that the province staked a Polyannish hope that greater federal intervention will extend OHIP+ into a universal pharmacare plan nationwide. This is an extension of the age-old political game played in Canadian healthcare. By clamoring for more federal funding, provincial politicians are trying to make people believe they can save money by paying more taxes to the federal government and less to the provinces.
Ontario deserves credit for trying to improve the access of needy Ontarians to prescription drugs. But insisting that all improvements in access must come through universal programs that pay for all kinds of healthcare costs for everyone, even those who can afford to pay for them on their own or from private insurance, is going to make these improvements costly for governments – and risks leaving Ontarians with other serious health needs behind.
A more effective approach would be to create new, or extend existing, programs that target those who need access the most.
Colin Busby is Associate Director of Research at the C.D. Howe Institute, and Åke Blomqvist is adjunct research professor at Carleton University and Health Policy Scholar at the C.D. Howe Institute.
Published in the Toronto Star