Mandatory universal drug plan, access to health care and health: Evidence from Canada

Wang, Chao; Li, Qing; Sweetman, Arthur; Hurley, Jeremiah

doi:10.1016/j.jhealeco.2015.08.004

Cited by 34 publications

(18 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To address this issue, Quebec has instituted a mandatory insurance policy, although publications assessing the impact of this policy are lacking. 6,7 Further study assessing the implications of mandatory insurance for private insurance, public support for legislative changes and the impact on out-ofpocket costs would be required before other provinces consider adopting mandatory insurance.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs

et al. 2017

View full text Add to dashboard Cite

Background:Research from 2006 documented substantial variation in medication coverage for residents across Canada. Since then, some provinces have implemented major medication plan reforms. We aimed to update the information on publicly funded medication insurance plans available across Canada and to compare out-of-pocket costs across the country. Methods:We compared provincial medication insurance plans using data from public websites and other public source documents. Using 2 hypothetical clinical examples, we determined the amount and type of a patient's out-of-pocket costs for 5 different patient subtypes that varied based on medication burden, age and income.Results: Each province offers a plan to all residents. Cost-sharing is employed across all provinces. Some residents must pay a premium to receive insurance or must pay 100% of their medication costs until they reach a deductible amount, above which government funding covers a portion of medication costs. With the scenario of low medication burden (medication cost about $500), out-ofpocket costs ranged from $250 to $2100 for higher-income residents and from $0 to $700 for lower-income residents. With the scenario of high medication burden (medication cost about $1800), the corresponding ranges were $250-$2500 and $0-$1100. The variation was due to province of residence, age and income. Interpretation:Variations in out-of-pocket payments continue to exist across the provinces, with some groups facing high expenses. Further work is required to understand the impact of different cost-sharing mechanisms, develop policies to limit out-of-pocket expenses and improve provincial drug plans. AbstractResearch CMAJ OPEN, 5(4) E809

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Our results lend support to calls for a national pharmacare program, which could potentially reduce prevalence of cost-related nonadherence by providing universal prescription insurance. [35][36][37] However, as suggested by our finding that 564 (6.3%) of the 8943 insured adults in our sample reported cost-related nonadherence, the extent to which insurance mitigates cost-related nonadherence depends on the out-of-pocket expenditures required. The dose-response relation between food insecurity and cost-related nonadherence that we found suggests the need for greater reductioneven exemption -of out-of-pocket drug expenses among those experiencing more severe food insecurity.…”

Section: Openmentioning

confidence: 53%

Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study

Men

Gundersen

Urquía

et al. 2019

cmajo

View full text Add to dashboard Cite

rescription drugs in Canada are covered by a patchwork of public and private insurance. Social assistance recipients are generally covered by public insurance, as are most older adults and Aboriginal people, 1 but most working-age adults rely on private insurance linked to their employment. 2 For those with no other drug coverage, provincial governments offer catastrophic insurance that caps the out-of-pocket expenses to a fixed amount or percentage of income. 3 Yet there are over 4 million Canadians not enrolled in a drug insurance plan. 4 Moreover, deductibles, coinsurance and copayment are common out-of-pocket expenses in both public and private insurance programs. 1 Law and colleagues 5 conducted a populationbased cross-sectional survey to study the consequences of patient charges for prescription drugs in Canada in 2016. They estimated that cost-related medication nonadherence-delaying, reducing or skipping prescribed medication owing to cost-was experienced by 8.2% of Canadians with a prescription in the previous year. The rate was especially high for young adults, lower-income households and those without drug insurance. An estimated 4.7% of Canadians cut other expenses to afford prescription drugs, with half of them reducing food spending, 5 which suggests a link to household food insecurity. Food insecurity, defined as inadequate access to food owing to financial constraints, affected 12.6% of Canadian households in 2012. 6 It has been linked to increased prevalence of chronic conditions, 7 poorer disease management, 8-10 greater use of health care services 11,12 and higher mortality risk in Canada. 13 The mechanisms by which food insecurity affects health remain largely unknown, but cost-related nonadherence is one potential pathway. Financially vulnerable households often make trade-offs among necessities such as food and medication. 14-16 Depending on the degree of financial

show abstract

“… 10 , 42 Three studies were based on qualitative methods. 43 – 45 One study adopted a natural experimental design, 46 while one was based on interrupted time series analysis. 47 One of the included studies was a review article, 48 while one was based on a small survey.…”

Section: Resultsmentioning

confidence: 99%

Cost-related nonadherence to prescription medications in Canada: a scoping review

Gupta¹,

McColl²,

Guilcher³

et al. 2018

PPA

View full text Add to dashboard Cite

PurposeThe evidence is emerging that prescription medications are the topmost drivers of increasing health care costs in Canada. The financial burden of medications may lead individuals to adopt various rationing or restrictive behaviors, such as cost-related nonadherence (CRNA) to medications. Therefore, the purpose of this study is to provide an overview of the type, extent, and quantity of research available on CRNA to prescription drugs in Canada, and evaluate existing gaps in the literature.MethodsThe study was conducted using a scoping review methodology. Six databases were searched from inception till June 2017. Articles were considered for inclusion if they focused on extent, determinants, and consequences of CRNA to prescription medication use in the Canadian context. Variables extracted for data charting included author(s), year of publication, study design, the focus of the article, sample size, population characteristics, and key outcomes or results.ResultsThis review found 37 studies that offered evidence on the extent, determinants, and consequences of CRNA to prescription medications in Canada. Depending on the population characteristics and province, the prevalence of CRNA varies between 4% and 36% in Canada. Canadians who are young (between 18 and 64 years), without drug insurance, have lower income or precarious or irregular employment, and high out-of-pocket expenditure on drugs are most likely to face CRNA to their prescriptions. The evidence that CRNA has negative health and social outcomes for patients is insufficient. Literature regarding the influence of prescribing health care professionals on patients’ decisions to stop taking medications is limited. There is also a dearth of literature that explores patients’ decisions and strategies to manage their prescription cost burden.ConclusionMore evidence is required to make a strong case for national Pharmacare which can ensure universal, timely, and burden-free access to prescription medications for all Canadians.

show abstract

Mandatory universal drug plan, access to health care and health: Evidence from Canada

Cited by 34 publications

References 47 publications

Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs

Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs

Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study

Cost-related nonadherence to prescription medications in Canada: a scoping review

Contact Info

Product

Resources

About