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Wood TF, Murphy RA. Combattre la toxicité financière associée aux soins contre le cancer au Canada. CMAJ 2024; 196:E612-E614. [PMID: 38719219 PMCID: PMC11073827 DOI: 10.1503/cmaj.230677-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Affiliation(s)
- Truman F Wood
- École de santé publique (Wood, Murphy), Université de la Colombie-Britannique; Service de recherche sur la lutte contre le cancer (Cancer Control Research) (Murphy), Institut de recherche sur le cancer de la Colombie-Britannique, Vancouver, C.-B
| | - Rachel A Murphy
- École de santé publique (Wood, Murphy), Université de la Colombie-Britannique; Service de recherche sur la lutte contre le cancer (Cancer Control Research) (Murphy), Institut de recherche sur le cancer de la Colombie-Britannique, Vancouver, C.-B.
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Abdelrehim M, Singhal S. Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study. BMC Oral Health 2024; 24:503. [PMID: 38685013 PMCID: PMC11057150 DOI: 10.1186/s12903-024-04271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health. METHODS This study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)-bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables. RESULTS Analysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20-39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as "fair to poor" more than those earning more. Adjusted estimates revealed that respondents aged 20-39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12-19. Additionally, those aged 40-59 were two times more likely to report poorer oral health status compared to those aged 12-19. CONCLUSION Given the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.
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Affiliation(s)
- Mona Abdelrehim
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Wood TF, Murphy RA. Tackling financial toxicity related to cancer care in Canada. CMAJ 2024; 196:E297-E298. [PMID: 38467415 PMCID: PMC10927292 DOI: 10.1503/cmaj.230677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Affiliation(s)
- Truman F Wood
- School of Population and Public Health (Wood, Murphy), University of British Columbia; Cancer Control Research (Murphy), BC Cancer Research Institute, Vancouver, BC
| | - Rachel A Murphy
- School of Population and Public Health (Wood, Murphy), University of British Columbia; Cancer Control Research (Murphy), BC Cancer Research Institute, Vancouver, BC
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Abdelrehim M, Ravaghi V, Quiñonez C, Singhal S. Trends in self-reported cost barriers to dental care in Ontario. PLoS One 2023; 18:e0280370. [PMID: 37418457 PMCID: PMC10328358 DOI: 10.1371/journal.pone.0280370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket. OBJECTIVES i) to explore trends in self-reported cost barriers to dental care in Ontario; ii) to assess trends in the socio-demographic characteristics of Ontarians reporting cost barriers to dental care; and iii) to identify the trend in what attributes predicts reporting cost barriers to dental care in Ontario. METHODS A secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson regression was used to calculate unadjusted and adjusted prevalence ratios to determine the predictors of reporting a cost barrier to dental care. RESULTS In 2014, 34% of Ontarians avoided visiting a dental professional in the past three years due to cost, up from 22% in 2003. Having no insurance was the strongest predictor for reporting cost barriers to dental care, followed by being 20-39 years of age and having a lower income. CONCLUSION Self-reported cost barriers to dental care have generally increased in Ontario but more so for those with no insurance, low income, and aged 20-39 years.
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Affiliation(s)
- Mona Abdelrehim
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Pico-Espinosa OJ, Hull M, MacPherson P, Grace D, Lachowsky N, Gaspar M, Mohammed S, Truong R, Tan DHS. Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey. CMAJ Open 2023; 11:E560-E568. [PMID: 37369522 PMCID: PMC10310342 DOI: 10.9778/cmajo.20220113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV is underutilized. We aimed to identify barriers to use of PrEP and strategies that may facilitate its uptake. METHODS Gay, bisexual and other men who have sex with men, aged 19 years or older and living in Ontario and British Columbia, Canada, completed a cross-sectional survey in 2019-2020. Participants who met Canadian PrEP guideline criteria and were not already using PrEP identified relevant barriers and which strategies would make them more likely to start PrEP. We described the barriers and strategies separately for Ontario and BC. RESULTS Of 1527 survey responses, 260 respondents who never used PrEP and met criteria for PrEP were included. In Ontario, the most common barriers were affordability (43%) and concern about adverse effects (42%). In BC, the most common reasons were concern about adverse effects (41%) and not feeling at high enough risk (36%). In Ontario, preferred strategies were short waiting time (63%), the health care provider informing about their HIV risk being higher than perceived (62%), and a written step-by-step guide (60%). In BC, strategies were short waiting time (68%), people speaking publicly about PrEP (68%), and the health care provider counselling about their HIV risk being higher than perceived (64%), adverse effects of PrEP (65%) and how well PrEP works (62%). INTERPRETATION Concern about adverse effects and not self-identifying as having high risk for HIV were common barriers, and shorter waiting times may increase PrEP uptake. In Ontario, the findings suggested lack of affordability, whereas in BC, strategies involving health care providers were valued.
