Factors influencing delays in patient access to new medicines in Canada: a retrospective study of reimbursement processes in public drug plans

© 2019 Salek, Lussier Hoskyn, Johns, Allen and Sehgal.Individuals who rely on public health payers to access new medicines can access fewer innovative medicines and must wait longer in Canada compared to major markets around the world. New medicines/indications approved by Health Canada and reviewed for eligibility for reimbursement by the Common Drug Review or the pan-Canadian Oncology Drug Review (CDR/pCODR) from the beginning of 2012 through to the end of December 2016 were analyzed, with data taken from the relevant bodies’ websites and collected by IQVIA. This analysis investigated individual review segments – Notice of Compliance (NOC) to Health Technology Assessment (HTA) submission, HTA review time, pan-Canadian Pharmaceutical Alliance (pCPA) negotiation time, and public reimbursement decision time, and analyzed the trends of each over time and contributions to overall time to listing decisions. Average overall timelines for public reimbursement after NOC were long and most of this time is taken up by HTA and pCPA processes, at 236 and 273 days, respectively. This study confirms that Canadian public reimbursement delays from 2013-2014 to 2015-2016 lengthened from NOC to listing (Quebec + 53%, first provincial listing + 38%, and country-wide listing + 22%), reaching 499, 505, and 571 days, respectively. Over the same period, time from NOC to completion of HTA has increased by 33%, and time from post-HTA to first provincial listing by 44%. The pCPA process appears to be the main contributor to this increasing time trend, and although some provinces could be listing more quickly post-pCPA, they appear to be listing fewer products. Reasons for large delays in time to listing include the many-layered sequential process of reviews conducted before public drug plans decide whether to provide access to new innovative medicines. Although there has been some headway made in certain parts of the review processes (e.g., pre-NOC HTA), total time to listing continues to increase, seemingly due to the pCPA process and other additional review processes by drug plans. More clarity in the pCPA and provincial decision-making processes and better coordination between HTA, pCPA, and provincial decision-making processes is needed to increase predictability in the processes and reduce timelines for Canadian patients and manufacturers.Peer reviewedFinal Published versio

Worksharing in Québec: Five Case Studies

This paper evaluates five recent experiences of worksharing in Québec since 1994: Bell Québec, Alcan, Scott Paper, the Ministère de l'Environnement et de la Faune and Sico. Participation in voluntary worksharing programs was high where workers' sacrifice (lost wages) was not great and where workers had previous experience with shorter or flexible work hours. Where worksharing was mandatory programs were less successful. We draw out implications for policy. To achieve higher participation rates and to give workers experience with shorter hours, governments can play a positive role in financing or kick-starting worksharing programs. Cette étude évalue cinq expériences récentes de partage du travail au Québec depuis 1994 : Bell Québec, Alcan, Les papiers Scott, le Ministère de l'Environnement et de la Faune, et Sico. Le taux de participation aux programmes de partage du travail offerts sur une base volontaire était élevé dans les entreprises où les sacrifices que devaient consentir les travailleurs (les pertes salariales) n'étaient pas considérables et dans celles où les travailleurs avaient déjà fait l'expérience d'un horaire de travail flexible ou réduit. Dans les cas où le partage du travail était imposé, les programmes ont remporté moins de succès. Nous déduisons des conséquences en matière de politique publique. Entre autres, pour atteindre des taux de participation plus élevés et initier les travailleurs à un horaire réduit, les gouvernements peuvent jouer un rôle positif en finançant ou en aidant à démarrer des programmes de partage du travail.Worksharing, work hours, Bell Québec, Alcan, Partage du travail, heures de travail, Bell Québec, Alcan

The Legal Issues Surrounding Free and Open Source Software: Challenges and Solutions for the Government of Québec

The Government of Québec is slowly but surely turning its attention to the issue of free and open source software in response to the interest shown by Québec’s software industry and the attention paid to the phenomenon by governments around the world. This openness is easy to understand given an environment in which online service provision to citizens must be enhanced while minimizing expenditures on technology, curtailing service providers’ control over the administration, and promoting the development of the information society in Québec. Nonetheless, as we see in the news, adoption of this new attitude toward to software development is not always immune to legal challenges. Consequently, the manner in which Québec law interacts with free and open source software, as well as the associated risks, assume a particular significance. The analysis we present here reveals that the law, as it currently stands in Québec, appears adequate to effectively address the various legal issues inherent in the use of free and open source software. First of all, no legal rule seems to be incompatible with the validity of free and open source licences, despite that fact that few of them were designed with the Québec legal system in mind. Moreover, both federal copyright rules and Québec regulations affecting contractual liability allow the authors and users of free and open source software to effectively preserve the freedom of computer code, which is typically the purpose of free and open source licences. Nonetheless, it remains the case that some legal risks are associated with free and open source software. These risks may arise from the formalism requirements included in the Copyright Act, prior violations of intellectual property rights by third parties, or simply from the broader contractual protection afforded to licensors. Consequently, integrating free and open source software into the technology strategy of the Government of Québec requires setting up some initiatives to allow these risks to be mitigated as much as possible and to enable the management of those risks that cannot be completely eliminated.

