I’m going to take a bit of a left-turn with this post. I’ve written a lot from the personal level – about what an HIV-diagnosis means for the person experiencing it. I’ve written about the complex mental health issues, the changes with my body, my emotional needs, and I think the personal journey is important. But as I come to a sense of peace with my diagnosis, I want to turn to the issues and concerns that face all HIV-positive people, and in some small way draw attention to how our lives could be improved.
I’ve gone back to school; this was something that I had decided to pursue before my diagnosis, and I considered changing my plans afterwards, but decided against changing my mind. I decided to follow the dream, and finish the Bachelor of Arts I started fresh out of high school, almost 10 years ago.
Last semester, we were tasked with choosing a public policy issue and arguing one way or the other for our chosen issue. Given my diagnosis and newfound interest in health-related policies, I wrote about the need for a nationalized pharmacare program. I thought for tonight’s post, I would re-purpose some of that paper and talk specifically about how such a program would benefit people living with HIV.
A note of caution, the research and the arguments are heavily focused on Canada, but I hope for international readers, there are some things of interest for you as well. Links to the research will be at the end of this blog post, and peppered throughout as hyperlinks in the content.
A quick overview
Interestingly enough, during my research I found out that Canada is the only industrialized nation in the world that provides universal health coverage to its citizens, but doesn’t package that with universal drug coverage. Provincial and territorial governments have programs available to specific populations (like the Trillium Drug Benefit here in Ontario).
- 24 per cent of Canadians have no drug coverage (public or private)
The financial question
I know what you’re thinking – if a national drug coverage program was to be created, it means higher taxes and more government spending. However, in the long-run, funding a national drug program actually would reduce costs to the healthcare system. Why? Simply put, with expansive coverage and access to necessary prescriptions, people adhere to treatment. Adherence to treatment keeps people healthier longer, and helps reduce follow-up visits, additional conditions and all the things that help lead to more and more people rushing to the doctor or the emergency room.
Interesting financial highlights
- Drug costs in Canada have risen more than 10 per cent each year since 1985
- Compared to public plans, private insurance plans have higher administrative fees; if the same level of coverage that private plans provide were to be provided under a public system, it would result in net savings of $560 million per year
What would national drug coverage mean for HIV-positive people?
To put it in simple terms, a national drug program would mean equal access to the life-saving drugs we need, at no cost to us.
Some would argue that a program like national drug care should be income-based. This would mean, say, someone who makes over $50K/year would pay a certain co-payment each time they refilled their prescription. Advocates for such a system argue that this creates fairness, with those who can paying just a little bit to help out those who can’t.
While this is a noble thought, here’s where it gets interesting: in a study of heart attack patients, it was found that eliminating co-payments entirely improved patient adherence to treatment.
Those of us who are on anti-retrovirals to treat HIV know how important it is for us to stick to our treatment. If we’re worrying about paying for our next refill, there’s always that lingering chance that we won’t adhere to treatment. If a program like national drug coverage can help change that, and help more people access and stay on treatment, then it’s all the more reason to have said program.
Having a nationally run, universal drug care program would have eased my mind substantially in the days and weeks after my treatment. I wouldn’t have had to go through the mumbo-jumbo that is the handbook to my employer’s insurance plan. I wouldn’t have to consider a period without benefits if I were to change jobs, or even lose my job.
A national drug care program would create stability and safety for so many HIV-positive people, and indeed all those who rely on prescription drugs to treat conditions and ailments that affect them.
It makes medical sense. It makes financial sense. And hey, I’m pretty sure that with a little convincing, it would convince a lot of voters — therefore making political sense, too.
For more information
I highly recommend reading some of the following, if you’re more interested in this topic:
◾A Roadmap to a Rational Pharmacare Policy in Canada
◾The Economic Case for Universal Pharmacare
◾Are Income-Based Public Drug Benefit Programs Fit for an Aging Population?
This article first appeared in Josh’s own blog The Plus Side of Life here.