Commission on the Reform of Ontario's Public Services

One potential way to reduce overall drug costs is to pursue with other provinces the possibility
of setting a common price for pharmaceuticals. Provinces could also reduce overlapping
regulations that add costs and present barriers to new drugs entering the market efficiently.
The ICES and HQO should also conduct drug comparisons to determine which is the most
efficient at treating a given ailment; current tests by Health Canada do not do this. The
government should ensure that all new drugs add value that exceeds their cost. As mentioned
elsewhere, Ontario should work with the federal government to ensure that Ontario’s interests
in expanding use of generic drugs are not undermined by a Canada–EU Free Trade
Agreement. The province should also use pharmacists to their full scope of practice, allowing
them to substitute a less expensive alternative to the physician’s prescription. They should
also be allowed to administer injectables and inhalant medications and prescribe for minor
ailments, as is done in Saskatchewan.
A number of other cost efficiencies are possible for the health care system:
� Centralize all back-office functions such as IT, human resources, finance and procurement;
� A central mechanism could oversee a “spot market” for goods and discretionary services,
such as diagnostics, infusions and specialist consultation services;
� A wider array of specialist services could be put to tender based on price and quality, while
remaining under the single payer model;
� More service delivery could also be put to tender, with the criteria for selection based on
quality-adjusted metrics, not just price;
� Accelerate the adoption of electronic records, working from the bottom up. Begin with
doctors, clinics and hospitals and ensure that they use compatible systems. Then build
bridges within a region, then across regions;
� Adopt the Nova Scotia model in which emergency medical technicians provide home care
when not on emergency calls; and
� Provide better information to individuals and families to facilitate self-care for people with
conditions such as diabetes.
Above all, the government should involve all stakeholders in a mature conversation on the
future of health care and the 20-year plan. Anything done in the health field can be politically
dangerous, especially if cost restraint is involved. It will be critical to explain the objectives
carefully and stress that this is not just another round of cost restraint.
The stars are aligning for just such a discussion. The stakeholders themselves are reaching
out with proposals for reform, many of which are consistent with our recommendations here.
All stakeholders must speak out — ordinary citizens and health care providers of all stripes,
drug companies whose products are one of the fastest-growing costs, employers who cover
their employees’ drug and other health costs, and academics who study these issues.
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