Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010–2015

Edmonds, Sterling; Hajizadeh, Mohammad

doi:10.1007/s10198-019-01074-x

Cited by 21 publications

(20 citation statements)

References 31 publications

(55 reference statements)

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“…The household size and total monthly expenditure in the last month before the survey were the variables used for the analysis. We used the household expenditure on health as the total OOP payment for healthcare services, and the total expenditure (TE) as a proxy for the households’ ability to pay [ 6 , 19 , 20 ]. The household expenditure is more advantageous than the household income because income is likely to be underreported and can vary over time [ 19 , 20 ].…”

Section: Methodsmentioning

confidence: 99%

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Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

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Section: Methodsmentioning

confidence: 99%

“…A health system is equitable if all people have fair access to healthcare, and if the people’s ability to pay is not limiting their healthcare utilization. In healthcare, the perspective of equity study is either healthcare utilization or healthcare financing [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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“…It is important to note that all types of OPHE are inequitable by their nature. 17,25 Thus, OPHE other than drugs and pharmaceutical products costs contribute to overall health system inequity should be given their due consideration. As OPEDP constitute a large portion of total OPHE in Canada, the implementation of universal pharmacare would be a large step towards reducing OPHE and promoting a more equitable healthcare system in Canada.…”

Section: Discussionmentioning

confidence: 99%

“…28 Although budget share (share of healthcare payments from total income/consumption) is used extensively in the current studies, there is no consensus on the threshold of catastrophic payments in the literature. The current studies 11,16,17,25,[29][30][31][32] have used the threshold between 3% of budget share to 40% of the capacity to pay (ie, income/consumption minus subsistence expenditure requirements). Similar to the threshold ranges used in the Statistics Canada's report, 33 we used 3 and 6% of household consumption as the cut-off.…”

Section: Ethical Issuesmentioning

confidence: 99%

“…Several empirical studies have demonstrated the financial hardships suffered by Canadians because of the uninsured costs of pharmaceutical drugs. 11,16,17 Even with brief periods of public attention in the past, the topic of pharmacare has remained relatively untouched by Canadian policy-makers because of a lack of electoral incentives and general concern over costs to be incurred by government 18,19 -despite robust cost proposals by Morgan and colleagues, 20,21 and Wolfson and Morgan. 22 Recently, however, pharmacare has become a central topic of public discussion and political discourse, which is demonstrated by its inclusion in the platforms of major political parties for the recent federal election and the establishment of the federal government's Advisory Council on the Implementation of National Pharmacare.…”

Section: Introductionmentioning

confidence: 99%

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Universal Pharmacare in Canada: A Prescription for Equity in Healthcare

Hajizadeh

Edmonds

2019

Int J Health Policy Manag

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Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.

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Effect of financial inclusion on out-of-pocket health expenditure: empirics from Ghana

2021

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Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010–2015

Cited by 21 publications

References 31 publications

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Universal Pharmacare in Canada: A Prescription for Equity in Healthcare

Effect of financial inclusion on out-of-pocket health expenditure: empirics from Ghana

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