The Bureau found that to compete for space on pharmacies' shelves, generic manufacturers offer rebates or other payments to pharmacies in most provinces. Public sources and information provided by parties interviewed for this study indicate that these are on average 40 per cent of the price the pharmacy is invoiced. Under the present system, in most provinces, pharmacies have limited incentive to pass on these cost savings to those who pay for them -- public and private plans, people paying out of pocket, and taxpayers.

"Canadians deserve to reap the benefits of the competition we observed," said Sheridan Scott, Commissioner of Competition. "This study helps to explain why they are not, and points to possible solutions."

Pharmaceuticals are the second-largest and fastest-growing source of health care costs in Canada. Generic drugs play an important part in helping to control prescription drug costs and provide competition for brand-name products when their patent protection ends. Despite this, several studies have found the price of prescription generics to be high in Canada compared to other countries.

Shifting the focus of generic competition from the pharmacies to public and private insurers and consumers could provide Canadians with large savings. In its study, the Bureau says measures for accomplishing this goal may include:

Providing manufacturers with incentives to compete to be listed on provincial and private plan lists of drugs that will be reimbursed;

Having plan providers decide which versions of generic drugs will be dispensed at the pharmacy based on a bidding process by manufacturers;

More in-depth monitoring of the net price paid by pharmacies for generic drugs to ensure the price paid by the plan reflects the rebates given to pharmacies; and

An increased role for private plans in obtaining lower prices for their customers.

The Competition Bureau will continue its work in the generic drug sector by examining possible options for obtaining the benefits from competition and the impediments to their adoption.

1996 to 2001
Despite improvements over time in indicators such as infant mortality, adverse birth outcomes continue to be a concern in industrialized countries. This is especially true for preterm birth, which is the single most important cause of perinatal mortality.

Unlike socio-economic disadvantage, recent immigration is less well understood as a dimension of potential disparities in birth outcomes.

This article, published today in Health Reports, analyzes differences in birth outcomes in Toronto on the basis of neighbourhood income and recent immigration.

The study examined 143,030 singleton live births to mothers in Toronto between April 1996 and March 2001. It divided neighbourhoods into five income groups from the highest one-fifth to the lowest, based on the proportion of their population below Statistics Canada's low-income cutoff.

The study found that regardless of where they lived in the city, recent immigrants to Toronto had the same risk of having good birth outcomes. This was in sharp contrast to the situation for longer-term residents, for whom a lower neighbourhood income increased the risk of preterm birth and other negative birth outcomes.

Among long-term residents, those in neighbourhoods with the lowest income had a 34% greater risk of preterm birth, compared with mothers in neighbourhoods with the highest income. This trend did not apply to recent immigrants.

To some extent, the relatively good birth outcomes for recent immigrant mothers may be explained by the "healthy migrant effect." For instance, recent immigrant mothers were less susceptible to conditions that can cause preterm birth. They had a lower prevalence of maternal illnesses, such as genito-urinary infection and pregnancy-induced hypertension, compared with longer-term residents.

While the study found that births to recent immigrant mothers were less likely to be preterm, paradoxically, they were more likely to be low birthweight and full-term low birthweight.

But although low birthweight was more common among recent immigrants, as it was for long-term residents of low-income neighbourhoods, the causes were likely different.

It is unlikely, for instance, that low birthweight among recent immigrant mothers would be due to higher cigarette and alcohol consumption, though these would be factors for longer-term residents. Rather, differences in body measurements and diet between recent immigrants and long-term residents were more likely causes.

Women born in southern and eastern Asia—which include countries that have provided the largest share of recent immigrants to Toronto—tend to be shorter and lighter and to have a lower caloric intake than longer-term residents. Such factors are known to contribute to smaller babies and, consequently, lower birthweight.

The study, "Birth outcomes by neighbourhood income and recent immigration in Toronto," is part of today's online release of Health Reports, Vol. 18, no. 4 (82-003-XWE, free), now available from the Publications module of our website.

For more information, or to enquire about the concepts, methods or data quality of this article, contact Marcelo Urquia (416-864-6060 ext. 3340; marcelo.urquia@utoronto.ca), University of Toronto.