Medication Access Via Hospital Admission

Abstract

Access to appropriate medications is an important determinant of health. Canada is one of a few countries in the world where outpatients generally pay for medications while medications administered to hospital inpatients are publicly funded. As a result, a significant portion of Canadians does not adhere to treatment regimens because of difficulty paying for medications. Patients are more likely to fill prescriptions if they are not charged. Providing access to medications without charge is known to improve health outcomes and reduce mortality. Under provincial laws, physicians with hospital admitting privileges generally decide which patients should be admitted to hospital based on the level of care they require. In this paper, the authors put forward that to provide patients with long-term access to medications, physicians could lawfully admit those patients to the hospital, administer the medications, and then grant them a leave of absence from the hospital until they require a medication refill. These patients would not occupy a bed in the hospital, yet would have access to essential medications they would not otherwise be able to afford. The paper explores the ethical, professional, and legal implications of admitting outpatients to the hospital for the sole purpose of providing them with medications that, according to the Canada Health Act, must be provided without charge to inpatients. The authors conclude the practice is not only consistent with accepted standards for physicians and with federal and provincial laws, but could also be seen as an ethical, professional and human rights obligation.