"Overall,
I concluded that progress toward cost-effective drug use
and a sustainable PharmaCare program is being compromised
by insufficient management attention. Although the program
has been a leader in implementing a number of initiatives,
such as the PharmaNet system, cost containment and drug
utilization strategies, and the Therapeutics Initiative,
progress to expand these useful initiatives to maximize
their benefit, has been slow. Expansion of these and other
initiatives can move PharmaCare further towards achieving
its strategic objectives. The key factors underlying this
slow progress are the
lack of sufficient human resources, clear direction, appropriate
performance measures and key accountabilities."
Wayne Strelioff, FCA, Auditor General, Managing
Pharmacare: Slow Progress Toward Cost-Effective Drug Use
and a Sustainable Program Report 8 - March 2006,
p. 2.
"In
summary, we profoundly disagree with the Auditor General's
overall conclusion that little progress has been made
by PharmaCare since the last audit. We have described
the work PharmaCare has undertaken internally to restructure
its benefit programs and make them more equitable and
sustainable. We have also described the leadership British
Columbia has taken on the national front to promote collaboration
and cooperation between jurisdictions, in order to ensure
all Canadians have access to safe and effective prescription
drug coverage."
Response from the Ministry, p. 71.
It is
hard to find another example where such differences exist
between a Ministry and the Auditor General. A major point
of departure between the Campbell government and the Auditor
General may be on the issue of how to control costs while
receiving value for money. The 2006 Report states: "Costs
of PharmaCare can be managed in two ways - by managing the
program effectively and by helping the population become
healthier and less reliant on medications." Compare
that to the Ministry's response which talks about restructuring
benefit programs, a euphemism for shifting costs from the
government onto those who are sick enough to need drugs.
What
is the public to think when the government disagrees with
the Auditor General's observation that: "My conclusion
is troubling because it echoes of an earlier conclusion
my office reached on the PharmaCare program. The conclusion
and key findings in our 1998/1999: Report
2 Managing the Cost of Drug Therapies and Fostering Appropriate
Drug Use, available at www.bcauditor.com, bear a
striking similarity to those in this report. …Although,
over the last six years, I have noted ministry progress
in dealing with some of these issues, the issues themselves
have become more compelling and PharmaCare's momentum to
move on them constrained by regular turnover of PharmaCare's
top management and chronic understaffing." (emphasis
added)
The
overall conclusion in the 1998/99 report by then Auditor
General George L. Morfitt said: "We concluded that
the Ministry of Health and Ministry Responsible for Seniors
is adequately managing the cost of drug therapies, although
it could do more to foster appropriate drug use." That
report was mild compared to the 2006 report.
The
2006 Report noted (p. 64) that according to the ministry's
2003/04 Annual Report "…any potential negative
impacts of Fair PharmaCare are being monitored, and that
preliminary evaluations indicate that drug use has not decreased
in either the senior or non-senior groups since implementation.
A partnership with Harvard University to carry out a long-term
evaluation of Fair PharmaCare until 2009 was also reported."
The Auditor did not mention reviewing the evaluations;
his report merely mentioned claims contained in the Ministry's
Annual Report.
Fair
PharmaCare was implemented in May 2003. In debate leading
up to its implementation, then Minister of Health Services
Colin
Hansen told the Legislature on October 31, 2002 that::
"We have already put in place a contract with officials
at the University of British Columbia to make sure that
this transition is properly monitored using PharmaNet data,
to make sure that no senior and no British Columbian is
negatively impacted in terms of their ability - based on
their ability to pay - to get the medications that they
need." I submitted a freedom
of information request for that contract and on August
5, 2003, I received copies of emails that amended a standing
agreement between the Centre for Health Services and Policy
Research (CHSPR) at UBC and the Ministry of Health, which
allegedly evidenced Hansen's claim that a contract was in
place with officials at UBC to monitor the transition to
Fair Pharmacare. In light of the Auditor General's Report
I
am now submitting a freedom of information request for
the report that should have been the product of the contract
Hansen referenced in 2002. If it exists, it would appear
that it was missed by both the Office of the Auditor General
and by the Ministry in their response when they referenced
a four page bibliography of evaluations with respect to
BC's Pharmacare program. Was Hansen wrong when he informed
the Legislature in 2002 or did the CHSPR report get buried?
Postscript:
Click here
for a copy of the letter faxed to the Auditor General
with a copy of this article and a question about his report.
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