When considering whether our health care system offers universal accessibility, we often think of elements such as physician availability and hospital waiting times. But you might expect that two patients in two different parts of Canada, with the identical disease, would receive the same drug treatment. Too often, that isn’t the case.

My experience as a cancer patient, and later as a patient advocate, tells me that Canada simply doesn’t have equal and timely access to effective medications that offer similar outcomes.

You can look at access in a few ways.

At the end of 1995, I was diagnosed with metastatic colorectal cancer, which later went to my liver and lungs. Prognosis – a 30% chance of surviving five years. It’s 15 years and many treatments and surgeries later, and for the last eight I’ve had no recurrence of cancer.

In my case, to obtain the necessary best care, I first had to go to New York State at my own (and great) cost. Later, I entered into a lengthy legal battle to get my costs reimbursed, as the standard of care that was medically required wasn’t available in Canada in a timely manner. Eventually, the Quebec Superior Court ruled in my favour, in a judgment that’s still used as a precedent for reimbursing out-of-country health care.

The reality is that even within this country, the availability and use of drugs can vary tremendously. The same drug may well not be administered or reimbursed in the same manner across jurisdictions.

First, equal access. With oncology drugs, for one, products that are reimbursed on one provincial formulary might not be on another. Why? Because given the added benefit, a province might deem the drug too expensive to cover. So even if there’s a medical consensus on a drug’s effectiveness, there’s no national standard on its application.

You can always buy the drug if your insurance covers it or if you have the money for it. But that’s restricting access. Shouldn’t evaluations by each jurisdiction and the criteria for reimbursement be based strictly on the drug’s merit and clinical practice guidelines?

Equal access is denied in another fundamental way. Some drugs are used as a first line of treatment, others as a second line drug, third line drug, etc. But a cancer drug that’s a first line treatment in one jurisdiction could be considered a second line treatment in another, and reimbursed that way. If your physician thinks you should be getting a different drug, in a different manner than it’s reimbursed, you have a problem.

Next, timely access – getting the drug you need when you need it.

Again, Canada falls short. For one, it generally takes Health Canada longer to approve drugs than it does the FDA in the U.S. But even after drugs are approved in Canada at the federal level, the timing for access is hardly the same across the country.

The Common Drug Review (CDR) conducts an objective review of the clinical and cost effectiveness of drugs, and provides formulary listing recommendations to the publicly funded drug plans in Canada (except Québec). Yet each health authority still has to sign off, and they’re not bound by the CDR recommendation. That leads to great inequities.

For cancer drugs in particular, the Pan-Canadian Oncology Drug Review (launched in fall 2010 everywhere except Quebec) will perform a similar role as the CDR. Currently, each province conducts its own review of new cancer drugs, which results in differences in the formulary listings of drugs and their financial coverage. But again, the decisions of this new review body won’t be binding.

There are other major disparities across Canada when it comes to equal and timely access to drugs. Drugs can be reimbursed differently depending on whether they’re administered orally in intravenously. Cycles of treatment can also be capped in different ways. Will you receive drugs that extend survival or drugs that benefit quality of life? It depends, in part, on your jurisdiction.

This is a matter of individual rights. If you’re struck with an illness, do you have the right to expect the very best care wherever you live? Should that care be available in a consistent manner?

The solutions are complex. The Canada Health Act talks about the importance of “reasonable access” to health services. But define “reasonable”. That’s subject to debate.

The fact remains, however, that the Canada Health Act doesn’t legislate equality. Until governments address this problem, patients in Canada – often without even knowing it – will continue to face barriers to the care they need.

Barry Stein is the President of the Colorectal Cancer Association of Canada, a patient advocate, an attorney, and a cancer survivor.