Taming the waterways: The Europeanization of Southern Québec's riverside landscapes during the 16th–18th centuries

The arrival of Europeans in the New World effected the interaction of 2 temperate biogeographical eco-zones: the Palaearctic and Nearctic. Alfred Crosby has hypothesized that the success of the Europeans as imperialists was due, in part, to the ability of their introduced biota to bring about the collapse of the indigenous populations and local ecosystems, leading to the formation of Neo-European eco-spaces. Through a comparison of paleontological and environmental archaeological data from southern Québec, Canada, we examined Crosby's ecological imperialism model and assessed the biological impact of colonialism on the physical landscape during the 16th to early 18th centuries. The Intendant's Palace site in Québec City is employed as a case study and diachronically contextualized with data from contemporaneous sites in the region. The Europeanization of the landscape as a result of settlement construction, subsistence, and commodification was evidenced through signs of deforestation as well as the arrival of socioeconomic taxa. The biological transfer of European species did not appear to herald the collapse of local ecosystems but rather the establishment of an ecological melting pot along the early colonial waterways of southern Québec

Nationalist movements and the state in Canada and France : ethno-territorial protest movements in Québec and Corsica, 1960 to 1995

Since the early 1960s ethno-territorial movements have increasingly challenged established patterns of political integration in western democracies. The purpose of this paper is to compare the formation and different paths of development of such nationalist movements in Quebec (Canada) and Corsica (France). The paper presents a brief outline of an argument more fully developed in a study on the two cases. After a short introduction I will first discuss theoretical aspects of minority nationalism. Secondly, I will try to give an overview over major findings and conclusions of my study.Ethno-territoriale Protestbewegungen in Kanada und Frankreich bedrohen seit den 1960er Jahren die Muster der politischen Integration in den beiden politischen Systemen. Anhand der Untersuchung der nationalen Bewegungen in Québec und Korsika soll die Frage nach den Ursachen für die unterschiedlichen Entwicklungswege dieser regionalen Protestbewegungen untersucht werden. Im Fall Korsikas kann von einer klaren Radikalisierung der Bewegungen gesprochen werden, die z.T im Untergrund gewaltsam für ein unabhängiges Korsika kämpft. In Québec hingegen konnte sich die nationale Bewegung frühzeitig ins politische System der Provinz integrieren, um von dieser Basis aus den Zusammenhalt der kanadischen Föderation zu bedrohen. In vergleichender Perspektive wird dabei die Interaktion der Bewegung mit der Staatsmacht als zentrale Erklärungsvariable eingeführt.Mouvements de protestation territoriuax au Canada et en France menacent les modèles de l’intégration politique dans le deux sytèmes politiques depuis les annèe 1960. L’exploration des mouvements nationaux au Québec et en Corse, doit Ltre éxaminée les causes pour les développements différentes des ces deux mouvements. Dans la Corse, on peut parler d’un radicalisation du mouvement nationale qui combat en partie puissament dans le sous-sol pour une Corse indépendante. En Québec cependant, le mouvement national pouvait s’intégrer toutefois dans le systèms politique de la province, pour menace de cette base la cohésion de la fédération canadienne. L’interaction du mouvement avec le pouvoir d’ètat est introduit comme variable d’explication de cet évolution

