Bad medicine

The cracks in Quebec's drug insurance plan are getting bigger

by PHILIP PREVILLE

Quebec's prescription drug insurance plan, at the time it was implemented last January 1, seemed to symbolize the future of social democracy. The drug plan was a brand-new, universal social program--something the country hadn't seen in some time--that would provide all Quebec citizens with prescription drug insurance. The plan would also save the province money: the government proudly said it would end up paying less for prescription drugs than it did before. The drug plan was an ideal marriage of activist politics and economic efficiency, progressive government for the tight-fisted '90s.

Now, less than four months into the life of the plan, the marriage does not seem so ideal after all. In Montreal, doctors, pharmacists and other health-care professionals are starting to speak publicly about the serious problems that are beginning to emerge. The drug plan's cost-sharing arrangements, in which citizens pay part of the cost of their drugs through a combination of premiums, deductibles and co-payments, is leaving many people--particularly low-income earners, the elderly, welfare recipients and the mentally ill--without the means to pay for their medication.

"The drug plan is definitely causing real problems for us," says MD Diane Roger-Achim of the downtown CLSC des Faubourgs, which serves many welfare recipients. "I see it every day. Just now, I tended to a man with a stomach ulcer who can't afford medication--it's the 21st of the month and he has no money left, so he will wait until next month to get his medication. Before the day is over, I will probably tend to two more people in the same bind."

Dr. Achim's testimony merely confirms the predictions made last year by the Coalition sur l'assurance-médicaments, an association of community groups fighting to reform the drug plan's cost-sharing structure.

Since the time the drug plan was in its planning stages last year, the Coalition has insisted that drugs should remain free for those living below the poverty line. Previously, seniors paid a maximum of $100 per year for prescription drugs, while welfare recipients received them for free. Now seniors pay anywhere from $187.50 to $500 per year, while those on welfare pay up to $200 per year.

For Kathleen Gorman of Project Pal, an organization which specializes in helping mental health patients live autonomous lives, the $200 is forcing many of her clients into "non-compliance," the inability to take their medication as prescribed. "It's been drastic here," Gorman says of the situation at Project Pal, most of whose clients are on welfare. "Suddenly, with the drug plan, many of the people we know are on reduced intake or total non-compliance."

While the government acknowledges that there is a problem, it insists that it is not as serious as the Coalition makes it out to be. "Everybody knows someone who can't afford medication," says Pierre Boucher, spokesperson for the Régie de l'assurance maladie du Québec (RAMQ). "There could be any number of reasons for the problem. There are people out there who aren't capable of budgeting properly."

Predictably, the non-compliance issue is having an impact on hospitals. Caroline Hooper, Director of Social Work with the Douglas Hospital, says an informal study showed that over a five-week period, 12 people came to the Douglas's emergency ward because they could not pay for medication.

The RAMQ's Boucher was unaware of the Douglas Hospital's study. He did admit, however, that the government will soon announce a $100,000 study to look into the drug plan's impact on welfare recipients--which, according to David Alper of the Coalition, is an admission that they know how serious the problem is. "They're keeping a straight face, but they know things are not working out as they had planned," Alper says.

In the meantime, both the Douglas Hospital and the CLSC des Faubourgs are now taking matters into their own hands, trying to find other ways to help their patients pay for their medication. But as Dr. Achim points out, the drug plan was supposed to remove the need for private charity, not create it.

Ultimately, Achim says, the government's unwillingness to provide free medication to the poor will result in greater social and economic costs through increased hospitalization. "When I prescribe oral antibiotics, the patient has to pay for them. But intravenous antibiotics at the hospital are free," says Achim. "So if you can't afford your antibiotics, you'll have to let your condition get worse and then you'll check yourself into a hospital and get treatment for free. But which one is truly less expensive?"