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1. Explain the essential differences between the Canadian and American health care systems. Are the five principles of the Canada Health Act expressed and/or achieved in the health care systems of both Canada and the United States? Consider the development of a parallel private health care system in Canada and the inequities it fosters. Don’t forget to rely on peer-reviewed public literature in addition to the relevant textbook chapters that we have covered so far.

2. How have the different political, economic, and ideological histories of Canada and the United States fostered the development of the Canadian and American health care systems as we know them today? You may want to consider the current Obamacare (as part of the Affordable Care Act) controversy within the context of the current government and its ideologies in the United States. Do we see similar controversies in Canada? Why or why not, given the ideological ecosystem in Canada and the United States? Don’t forget to rely on peer-reviewed public literature in addition to the relevant textbook chapters that we have covered so far.

3. How has the issue of access to pharmaceuticals been addressed in Canada and the United States? What is the current Canadian initiative that is advocating for a national pharmacare program for Canadians? Would this national program help to further or hinder the five Canada Health Act principles? Don’t forget to rely on peer-reviewed public literature in addition to the relevant textbook chapters that we have covered so far.

The Current Status of Prescription Drug Access in Canada

Many clinicians, academics and the public have been perplexed since 2009 by the fact that prescription drugs are used outside hospital setting though its’ the main treatment modalities in health care (Stephens, Handke&Doshi, 2012). Despite Canada having overall public health care system it lacks coverage for prescription drugs which are even with adverse consequences for Canadians due to gaping holes in the system(Stephens, Handke&Doshi, 2012). Canada comparator nations are far much ahead as Canada lags behind in relation to accessibility to cheap prescriptions, safeand quality use of medication, as well as technology use like e-prescription which has the ability to improve the system(Stephens, Handke&Doshi, 2012).

How Canada has addressed issues of access to pharmaceuticals

Though there were many other proposed solutions in the past, only the national pharmaceutical strategy which was applauded as the most acceptable step that would help in critical issues in public policy concerningcheap pharmacotherapy and safety of medication use achieving good monetary value and also very important achieve improved health(Stephens, Handke&Doshi, 2012). The prime minister and premiere ministers gave 9 specific action items. This included developing, assessing and cost options for catastrophic pharmaceutical coverage, establishment of a national drug formulary for jurisdiction participatory based on cost effectiveness and safety, strengthening the evaluation of real world drug safety and effectiveness, pursue better strategies for purchasing the drugs and vaccine in best prices, accelerate the accessibility of generic drugs, broadening  the practice of e-prescribing and development of electronic health records and lastly enhancing the analysis and cost-effectiveness policies(Stephens,  Handke&Doshi, 2012).  

The health minister in 2005 renewed their commitment to the strategyadding an article which was linked toinsurance of rare diseases that were very expensive(Stephens, Handke&Doshi, 2012). Four years later after the launching, people worried of what had happened to the strategy but later on Jan. 30, 2009 2 reports by a nongovernment agency known as the Health Council of Canada responded to this worry and definedclear guidelines to follow infuture(Eades, Ferguson & O'Carroll, 2011).

Despite all the guidelines offered to improve the national pharmaceuticals strategy the councilfor health believesthat little has been achieved in the commitment made which is less than satisfactory. The council suggests that stakeholders should renew their commitment to the realization of the principles of a national drug policy strategy(Stephens, Handke&Doshi, 2012).

The United States is leading in per capita prescription drug spending globally with a representation of 30 to 40 percent of all worlds’ market(Lee, Fischer, Shrank, Polinski&Choudhry, 2012).  Recent studies published reports that there has been a drop in research funding in US even as other studies had earlier reported that in 2007, 40 percent of the worldwide total of nearly 6,500 drugs in clinical development were from U.S(Lee, Fischer, Shrank, Polinski&Choudhry, 2012).Researchers point further that, disappointment in recent years over the commitment that were made by the National Institutes of Health (NIH) to biomedical research promising to develop new treatments due to inflammatory losses, budget cut and increases in development costs(Lee, Fischer, Shrank, Polinski&Choudhry, 2012). Since 2003-2015 there has been decrease in NIH budget by 22 %, while in 2016 congress increased very little commitment by adding 5.9%. Most expert fear that more budget is required and if the trend continues in this area US could be risking seeing reduction in in NIH funded research output in very near future (Lee, Fischer, Shrank, Polinski&Choudhry, 2012).

