Challenges in Obtaining Effective Access to Prescribed Drugs and Protection Against Financial Disruption: Addressing Barriers to Cancer Care in Ontario

Abstract

Effective coverage (“access”) is a powerful metric that can provide a more subtle understanding of whether and how well a health system is delivering services to its populations. Effective access is represented by four dimensions which are availability, affordability, financial protection (including, income support such as paid sick leave), and quality. The present study reviews each of these aspects, compares Canada’s (Ontario) experience with other OECD countries, and examines the proposals of improving cancer patients’ outcomes. Unlike many OECD countries, there is no universal coverage for prescription drugs outside of the hospital care in Ontario and Atlantic provinces. Excepting Quebec, the absence of prepaid ‘mandatory’ health and drug insurance plans leave many Canadians in Ontario and other provinces at risk of financial catastrophe and impoverishment, if they are diagnosed with cancer. Long wait times for potentially life-savings treatments, slow addition of new cancer drugs to provincial formulary and restrictive drug coverage criteria further confound the access barriers, leading to unnecessary adverse consequences for patients. Private insurance plans for drug coverage are unaffordable (in terms of high premiums, deductibles, and co-payments) for many and exclude people with pre-existing conditions. Inadequate provision of paid sick leave as compensation for the loss of income can seriously endanger the patient's ability to continue the treatment and hence the recovery process. From the perspective of effective coverage, it is observed that Canada (Ontario) does not measure up well when compared to peer countries.