Pharmacare in Canada: How developing person-centred pathways can promote policy adoption
Government could further the adoption and implementation of proposed or enacted policies that impact citizens by promoting public acceptance through the communication of person-centred policy pathways.
By Cheryl Camillo, MHA Director and Associate Professor, Johnson Shoyama Graduate School of Public Policy; CSIP ResearcherDr. Camillo initially presented this innovative policy tool at a December 4, 2019 CSIP Innovation Research Forum “Improving Policy Adoption and Implementation through the Communication of Policy Pathways.” Camillo will be presenting her related paper “Understanding, reducing, and eliminating administrative burdens through the modeling of citizen client pathways,” which draws on her experience running means-tested public health insurance programs, at the XIX Nordic Political Science Association Conference in August.
Government could further the adoption and implementation of proposed or enacted policies that impact citizens by promoting public acceptance through the communication of person-centred policy pathways.
There are many reasons why policies do not get adopted or implemented. Sometimes, for example, policy proposals are not adopted because of partisan or ideological reasons, but other times policies are not enacted or implemented due to citizens’ active objections, or their failure to demonstrate sufficient support for policymakers to risk proceeding.
Policies that are most likely to be resisted by the public are those that propose changes that will impact most, if not all citizens, in technically complex policy domains, like healthcare or stewardship of the environment, in which many interest groups are competing for advantages. Frequently citizens have difficulty sorting through dense evidence and stakeholders’ competing claims to determine the policy’s potential impact upon them, so they default to supporting the “devil they know”—the status quo. Arguably, Canada has yet to adopt universal pharmacare despite 55+ years of recommendations by blue ribbon commissions because interest groups hold different positions on pharmacare options and policymakers do not perceive enough public support to offset the the political costs of some stakeholders’ objections.
Public acceptance could be built through the dissemination of person-centred pathways modeled after the patient-centred care pathways used in healthcare delivery settings. I define a patient-centred care pathway as a multi-disciplinary structured and standardized course of treatment for a specific population co-determined by physicians, researchers, and patients using synthesized evidence, which describes and depicts the sequences of steps and information flow necessary for achieving desired outcomes. A citizen-centered policy pathway would depict, like a roadmap or infographic, how the policy would unfold in relation to individual citizens, or at least segments (such as age cohorts and income groups) of the population, and would describe, preferably quantify, the impact on citizen finances, resources, and well-being over time. Ideally, policy pathways would be developed collaboratively by public officials, technical experts, and citizen representatives.
If Canadians could glean from a one or two-page document how they could get a pharmacare card, what outpatient prescriptions they could fill with it, what out-of-pocket expenses, if any, they would have to pay, how their individual tax burdens would change, if at all, and how their benefits and costs would compare to those of their neighbours, they would be more likely to form an opinion on the proposal and, I believe, to support it. The Final Report of the Advisory Council on the Implementation of National Pharmacare has a well-written chapter (Chapter 8) that describes “what national pharmacare will mean” for patients and their families, employers and business, and citizens and taxpayers, but most citizens are unlikely to search for and read the report. Plus, the information in the chapter, including facts like copayment amounts, is spread over five pages. Furthermore, the financial costs and benefits it estimates are for “the average Canadian,” but there is no ready explanation of what average means. In addition, it lacks, in this age of communicating through emoji-laden text messages, a diagram to show Canadians who currently have some outpatient prescription drug coverage (provided by their employer or province) how they will transition from their current plan to pharmacare.
Skeptics might argue that person-centered policy pathways are too simplistic a tool to forge public acceptance of a complex policy; however, few citizens demand complicated policies or thick description from their public
officials, which is why political campaigns operate by the maxim “keep it simple stupid.” Another potential criticism of policy pathways is that they would be resource-intensive to make because their production would require policy knowledge, data, and expertise in design or presentation. To that I would reply that they are too costly not to develop—failures to implement policy to address pressing problems, such as the inability of many Canadians to access affordable outpatient drugs, come at a much greater cost, not only in monetary terms, but in citizen confidence and health and well-being.