The treatment of cancer requires a multi-disciplinary approach. Comprehensive cancer centres and hospital-based clinics provide more than 90% of cancer care. Cancer Care Ontario is responsible for providing all radiation oncology services and the majority of medical oncology services.
The latter includes not only medical services but the reimbursement to cancer clinics for the cost of new intravenously administered cancer drugs. Oral cancer drugs, which are growing in number, are covered for patients over the age of 65 by the Ministry of Health (MOH). Patients under 65 receive coverage either through their employer’s drug plan or, for those without employer-provided drug plans, through enrollment in the MOH subsidized Trillium Drug Plan.
Timely access to surgical oncology services has recently become a problem. Canada has fewer hospital beds per inhabitant than any western European country, according to the Ontario Hospital Association. Lack of access to acute care beds for surgery is exacerbated by the use of these beds for patients with chronic conditions who cannot be accommodated in under-resourced designated long-term care facilities. Employer benefits programs cannot mitigate this lack of resources in the public system. Currently, the only way for employers to address this issue is through intervention at the government level. This lack of resources makes cancer care a long, arduous journey rather than a short interruption in an employee’s work life.
The cost of delayed and cancelled surgeries has not been quantified in Ontario. Health economists tend to view this with little interest, speculating that the workplace could easily use the unemployed to compensate for workers on health-related absences. This is an overly simplistic and impersonal view. Larger employers might manage in this scenario, but smaller employers bear the burden of short-term disability costs when operating room times for cancer surgery cannot meet our needs in a timely and predictable way.
When Ontario was faced with unacceptable wait times for heart surgery, a cardiac network was organized. This system has worked very well, and we no longer hear of undue delays for patients requiring cardiac surgery. A similar system for cancer surgery could be modelled on this successful approach.
Another issue of importance to employers is the cost of new cancer medicines that are taken orally. Again, larger employers may be able to absorb these costs, but smaller companies will immediately notice the increase in their drug plan cost, which may not be affordable. The creation of a catastrophic drug plan at the national or provincial level may address this issue. Smaller employers may require some financial incentives to motivate them to participate in such a program.
The Cancer Advocacy Coalition of Canada has advanced this proposal in collaboration with other patient advocacy groups. Employers must communicate to the MOH the business case for timely access to new cancer drugs and influence decision-makers to explore options to make such coverage available. They must also work with their insurance companies to devise attractive and affordable insurance plans for catastrophic disease.
The federal transfer payments to provinces, which were negotiated almost 10 years ago, are now up for review. This is an opportunity for insurers to propose to employers new risk and cost management strategies for the provision of cancer drug treatments. It is also an opportunity for provincial governments to explore new partnerships to address wide disparities in cancer drug coverage that exist in Ontario and throughout Canada.
Dr. Pierre-Paul Major is an associate professor at McMaster University.
Back to more coverage from the 2011 Cancer Care Summit, hosted by Working Well.