Impact of income-based deductibles on drug use and health care utilization among older adults

Law, Michael R.; Cheng, Lucy; Worthington, Heather; Mamdani, Muhammad; McGrail, Kimberlyn; Chan, Fiona K.I.; Majumdar, Sumit R.

doi:10.1503/cmaj.161119

Cited by 10 publications

(8 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, our prior study examining a very similar change from no deductible to a deductible of 2% of household income for those born in 1939 or earlier and after 1939 showed no change in overall drug use. 8 Although the population in that study had incomes just above the threshold in the present study ($15 000-$30 000), we believe that the major difference is the age of the populations under study -an average age of 66 years in the prior study versus 38 years in the present study. This is consistent with differences in cost-related nonadherence reported in a survey study, in which younger populations consistently reported more issues in affording their prescription drugs than did older populations.…”

Section: Discussioncontrasting

confidence: 54%

Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study

Law

Cheng

Worthington

et al. 2019

cmajo

Self Cite

View full text Add to dashboard Cite

D rug coverage in Canada varies widely despite universal coverage for physician and hospital services. 1 Some provinces, including British Columbia, Saskatchewan, Manitoba, and Newfoundland and Labrador, provide coverage through so-called income-based coverage programs. These programs require households to spend a fixed proportion of their household income on prescription drugs before public coverage takes effect. Other provinces have coverage programs that include deductibles for particular segments of the population, such as Ontario's Trillium Program for residents aged 25-64 years. We know from prior surveys that cost-related nonadherence remains an issue for many Canadians. 2 Furthermore, the use of deductibles is potentially problematic, as there is extensive evidence, from both Canada and other countries, that out-of-pocket copayments reduce the use of essential drugs. 3-5 However, the specific impact of income-based deductibles remains less clear. For example, an analysis done shortly after BC's income-based plan Fair PharmaCare was implemented, in 2003, suggested the plan did not alter population-level prescription drug use, 6 whereas, evidence from Manitoba suggested that income-based deductibles decreased the use of inhaled corticosteroids by children with asthma. 7 Yet as with the BC study, the prior coverage regimen in Manitoba included a deductible per family. 7 Our recent study using a

show abstract

Section: Discussioncontrasting

confidence: 54%

Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study

Law

Cheng

Worthington

et al. 2019

cmajo

Self Cite

View full text Add to dashboard Cite

show abstract

“…The results confirm expenditure as a percentage of income is greatest for those with low incomes, consistent with the previous research [ 18 ]. It is worth noting that most government mean tests for healthcare services in Canada use 3–4% of family income as a co-pay cut-off, with values above this qualifying for full coverage [ 28 ]. Finally, the limited literature that does exist on patients with cancers’ OOPC is mostly in a predominately private, for-profit healthcare setting, so this research adds significantly to our understanding of the financial impact when the majority of care is publicly funded.…”

Section: Discussionmentioning

confidence: 99%

Patient and family financial burden associated with cancer treatment in Canada: a national study

Longo

Fitch

Loree

et al. 2021

Support Care Cancer

View full text Add to dashboard Cite

Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. Conclusions In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

show abstract

“…Law and colleagues 1 report that income-based deductibles did not significantly affect drug use or physician and hospital resource utilization among older adults, which runs counter to findings from other such studies. The authors conclude that, in some circumstances, income-based deductibles can be used to help finance drug coverage without affecting adherence to treatment.…”

mentioning

confidence: 66%

The role and impact of cost-sharing mechanisms for prescription drug coverage

Gagnon

2017

CMAJ

View full text Add to dashboard Cite

Impact of income-based deductibles on drug use and health care utilization among older adults

Cited by 10 publications

References 13 publications

Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study

Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study

Patient and family financial burden associated with cancer treatment in Canada: a national study

The role and impact of cost-sharing mechanisms for prescription drug coverage

Contact Info

Product

Resources

About