Medication access via hospital admission

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. The nationally representative Canadian Community Health Survey revealed that 9.6% of Canadians report not adhering to treatment regimens because of difficulty paying for medications; this number is more than 3 times higher among those in lower income brackets (35.6%). The rate of nonadherence is greater for more expensive medications, and 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. 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. For example, a patient who does not have private insurance and who cannot afford diabetes treatments would be administratively admitted to a hospital without ever setting foot inside but would be dispensed metformin or insulin from the hospital’s pharmacy.

We explore 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. We conclude the practice is consistent with accepted standards for physicians and with federal and provincial laws.