Provinces will begin bulk-buying several different generic drugs as part of the first steps Canada's premiers are taking to make health care less costly and more efficient for Canadians.

The initiative was introduced Thursday at the Council of Federation, the annual gathering of premiers, as part of a report on health care co-authored by Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz.

A national competitive bidding process is to be initiated by this fall, according to the recommendations in the report. It says this will "result in lower prices taking effect by April 1, 2013."

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However, premiers are not clear exactly how much the savings will be. And although all of the premiers endorsed the report, it is not incumbent on the provinces to adopt the measures.

Ontario Premier Dalton McGuinty noted that his province is going "a little bit further, perhaps a little bit more quickly" than what is suggested in the report. He said that on the matter of generic drug costs his government's actions have already saved Ontario taxpayers over $500-million annually.

Besides bulk-buying of the drugs, the report - From Innovation to Action - also looked at other areas of the health-care system, including managing chronic diseases.

In the report, which the two premiers worked on for only six months, they call for a standardized approach to dealing with wounds and foot ulcers, related to diabetes.

Premier Wall noted that in Saskatchewan last year there were 453 people hospitalized because of foot ulcers. And he said that 30 per cent of those hospitalizations would be unnecessary if they adopted the recommended standard of care outlined in the report. As well, there were 118 foot amputations of which 80 per cent were unnecessary. This cost the province between $3- and $4-million.

"They didn't need to happen if we were using the standard of care ...," said Premier Wall.

The report lists a number of clinical practice guidelines for the ulcer treatment, such as preventative measures including better monitoring of an individual's lifestyle, body weight and annual or even more frequent examination of feet in high risk individuals.

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The premiers took up leadership on the health care file after the Harper government decided to "absent itself," said Nova Scotia Premier Darrell Dexter, the host of this summer's gathering, from the debate.

"We took it upon ourselves to provide that leadership," said Premier Dexter, who has repeatedly called for a first minister's conference to talk about national issues such as health care and the economy.

There has not been a first ministers' conference since 2008.

The Premiers were highly critical of the federal government for not negotiating with them for a new health accord. The one negotiated between the then Paul Martin government and premiers expires in 2014.

Late last year Stephen Harper told the provinces that they would have the funding it wanted for health care but left the ball in their court. Health care delivery is a provincial responsibility.

Provinces have tried before to co-ordinate on health care issues but have failed. This time, however, is different, claimed PEI Premier Ghiz because they are now co-operating at the "premier level."

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"We decided as provinces we don't need the federal government ... we run the health-care system," said Premier Ghiz, noting that the "only thing" the federal government does is "provide a cheque for about 20 per cent of the costs ..."

He said the recommendations in this report are things that the provinces can accomplish "without the federal government being at the table."