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Kolhatkar A, Cheng L, Morgan SG, Goldsmith LJ, Dhalla IA, Holbrook AM, Law MR. Patterns of borrowing to finance out-of-pocket prescription drug costs in Canada: a descriptive analysis. CMAJ Open 2018; 6:E544-E550. [PMID: 30459172 PMCID: PMC6276978 DOI: 10.9778/cmajo.20180063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Out-of-pocket drug costs lead many Canadians to engage in cost-related nonadherence to prescription medications, but our understanding of other consequences such as borrowing money remains incomplete. In this descriptive study, we sought to quantify the frequency of borrowing to pay for prescription drugs in Canada and characteristics of Canadians who borrowed money for this purpose. METHODS In partnership with Statistics Canada, we designed and administered a cross-sectional rapid-response module in the Canadian Community Health Survey administered by telephone to Canadians aged 12 years or more between January and June 2016. We restricted our analyses to participants who responded to the question regarding borrowing money to pay for prescription drugs and used logistic regression to identify characteristics associated with borrowing. RESULTS A total of 28 091 Canadians responded to the survey (overall response rate 61.8%). The weighted proportion of respondents who reported having borrowed money to pay for prescription drugs in the previous year was 2.5% (95% confidence interval 2.2%-2.8%), an estimated 731 000 Canadians. The odds of borrowing were higher among younger adults, people in poor health and people lacking prescription drug insurance. Other factors associated with increased adjusted odds of borrowing were having 2 or more chronic conditions, low household income and higher out-of-pocket prescription drug costs. INTERPRETATION Many Canadians reported borrowing money to pay for out-of-pocket prescription drug costs, and borrowing was more prevalent among already vulnerable groups that also report other compensatory behaviours to address challenges in paying for prescription drugs. Future research should investigate policy responses intended to increase equity in access to prescription drugs.
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Affiliation(s)
- Ashra Kolhatkar
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont
| | - Lucy Cheng
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont
| | - Steven G Morgan
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont
| | - Laurie J Goldsmith
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont
| | - Irfan A Dhalla
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont
| | - Anne M Holbrook
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont
| | - Michael R Law
- Centre for Health Services and Policy Research (Kolhatkar, Cheng, Law), School of Population and Public Health; School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.
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Yoong D, Bayoumi AM, Robinson L, Rachlis B, Antoniou T. Public prescription drug plan coverage for antiretrovirals and the potential cost to people living with HIV in Canada: a descriptive study. CMAJ Open 2018; 6:E551-E560. [PMID: 30482757 PMCID: PMC6276936 DOI: 10.9778/cmajo.20180058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antiretrovirals are expensive and people living with HIV may experience a range of financial burdens when accessing these medications. Our aim was to describe the policy of all Canadian public drug insurance programs for antiretroviral drugs and illustrated how these policies might affect patients' annual out-of-pocket expenditures. METHODS In December 2017, we reviewed public drug programs offering antiretroviral coverage in Canada using government websites to summarize eligibility criteria. We estimated the annual out-of-pocket costs incurred by people living with HIV by applying the cost-sharing rules to 2 hypothetical cases, a single man and a married woman with a net household income of $39 000 and $80 000, respectively, receiving identical prescriptions in different jurisdictions. RESULTS We observed substantial variation in the subsidy provided based mainly on geography, income and age. All 5 federal programs and 6 of 13 provincial and territorial jurisdictions offered universal coverage. In the remaining regions, patients spend up to several thousand dollars annually depending on income (Manitoba), age and income (Ontario, Saskatchewan) and age, income and drug costs (Quebec and Newfoundland and Labrador). We found the greatest variation for our higher income case, with out-of-pocket expenses ranging from 0 to over 50% of the antiretroviral cost. INTERPRETATION There is considerable inter- and intra-jurisdiction heterogeneity in the cost-sharing policies for antiretrovirals across Canada's public drug programs. Policy reforms that either eliminate or set national standards for copayments, deductibles or premiums would minimize variation and could reduce the risk of cost-associated non-adherence to HIV therapy.
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Affiliation(s)
- Deborah Yoong
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
| | - Ahmed M Bayoumi
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Linda Robinson
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Beth Rachlis
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
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Ivers N, Brown AD, Detsky AS. Lessons From the Canadian Experience With Single-Payer Health Insurance: Just Comfortable Enough With the Status Quo. JAMA Intern Med 2018; 178:1250-1255. [PMID: 30083756 DOI: 10.1001/jamainternmed.2018.3568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With single-payer public health insurance again on the political radar in the United States at both the state (California) and federal (Democrat party) levels, the performance of the Canadian health care system during the last 50 years and the lessons it may offer should be considered. Canadians are proud of their universal approach to health insurance based on need rather than income. The system has many strengths, such as the ease of obtaining care, relatively low costs, and low administrative costs, with effectiveness and safety roughly on par with other countries, including those, such as the United States, that spend considerably more per capita. There are increasing frustrations, however, with system performance, especially with issues related to access and coordination of care. Medicine has changed dramatically since the introduction of Canadian Medicare in the late 1960s, which primarily covered acute care physician and hospital services-the needs of the time. Meaningful reforms that match coverage and services to changing needs, especially those of community-based patients with multiple chronic conditions, have been difficult to implement. The status quo represents a compromise struck decades ago between payers and physicians and organizations that provide health care, and the current system works just well enough for those who both need it and vote. Enacting substantial change simply carries too much risk. Perhaps the most important lesson that the United States can learn from Canada's experience during the last 50 years is that a single-payer health care system solves a lot of problems, but it does not equate to an integrated, well-managed system that can readily meet the changing health care needs of a population.
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Affiliation(s)
- Noah Ivers
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario.,Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
| | - Adalsteinn D Brown
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario
| | - Allan S Detsky
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario.,Department of Medicine, University of Toronto, Toronto, Ontario
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Affiliation(s)
- Fiona Clement
- From the Department of Community Health Sciences, O'Brien Institute of Public Health, University of Calgary, Calgary, Alta., Canada
| | - Katherine A Memedovich
- From the Department of Community Health Sciences, O'Brien Institute of Public Health, University of Calgary, Calgary, Alta., Canada
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Gupta S, McColl MA, Guilcher SJ, Smith K. Cost-related nonadherence to prescription medications in Canada: a scoping review. Patient Prefer Adherence 2018; 12:1699-1715. [PMID: 30233150 PMCID: PMC6134942 DOI: 10.2147/ppa.s170417] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The 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. METHODS The 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. RESULTS This 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. CONCLUSION More 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.
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Affiliation(s)
- Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada,
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada,
| | - Sara J Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Queen's University, Kingston, ON, Canada
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