A lesson for Canada: Québec pharmacare system creates winners and losers

Québec spends $200 more per person than the rest of Canada to provide prescription drug coverage to everyone in the province, finds new research that could inform plans for a nationwide universal drug plan.

University of British Columbia October 10, 2017

Québec introduced a private-public drug coverage system in 1997. In contrast to a universal public drug plan, the Québec system requires all employers that provide any health benefits to also provide private drug coverage for their employees. Seniors, people on social assistance and anyone else who does not get private coverage through their employers are required to contribute to an insurance-style drug plan from the provincial government.

“Québec introduced an insurance-based drug coverage system 20 years ago that was supposed to save taxpayers money,” said Steve Morgan, a professor in the school of population and public health at UBC and lead author of the study. “We found that it came at an astounding cost to Québecers.”

Researchers at UBC, Carleton University, Concordia University and the University of Montréal examined the benefits and costs of Québec’s system, 20 years after it was implemented, and compared the results to the rest of Canada and similar countries around the world.

The researchers found that Québec’s private-public system has increased access to medicines for the working population but it has come at a cost of approximately $200 more per person than the rest of Canada.

Canada as a whole spends $200 more per person than comparable countries that include prescription drug coverage within their universal healthcare systems.

“Private and public spending for medications is 75 per cent more per person in Québec compared to countries with universal pharmacare,” said Marc-André Gagnon, a professor at the school of public policy and administration at Carleton University. “However, as compared to these countries, we are far behind in terms of access to medications: more than twice as many Québecers cannot fill their prescriptions for financial reasons.”

The researchers also found that the increased coverage in Québec is disproportionately expensive for low-income individuals and families compared to households with higher incomes. The premiums under Québec’s partially-subsidized public drug plan can amount to more than three per cent of a $40,000 household income, but only 1.6 per cent for households with an $80,000 income.

Workers with private insurance offered through their employers can end up paying even more as insurers are able to raise premiums annually. Researchers found that the private plans can cost 10 per cent of a person’s income if they are a part-time worker.

“The biggest winners in the Québec system have been the industry stakeholders that have made billions more than they would have made if Québec had implemented a universal public plan 20 years ago,” said Morgan.

A recent report from the parliamentary budget officer estimates that a universal, public pharmacare system would save Canadians more than $4 billion per year while this study suggests that applying Québec’s private-public model in all provinces would cost Canadians over $5-billion more per year than they currently pay.

The researchers say these findings should be considered as the federal government contemplates different models for providing universal pharmacare to all Canadians.

This study was published today in CMAJ.

Source UBC News  via Science Daily



Health Services: Evaluating the effects of Québec’s private–public drug insurance system, Steven G. Morgan, Marc-André Gagnon, Mathieu Charbonneau, and Alain Vadeboncoeur. CMAJ October 10, 2017 189:E1259-E1263;

  Further reading

Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada, Steven G. Morgan PhD, Winny Li MSc, Brandon Yau BSc, Nav Persaud MD MSc. CMAJ February 27, 2017 vol. 189 no. 8 doi: 10.1503/cmaj.161082

Development of a preliminary essential medicines list for Canada, Michael S. Taglione BSc, Haroon Ahmad BA MA, Morgan Slater PhD MSc, Babak Aliarzadeh MPH MD, Richard H. Glazier MD MPH, Andreas Laupacis MD MSc BA, and Nav Persaud BA BSc MD MSc. CMAJ Open. 2017 Jan-Mar; 5(1): E137–E143. Published online 2017 Feb 16. doi: 10.9778/cmajo.20160122

Universal prescription drug coverage in Canada: Long-promised yet undelivered, Steven G. Morgan PhD and Katherine Boothe PhD. Healthc Manage Forum. 2016 Nov; 29(6): 247–254. Published online 2016 Oct 15. doi: 10.1177/0840470416658907

Estimated cost of universal public coverage of prescription drugs in Canada, Steven G. Morgan PhD, Michael Law PhD, Jamie R. Daw BHSc MSc, Liza Abraham BSc, Danielle Martin MD MPubPol. CMAJ April 21, 2015 vol. 187 no. 7 First published March 16, 2015, doi: 10.1503/cmaj.141564

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