Saturday, June 5, 2010

The real story behind the "professional allowance" debate

The whole thing about drug stores in Ontario crying foul over the province's proposal to end the professional allowances (i.e. kickbacks, there really is no other word for them other than payola) seems to revolve around the argument that services to patients -- um, customers -- will be hurt if the government doesn't come up with enough money to compensate for what will be lost, roughly $750 million per year.    And the whole idea behind eliminating such allowances was to reduce consumer costs and especially for the government which pays a substantial portion of drugs used by seniors and those on social assistance.

The drug stores might have a prima facie argument except for a few things.    For one, when the announcement was made by the province's health minister, Deb Matthews, the largest drug store chain by far in Canada responded by cutting back store hours.    In seven stores.   All in Matthews' London area district.   Coincidence?   If it was, then I have a bridge in Brooklyn I'd like to sell you.

For another drug stores here, like in the United States, do not resemble true health services sales outfits as they do overpriced supermarkets and beauty boutiques.   Since the stores in Ontario have not been able to sell tobacco for years (except in "smoke shops" with a separate entrance) they've had to make do by peddling cosmetics.    Nearly every such store I've been in lately forces the customer through the salon and a tabloid magazine rack before I can even get to the glorified convenience store -- let alone the actual pharmacy counter or the post office, either or both my usual destinations.   I don't begrudge trying to make a buck, but what do most people go into a drug store for?   Drugs, or to buy stamps or send a parcel.    The most important units are in the least convenient locations.    I don't care what they teach in marketing classes, but this is not smart marketing.

The huge profit margins they make from selling groceries and the like should more than make up for any perceived losses from losing the scratch my back money.   And then some.

In defence of the stores, I do have to admit if the government's approach is an overkill reaction to some unscrupulous pharmacists -- a small minority from the whole of the profession -- who figured out how to sell some drugs several times over and bill the Ontario Drug Benefit Plan for such sales even though the drug was only sold once.    If such is the case, then go after the druggists and the drug companies that facilitate what is blatant fraud and don't punish the whole class.   The government sought legal action more than a year ago against the crooks and there's still no resolution from what I've been able to find from my web searches ... but in the same period, the allowances paid jumped from $680 million to $750 million.   That's 10.3%, way above the inflation rate which had been flat or even negative during that time.

The pharmacists say they'd drop their campaign if the government was willing to cough up about $260 million, more than double what they're offering.   The druggists also have suggested the dispensing fee, currently $6.11 ($2 for indigents) and which has been frozen there since 1999, should reflect the actual costs -- which they claim is currently around $11.25 and should be increased in future years to the rate of inflation.    As a comparison, the current co-pay for prescriptions in England where there is universal coverage for all patients regardless of income is £7.20 (about CAD 10.96 at current rates -- the co-pay is lower or nil in the other UK countries).

I could accept that as long as there's a phase in period -- going from $6.11 to $11.25 in one swoop would be too much of a shock for too many.

But let's have some honesty on both sides for a change.    The government should be truthful about why they're doing this and use their time to prosecute those who actually defraud the system.    And it would be nice to see Ontario move towards a universal drug plan like British Columbia and Québec have -- the money from the premium we pay on our income taxes every year must be going somewhere so why not something as primary as the drugs we need?

From the drug stores' side, they need to be honest about what they've been doing to this point and where they are going forward.    Don't unilaterally punish patients or blame the government for all their problems.   And sell drugs and ancillary appliances as your primary business, not your sideline.   As the British pharmacist told Michael Moore in SiCKO! he didn't spend years of training in chemistry just so he could be selling groceries.   That means making the drug counter convenient to get to, not going through an increasingly annoying obstacle course.

In the end, everyone can benefit and businesses can still make a profit.    But not at the expense of holding patients hostage.     In general, I think the McGuinty government is right although their approach leans a bit towards using a sledge hammer to swat a fly.

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