The Progressivity of Income Taxation: A Comparison between Quebec and Ontario

This study compares the progressivity of the income tax of Quebec and Ontario. After observing the predominance of income taxation in Quebec and Ontario, by way of international and interprovincial comparisons and illustrating the presence of progressivity in both provinces, progressivity indicators are described. Using these indicators, we measured the progressivity of the Quebec and Ontario tax systems for four different family situations and six levels of income. The results show that in certain situations, Quebec’s tax system is more progressive while in others, the reverse is true. More specifically, Quebec’s tax system is more progressive for changes in income at the lower end of the income scale while in general Ontario’s system is more progressive for higher incomes. These results confirm the greater concentration of Ontario’s income tax on high-income taxpayers that we have previously illustrated in the study. L’étude compare la progressivité des impôts sur le revenu du Québec et de l’Ontario. Après avoir constaté l’importance de l’imposition du revenu au Québec et en Ontario, par des comparaisons internationales et interprovinciales, et avoir illustré la présence de progressivité dans les deux cas, nous présentons des indicateurs de progressivité. À l’aide de ces indicateurs, nous avons mesuré la progressivité des régimes d’imposition québécois et ontarien pour quatre situations familiales différentes et pour six niveaux de revenus. Les résultats montrent que, dans certaines situations, la progressivité est plus grande au Québec alors que, dans d’autres cas, la progressivité est supérieure en Ontario. Plus précisément, la progressivité est plus grande au Québec pour les variations de revenus au bas de l’échelle des revenus tandis qu’elle est en général plus élevée en Ontario pour les revenus supérieurs. Ces résultats confirment la plus grande concentration de l’impôt ontarien sur le revenu auprès des contribuables à revenu élevé que nous avions précédemment illustrée dans l’étudeQuebec, Ontario, progressivity, income tax, tax policy, indicator, Québec, Ontario, progressivité, impôt sur le revenu, politique fiscale, indicateur

Treason at Quebec: British Espionage in Canada during the Winter of 1759

In the spring of 1760, the British garrison at Québec, commanded by James Murray, found itself the target of a French army intent upon the recapture of the colonial capital. Led by the exceptionally able François de Levis, the French hoped to surprise Murray’s outnumbered and isolated army, but even as the French embarked at Montreal on 20 May, Murray was writing that he had “received certain intelligence” of French preparations and had taken appropriate precautions. Much of this foreknowledge came from British spies working behind the French lines. Although prior to September 1759 the British had not possessed a single operative in Canada, Québec, now in British hands, became the base for a modest espionage organization which proved capable of scattering informants throughout the towns and countryside of New France and recruiting at least one agent in the confidence of the very highest officials of the colonial administration

Nodal Pricing and Transmissions Losses. An Application to a Hydroelectric Power System

Since January 1st, 1997, the wholesale electricity market in the U.S. has been open to competition through FERC Order 888. In order to satisfy the reciprocity requirements which were imposed by FERC to foreign utilities, Hydro-Québec made her transmission grid accessible to third parties. A single flat rate is applied to account for transmission losses; location and time of use play no role. Hydro-Québec is a hydro based utility and it has very long linear high voltage power lines which link hydro power sites in the north to consumption centres in the south. In this paper, we compare three different methods of incorporating transmission losses into nodal prices for a simpplified model of Hydro-Québec electric network: flat rate, linear power loss rates, and quadratic power loss rates. The latter two vary by node and time of use. We estimate that nodal price differences between the flat rate and the quadratic power loss rates can be as large as 27.8% on the producer side and 32.7% on the consumer side. The implications of such price differences for the location of economic activity over the service area could be significant.Electricity, Transmission Pricing, Hydro Power

Les confins nordiques de la Province de Québec, selon l’Acte constitutionnel de 1774

Une théorie veut que la partie du territoire du Québec située entre le Nouveau-Québec et la ligne de partage des eaux séparant les bassins de la baie d'Hudson et du Saint-Laurent ait appartenu à la Compagnie de la Baie d'Hudson au moment de l'adoption de l'Acte de Québec en 1774 et qu'elle ait été ajoutée au Québec en 1898, mais seulement à titre de province canadienne; il en résulterait qu'advenant la sécession du Québec, ce dernier devrait abandonner toute prétention à ce territoire. Le présent texte a pour objectif de démontrer, à la lumière du règlement d'un litige se rapportant à la frontière septentrionale de l'Ontario au siècle dernier, que le territoire en question faisait plutôt partie de la Province de Québec à la suite de la délimitation prévue à l'Acte de Québec.A theory has it that the part of Québec's territory situated between New Québec and the height of land between the Hudson Bay and the St. Lawrence River basins belonged to the Hudson's Bay Company when the Québec Act was adopted in 1774 and that it was not added to Québec until 1898, and then only as a province of Canada. As a consequence, in the event of secession, Québec would relinquish any claim to this part of its present territory. The purpose of this paper is to demonstrate, in light of the settlement of a dispute relating to the northern boundary of Ontario in the XIXth century, that the area in question was really part of the Province of Québec under the terms of delimitation of the Québec Act