Multinational Pharmaceutical Companies Shortchange Canada in Research and Development Investments: Is It Time to Pursue Other Options?

In 1987, the government passed legislation to protect brand-name pharmaceutical firms against competition from generic drug brands in exchange for economic investment in Canadian pharmaceutical research and development (R&D). Since 2002, brand-name pharmaceutical companies' R&D investments have fallen short of their commitment, while Canadians now pay the fourth highest drug prices of all the Organisation for Economic Co-operation and Development member countries. In this article, we examine the degree to which brand-name pharmaceutical companies have fallen short of their promises, discuss whether a patent policy is the best strategy to secure Canadian pharmaceutical R&D funding and propose practical alternatives to this arrangement.

Response to the Letter to the Editor.

We thank Dr. calder for her response on behalf of the canadian Medical Protective Association (CMPA) to our article (Lee et al. 2021), and we appreciate the opportunity to address her comments. Dr. Calder claims that we did not undertake a full systematic review. Systematic reviews are distinct research undertakings beyond the objective of this manuscript. Importantly, bias and conflict of interest need to be avoided, and we propose that an organization with a vested interest in the topic is not the appropriate author of such a systematic review. If indeed CMPA has literature that supports their case, we ask them to release such information for critical review. Dr. Calder also critiques our article on the grounds that no-fault compensation would not improve patient safety. We disagree. Countries such as New Zealand and Sweden have had no-fault systems, which do not compromise patient safety, in place for over 40 years, and provide a model for how Canada can do this.

The Induced Productivity Decline Hypothesis: More Physicians, Higher Compensation and Fewer Services.

Public outrage regarding physician shortages during the past two decades have led to policies aimed at significantly increasing physician supply, yet access remains elusive. In this paper, we examine this puzzling trend and the causes underlying it by analyzing physician supply, compensation and productivity and the reasons behind productivity decline. We hypothesize that excess physician compensation beyond a target income induces productivity decline. In contrast to a wage-productivity gap for the average Canadian worker (where productivity has increased but compensation has not kept pace), physicians are experiencing a "reverse wage-productivity gap" whereby compensation is increasing but productivity is decreasing, resulting in more physicians, higher compensation and fewer services. We conclude by discussing potential policy options to address how best to provide timely access to medical care for Canadians while keeping physician healthcare expenditures at sustainable levels.

Canada's System of Liability Coverage in the Event of Medical Harm: Is It Time for No-Fault Reform?

Many Canadians believe that physicians have malpractice insurance via the Canadian Medical Protective Association (CMPA). However, the CMPA is not an insurance company; it is a defence fund for physicians and has no obligation to compensate all claimants. CMPA expenses have increased nearly tenfold in 30 years and although public budgets support the majority of CMPA fees, less than 0.3% of injured patients receive compensation. A reform of the system is vital. Several developed countries have adopted a "no-fault" system to provide more equity and transparency and to ensure that the majority of funds go directly to injured patients rather than toward the payment of legal and administrative fees.

Increased Private Healthcare for Canada: Is That the Right Solution?

Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare - universality and accessibility - as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth. Therefore, increased private financing is not the panacea proposed for improving quality or sustainability. The debate over the future of medicare should not be rooted in the source of its funding but rather in the values Canadians deem essential for their healthcare system.

The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU.

INTRODUCTION: Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations. METHOD: This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units. The associations between these data and neonatal outcomes in extremely preterm infants (born at < 29 weeks' gestation) were then assessed using multivariable analyses. RESULTS: Perceptions of unit culture and QI implementation varied according to occupation and age. Higher hierarchical culture was associated with increased survival without major morbidities (odds ratio, 1.04; 95% confidence interval, 1.01-1.06), as were higher QI implementation scores (odds ratio range, 1.20-1.36 by culture type). DISCUSSION: Our data suggest that organizational culture, particularly hierarchical culture, and level of QI implementation may play a role in neonatal outcomes.