Modernizing the Canada Health Act in the 21st Century

The type of health care and medical services that individuals need have changed substantially over the years. However, the Canada Health Act (CHA) which was founded in 1984 has not adapted with the population’s ever-changing needs. Many services that are now considered a necessity are still not covered (Kandola, 2020) under the CHA – for example, prescription medication (Flood & Thomas, 2016).

In the cardiac catheterization lab, we perform percutaneous coronary interventions (PCI) otherwise known as angioplasties. We advance small catheters, balloons, and drug-eluting stents through an artery to the blocked vessel in the heart. The blocked coronary artery is then re-opened to restore blood flow and cardiac function. Often the patient comes to us as an emergency known as a STEMI or myocardial infarction. The socioeconomic status of the STEMI patients can vary in Toronto due to our large variations in housing and income.

(Institute for Quality and Efficiency in Health Care, 2016)

After having a PCI procedure, patients are generally put on dual antiplatelet therapy for at least one year. The most common dual antiplatelet therapy used is a daily dose of 81mg of Aspirin with 75mg of Clopidogrel/Plavix. In 2010, the price per pill in dollar amounts for 81mg of Aspirin was 0.1297 dollars and 75mg of Plavix was 2.5775 dollars (Banerjee et al., 2010). Therefore, the monthly cost for dual antiplatelet therapy in 2010 was approximately 81.21 dollars. Given that 11 years has passed, there has been definite increases in cost of living and pharmaceutical supplier fees. Thus, the monthly cost of the dual antiplatelet therapy in 2021 must be substantially higher.

As mentioned previously, many STEMI patients come from a lower socioeconomic status. They often cannot comply to the required 12 months of dual antiplatelet therapy due to financial constraints. As a result of noncompliance, the deployed stent often clots and results in in-stent restenosis. It has been found that patients with financial difficulties tend to skip doses, reduce dosages, delay refilling, not fill, or forego basic needs (Law et al., 2018). These individuals can also have other comorbidities such as diabetes in addition to cardiac disease which may require additional prescription medications. Consequently, they may then have to choose between treating different illnesses. Moreover, patients that are unable to comply with prescription drug therapy often have a cascade effect where they forego other services as well such as cardiac rehab. This service is essential to one’s recovery post cardiac arrest. If the Canada Health Act can be expanded to include prescription drug coverage, it would save many lives and improve the general health of our population. Patients will no longer have to choose between funding basic needs versus their prescription medications. This will also allow patients to feel more comfortable utilizing other care services, such as Cardiac Rehab when they are able to comply with prescribed therapy without causing further financial burden.

References

Banerjee, S., Brown, A., McGahan, L., Asakawa, K., Hutton, B., Clark, M., Severn, M., Sharma, M., & Cox, J.L. (2010). Clopidogrel versus Other Antiplatelet Agents for Secondary Prevention of Vascular Events in Adults with Acute Coronary Syndrome or Peripheral Vascular Disease: Clinical and Cost-effectiveness Analyses. Canadian Agency for Drugs and Technologies in Health, (133), 1-75. Retrieved October 2, 2021, from https://www.cadth.ca/media/pdf/H1481_Clopidogrel_vs_Antiplatetel_Agents_tr_e.pdf

Flood, C.M., & Thomas, B. (2016). Modernizing the Canada Health Act. The Dalhousie Law Journal, 39(2), 397-411.

Institute for Quality and Efficiency in Health Care. (2016). Cardiac catheter with balloon and stent [Image]. Informedhealth. https://www.informedhealth.org/what-happens-during-cardiac-catheterization.html

Kandola, A. (2020). Sildenafil [Image]. Medical News Today. https://www.medicalnewstoday.com/articles/what-is-the-most-effective-pill-for-ed

Law, M.R., Cheng, L., Kolhatkar, A., Goldsmith, L.J., Morgan, S.G., Holbrook, A.M., & Dhalla, I.A. (2018). The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey. CMAJ OPEN, 6(1), E63-70. https://doi.org/10.9778/cmajo.20180008