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JIM VIBERT: Seniors want health-care bureaucrats out of the way

Nova Scotians trust their doctors. So should the policymakers and gatekeepers for the Pharmacare program, writes Jim Vibert.
Nova Scotians trust their doctors. So should the policymakers and gatekeepers for the Pharmacare program, writes Jim Vibert. - Stock

Some Nova Scotia seniors say the provincial government could make an immediate improvement to their health care — and the quality of their lives — by getting the health bureaucrats out of the way and letting doctors practise medicine.

In the past week, Premier Stephen McNeil announced details about a bevy of new health facilities in Cape Breton, added 16 new spaces for Nova Scotians at Dalhousie’s Medical School and announced a new medical centre for Middleton, in his own riding.

But the benefits for Nova Scotians from those announcements are mostly years off. The exception is the new centre in Middleton. The premier announced it Tuesday, construction will start this fall, and the new facilities should be ready to use in a year.

The Middleton announcement, and the speed with which the province can get certain projects done, was not lost on folks in Pugwash and along Cumberland County’s north shore. The premier was in their neck of the woods in April 2017 — just a couple of weeks before he called a provincial election — to announce a new hospital for Pugwash, with construction to start in 2018.

There’s been no sign — in Pugwash anyway — of work on the new hospital, leaving some to suspect that it became a lower priority when Cumberland North elected Conservative Elizabeth Smith-McCrossin in that 2017 election. The Health Department reports that the Pugwash hospital has made it to the “design and development” phase, and funding for the hospital is in the current year’s capital plan.

While the folks in northern Cumberland County endure the political-bureaucratic slow-walk to their new hospital, seniors across Nova Scotia are bumping up against another bureaucratically constructed barrier to better health care.

Nova Scotians trust their doctors. So should the policymakers and gatekeepers for the Pharmacare program

Some commonly prescribed medications are only covered by seniors’ Pharmacare after the patient’s doctor seeks and receives a “special approval” from the Pharmacare program.

And seniors in need of these “special approvals” report that their doctors are reluctant to seek them because it often leads the docs into a time-consuming back-and-forth with Pharmacare coverage gatekeepers.

In a province where family doctors are at a premium — those with one are afraid of losing one and many of those without one are just afraid — you’d expect the health bureaucracy to be working to free doctors from needless paperwork so they can see more patients.

You’d be wrong. Lots of medications — particularly newer, more effective and generally more expensive drugs — aren’t covered by Pharmacare unless the doctor is willing to devote whatever time the health bureaucracy deems necessary to gain the “special approval.”

Doctors report that they run this gauntlet with medications to treat diabetes, dementia and when it comes to blood thinners, you’d think someone in the decision-making tree was heavily invested in Warfarin.

Despite significant advances in blood medications, Warfarin is the blood-thinner of choice for Nova Scotia’s Pharmacare plan, and until and unless there’s proof that it’s not working, it’s the blood-thinner Pharmacare subscribers receive.

Granted, Warfarin has been thinning blood and killing rats for decades, but patients on it need to be monitored, with regular blood tests generally followed by a doctor’s appointment. The newer medications — those that require “special approval” in Nova Scotia — do not require that level of monitoring, eliminating the blood testing, etc. So, Warfarin, while cheaper than the newer drugs in this class, may be a false economy when the costs of monitoring are added.

Plus, seniors on the newer drugs are freed from a monthly ritual of blood tests and follow-up visits to their doctors. The newer meds improve their quality of life.

Nova Scotians trust their doctors. So should the policymakers and gatekeepers for the Pharmacare program, and they can start by removing the “special approval” requirement for drugs that are covered routinely by private insurance plans.

The province says the Nova Scotia Pharmacare criteria are consistent with other publicly funded drug programs in Canada.

“To provide the information that a patient meets the coverage criteria (for “special approval’), a prescriber (a doctor, possibly a nurse practitioner) can either provide a written request or call the Pharmacare program to speak directly with a staff pharmacist consultant,” the Health Dpartment wrote in reply to questions about the special approvals. Doctors report that gaining “special approval” often requires they do both.

This seems to be one of those places where the government could actually streamline — or remove — bureaucracy and improve frontline health care, which was a central theme for the Liberals before they got to government.

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