November 14, 2013

Open Editorial!
Discrimination based on geography: Albertans deserve better cancer care
Ashley M. Cornish, RN PhD Student Faculty of Nursing, University of Alberta

As Canadians, we pride ourselves on being citizens of a nation that provides healthcare to all. We think of ourselves as completely devoid of the healthcare issues plaguing our southern neighbours in the United States. We delude ourselves into believing we are part of a superior system, one that does not discriminate based upon geographic location, age or illness. However, this is simply not the case, especially when it concerns the coverage of expensive prescription medications. ! Healthcare within Canada is guided by the federally enacted Canada Health Act which stipulates comprehensiveness in its mandate. However, healthcare spending and passage of the Canada Health Acts principles is left to individual provincial governments. While some might laud this freedom given to provincial governments as positive, allowing for independence and creation of regional priorities, in actuality it creates widespread health disparities based upon geographic location. Stark di"erences in healthcare spending are especially pronounced in the case of

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expensive prescription medications necessary for the treatment of cancer.! Recent statistics released by the the Public Policy Forum and Canadian Cancer Society classify cancer as the leading cause of death in Canada, with 40# of women and 45# a"ected by the disease at some point during their lives. Though these statistics are relatively well$known by the Canadian public, less well$known are the signicant long $term nancial burdens incurred by many cancer patients. ! While a large percentage of cancer therapies including surgery, radiation and chemotherapy are delivered within healthcare settings, not all cancer treatments are conned to hospital walls. There are often mandatory pharmaceutical therapies taken by cancer patients within their own homes to lessen side e"ects and make the treatment process physically and mentally tolerable. These therapies are typically not covered under provincial pharmacare strategies, leaving the cancer patient or their insurance companies to manage a large bill. While it is estimated by the Canadian Life and Health Insurance Association that 61.5# of Canadians are covered by health insurance plans, not all plans cover cancer pharmaceuticals and some may have a maximum yearly billable amount, leading to signicant out of pocket nancial expenses. ! A recent report by the Canadian Cancer Action Network stated that the average private health insurance plan had an annual cap of %25,000 for pharmaceutical treatments. This is far exceeded by the typical pharmaceutical regimen of a cancer patient amounting to in excess of %60,000. This amount does not take into consideration lost wages due to illness, or other costs related to treatment such as transportation or accommodation. These exorbitant costs can lead some to complete nancial ruin and further exacerbate the emotional hardships related to a cancer diagnosis. ! Though this is often the story with cancer patients in Alberta, the same economic hardships are not seen in every province across Canada. Some provinces, such as Saskatchewan, provide coverage for these costly pharmaceuticals under a provincial pharmacare strategy. Therefore, cancer patients in these provinces are not subject to the same degree of nancial burden. !
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This di"erence in coverage amongst Canadian provinces begs the question: should Albertans be subject to health inequities merely due to their geographic location? Why, in Alberta, where we spend amongst the highest amount on healthcare per person per year &%4,606' of all provinces, do we have such poor support for our cancer patients? ! This disparity needs to be on the forefront of Albertas health policy agenda. Citizens of the public must engage with the cancer pharmacare dialogue and demand change from our politicians. We are in desperate need of a realignment of Albertas health spending priorities, complete with strategies to protect one of societys most vulnerable groups, cancer patients, from nancial ruin associated with treatment. ! It is with this I urge Albertans to speak with their local MLAs to demand this topic be given su(cient attention within our provincial legislature. As more and more Albertans are diagnosed with cancer, awareness must be heightened to the nancial burden of this disease. We must address this issue if not for ourselves, but future Albertans.! After all, we may only judge both our society and selves on our treatment of our most vulnerable citizens. A cancer diagnosis within Alberta should not mean certain nancial death.

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