Romanow Commission Special Report

Roy Romanow tabled his report titled "Building on Values" just after 10:00 a.m. in Ottawa on November 28, 2002. Mr. Romanow reiterated his belief that Canadians do have a sustainable health care system, and commented that Canada's health outcomes are among the best in the world. He also passionately rejected any possibility of increased private sector involvement in health care delivery.

In terms of immediate health care funding, Mr. Romanow recommends that the federal government increase its share of health care funding to a minimum of 25% of the cost of insured health services (provinces report that Ottawa currently pays about 14% of health costs). He proposes an initial transfer of funds over two years ($3.5 Billion in 2003/04, and $5 Billion in 2004/05) to "kick start" needed changes in five areas:

 

• The Rural and Remote Access Fund would improve timely access to care in rural and remote areas.

• The Diagnostic Services Fund would improve wait times for diagnostic services.

• The Primary Health Care Transfer would support efforts to remove obstacles to renewing primary care delivery.

• The Home Care Transfer would provide a foundation for an eventual national homecare strategy.

• The Catastrophic Drug Transfer (beginning in the fiscal year 2004/05) would assist provinces to better protect their citizens in instances where they require expensive drug therapies to remain healthy.

The report outlines a total of 47 recommendations. Among them:

• Establishing a Canadian Health Covenant, that expresses Canadians' "collective vision for health care and that outlines the responsibilities and entitlements of Canadians. "

• Modernizing the Canada Health Act by updating to principle of Comprehensiveness to include diagnostic and homecare services, and by adding a sixth principle of Accountability.

• Creating a Health Council of Canada - an intergovernmental Council which will serve to establish overall system objectives, common indicators and benchmarks, criteria for measuring, tracking health and reporting to Canadians on system performance. The Council will also evaluate new technologies and coordinate the existing health technology assessment activities. The Health Council would be built on the existing infrastructure of CIHI and CCOHTA.

When discussing prescription drugs, the Commission's report acknowledges the changing role that drugs play in our health care system stating that drugs "…have fundamentally changed the face of health care in Canada. " The report further states that too many Canadians are without drug coverage, that the provinces' drug programs vary widely, and that in recent years, provincial and territorial health departments have tried to contain the growing costs of their drug programs by narrowing the range of eligible recipients, by raising deductibles, by limiting access to medications, and by implementing more stringent means testing.

Mr. Romanow maintains that there are two major issues related to prescription drugs: "the first is improving the access and ensuring that financial barriers do not prevent Canadians from accessing the prescription drugs that they need. The second issue is continuing to improve the quality, safety, and cost effectiveness of prescription drugs. " In order to address these two issues, the Commission's report makes five recommendations:

• New Catastrophic Drug Transfer - to provide short term catastrophic coverage for Canadians and to ensure the expansion of existing provincial programs.

• A new National Drug Agency - to ensure a comprehensive, streamlined, and effective process for addressing new drugs and ensuring the safety, quality and cost-effectiveness of all new drugs.

• A National Formulary for prescription drugs - this formulary would be developed by the National Drug Agency in conjunction with the provinces and territories to provide consistent coverage, objective assessments and help contain costs.

• A new medication management program linked to primary health care - this would ensure that the effectiveness of prescription drugs can be monitored by teams and networks of health care providers.

• Patent review - certain aspects of the patent act (evergreening and notice of compliance regulations) should be reviewed to speed entry of generic drugs to the market.

In somewhat contradictory statements, the report pronounces that "creating a separate federal prescription drug program would only further complicate the patchwork of programs that already exist. " However, Mr. Romanow also recommends the creation of a National Drug Agency to control costs of the evaluation of new drugs. The agency would evaluate new and existing drugs, and would also ensure quality, safety, and cost effectiveness of all prescription drugs. He foresees the establishment of a national formulary of prescription drugs to provide consistency across the country, to ensure the objective assessments of drugs, and to contain costs.