A paper published by the Montreal Economic Institute (MEI) argues that replacing the current public-private health care system with a fully public, national pharmacare system could leave Canadians without access to certain drugs.

While those in favour of a national drug plan argue that it would give the government greater negotiating power with pharmaceutical companies, MEI economist Yanick Labrie suggests that any financial savings would be the result of rationing and not greater efficiency.

"Foreign experience has much to teach us about the dangers of adopting a monopolistic drug insurance system here in Canada," writes Labrie. He singles out the British health care system as an example, and says that UK policies aimed at controlling spending have ultimately prevented patients from obtaining drugs that were available elsewhere in Europe. He also notes that in New Zealand, which also has a fully public plan, only 13% of all the drugs approved between 2009 and 2014 were added to the government’s list of reimbursable products.

Instead of implementing a fully public national plan, Labrie argues that it is worthwhile considering the merits of mixed universal plan like the one Quebec implemented in 1997. Although costs have increased since the system was introduced, Labrie says this is due in large part to the fact that Quebec has resisted, more than other provinces, the temptation to ration access to innovative drugs.

"It is also important to note that this greater spending on drugs coincides with lower spending in the public health care system than elsewhere in the country," he concludes. "As the hospitalization rate has been trending downward since the start of the 2000s, we can deduce that more accessible pharmaceutical therapies in Quebec have likely replaced other kinds of more expensive medical care, like surgeries in a hospital setting."