Canada's National Pharmaceutical Strategy and its Action Items

In the last decade American pharmaceuticals industry have been profitable especially since the introduction of the Affordable Care Act, also known as Obamacare.As of 2015, 16.9 million Americans who were uninsured got insured as a result of Obamacare(Lee, Fischer, Shrank, Polinski&Choudhry, 2012). Drugs are too expensive in US making majority unable to afford despite having increased access to prescription drug coverage(Lee, Fischer, Shrank, Polinski&Choudhry, 2012). This means also that, people still are not able to afford insurance or co-pays. Non-compliance to medicine is a serious problem in US.

The current Canadian initiative that is advocating for a national pharmacare program for Canadians

There are new approaches developed to rewarding pharmaceutical innovation. There are proposed mechanisms believed to be more effective and include ‘push’ and “pull” programs.The two are alternatives to the patent system that would effectively increase innovation. They subsidize the cost of drug discovery(Stephens, Handke&Doshi, 2012). They have received more attention in public subsidy of basic research public subsidy III clinical trials (Stephens, Handke&Doshi, 2012). Public subsidies for basic research have been in existence since Canadian Institutes of Health Research and US National Institutes of Health budgets have been put to sponsoring basic research germane pharmaceutical research and development(Stephens, Handke&Doshi, 2012).

Phase III public funding of clinical trials is meant to release single largest cost of research and development (about 21%) from drug companies(Stephens, Handke&Doshi, 2012). Public spending on clinical trials is also the focus to be relatively modest because government already spends a lot of clinical trials, government incur expenses lesser by 11% expenses incurred by medication industry, and lastly fear of public funding tempering with the tendency of regulators to impose additional restrictions on conduct of clinical trials(Eades, Ferguson & O'Carroll, 2011).

Royalty-based schemes

Pull programs appear in two tastes which includes paid royalties and publicly funded payments (Stephens, Handke&Doshi, 2012). Royalty schemes means firms bid for the rights to ‘drug candidates’. Bids have royalty rates that would accumulate from all firms selling the drug if there is regulatory approval of the product(Stephens, Handke&Doshi, 2012).

Firm which bid the lowest royalty rate wins the auction but covers remaining costs for the drug development and clinical trials which reflects expectations of the remaining costs, conditional on approval, and the likelihood of regulatory approval(Stephens, Handke&Doshi, 2012).

Reward-based scheme

For low-income countries, Kremer and Glennersterproposed guarantee subsidies from the government for pre-specified totalvaccines units created(Stephens, Handke&Doshi, 2012). These subsidies would reduce prices to consumers at once by creating a profitableinducementdevelopment of vaccine research.

The five Canadian Health Act principles are portability, accessibility, universality, comprehensiveness and public administration(Eades, Ferguson & O'Carroll, 2011). The above program would see Canada move to greater heights in the provision of pharmaceuticals to her citizen if the stakeholders would remain focus to implement it.

Conclusion

People with low income require the most ultimate support from the government. The government should insure her people, subsidize medication services or even reduce taxing on medicine so that people can afford. Also it would be more advisable if the government supported public research so as to increase affordable medical care. The US government should try new ways to reduce the cost of drugs which is not affordable to all its citizens. This means even though the US government is trying its best to insure as many citizens there are more which is required to be done.

References

Lee, J. L., Fischer, M. A., Shrank, W. H., Polinski, J. M., &Choudhry, N. K. (2012). A systematic review of reference pricing: implications for US prescription drug spending.

Stephens, J. M., Handke, B., &Doshi, J. A. (2012). International survey of methods used in health technology assessment (HTA): does practice meet the principles proposed for good research?. Comparative Effectiveness Research, 2, 29-44.

Eades, C. E., Ferguson, J. S., & O'Carroll, R. E. (2011). Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC public health, 11(1), 582.

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