Research Pillar: Health Services

Prescription medicines play a key role in the treatment and prevention of disease, as evidenced by the fact they are the second-largest and fastest-growing component of health care expenditures in British Columbia. Dr. Michael Law's research program includes studies on the broad themes of pharmaceutical policies, coverage, and costs. Pharmaceutical Policies. In January 2009, a policy change in British Columbia gave pharmacists the authority to independently modify and renew prescriptions. While this policy was intended to improve patient access to drugs and reduce the already heavy burden on primary care physicians, concerns have been raised about potential negative effects on patient safety due and reduced continuity of care. This policy has not been rigorously evaluated.

Dr. Law is currently studying the effects of this policy change on drug utilization and costs, patient adherence to medication, and the number of visits patients make to physicians and hospitals. Pharmaceutical Coverage. Canadians pay for prescription drugs through a patchwork of mechanisms, including public drug programs, private drug insurance, and out-of-pocket payments. In 2008, private insurers paid $9.3 billion in drug costs, representing 31% of overall expenditure. Despite this, we have little sense for how private health benefits plans are changing in light of tough economic times. He is currently leading an investigation into private drug insurance benefits in Canada. Pharmaceutical Costs.

Dr. Law is conducting a series of studies on pharmaceutical costs. This research includes a Health Canada-funded study investigating the factors related to cost-related non-adherence to prescription medicines, an investigation into generic drug prices in Canada compared to international peers, and a continuation of his past work studying the influence of direct-to-consumer advertising on prescribing of medicines. Dr. Law’s research promises to help inform the future design and refinement of important and controversial pharmaceutical policies, provide insights into the trends in private drug insurance benefits in Canada, and create greater understanding of the influence of drug pricing on compliance. This research has the potential to create important changes in the health care system.

In Canada, health system funding has reached a crisis point. Not only are health care costs continuing to rise, but there are increasing conflicts about how these funds are allocated. Provinces are exploring different policies to improve the safety, efficiency, and efficacy of care, including patient-based payment for hospitals to increase 'volume' of hospital care, targeted pay-for-performance programs to reduce wait times, and alternative payment plans for physicians. While these funding policies are designed to change the incentives of providers and health care organizations, there are few methods to measure whether these policies are actually leading to health system improvements.

Dr. Jason Sutherland's applied research program examines the system-level and patient-level effects of new and existing funding policies. This program of research will help measure how health system expenditures are improving the health of BC’s residents, improving co-ordination between settings, and improving the quality of care. His work will assist policy- and decision-makers to interpret the complex relationships between health funding policies, health expenditures, utilization, gain in health, and health outcomes. This program of health services research has the potential to improve the effectiveness, efficiency, and equity of British Columbia's, and Canada's, health care system. By understanding how policy-makers’ decisions are impacting the health care residents receive, Canada's health system decision-makers will be more empowered to make the best decisions.