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Affiliation(s)
- Oscar Javier Pico-Espinosa
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Hull
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Paul MacPherson
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Daniel Grace
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Nathan Lachowsky
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Gaspar
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Saira Mohammed
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Robinson Truong
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Darrell H S Tan
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
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Nauenberg E, Yurga E. Public-private partnership alternative for a national pharmacare program in Canada. J Pharm Policy Pract 2023; 16:21. [PMID: 36747233 PMCID: PMC9903457 DOI: 10.1186/s40545-023-00526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recently, the government and an opposition party cut a deal that involved a promise to consider implementing a single-payer pharmacare scheme in Canada in exchange for supporting the current minority government. There have been political headwinds from the private extended health insurance industry, the provinces of Ontario and Quebec, as well as the pharmaceutical industry. We suggest a new multiple-payer of mixed-resort framework that achieves both the goal of universal coverage and preserves the private extended health insurance industry through a scheme based on the current coordination of benefits between private payers in this sector. METHODS We employ game theory to better understand the dynamics within a market that involves multiple payers. In particular, we use the game of Collective Action to help illustrate the problems of free-ridership. RESULTS An analysis of the dynamics of this market suggests that ex-ante agreements need to be struck between all payers in a multi-payer marketplace to achieve both stability and sustainability of such a framework. CONCLUSION We show that universal coverage is still possible while leveraging the existing system of private extended health insurance so long as a well-established system for coordinating benefits between public and private payers is established. A stable public/private partnership can achieve universal coverage so long as a system for coordinating benefits is instituted. The proposed alternative will achieve the same goals, but maintain a niche for the private sector thereby maintaining therapeutic variety in the marketplace.
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Affiliation(s)
- Eric Nauenberg
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Canadian Centre for Health Economics, University of Toronto, Toronto, Canada. .,Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Canada.
| | - Emre Yurga
- grid.17063.330000 0001 2157 2938Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Canadian Centre for Health Economics, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Canada
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Ayodele B, Guo EX, Sweetman A, Guindon GE. Inequity in insurance coverage for prescription drugs in New Brunswick, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:504-518. [PMID: 35488147 PMCID: PMC9263015 DOI: 10.17269/s41997-022-00639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To describe the extent to which New Brunswick residents reported having drug insurance coverage supplementary to Canadian Medicare; to examine associations between socioeconomic and demographic characteristics, health status, language identity, and having reported such coverage; and to document any changes in coverage associated with the introduction of the New Brunswick Drug Plan in 2014. METHODS We used repeated cross-sectional data for New Brunswick from eight cycles of the Canadian Community Health Survey from 2007 to 2017 and undertook logistic regression analysis. RESULTS We found statistically significant, substantial and policy-relevant socioeconomic differences in the reporting of prescription drug insurance coverage among those 25-64 years and those ≥ 65 years of age, and an increasing reliance on private drug insurance over time. We found that individuals in the second decile of household income were particularly vulnerable to reporting neither public nor private drug coverage. The introduction of the New Brunswick Drug Plan in 2014 does not appear to have led to increased public drug coverage; however, from 2014, the decreasing trend in public drug coverage appears to have ceased. Those who reported lower health status usually had lower odds of reporting private drug coverage but higher odds of reporting public drug coverage. Driven by differences in private coverage, we found that relative to anglophones, francophones were less likely to report any drug coverage. CONCLUSION Our findings emphasize the shortcomings of drug insurance systems such as that introduced in New Brunswick and substantiate calls for a universal drug program. New Brunswick's increasing reliance on private drug insurance is of concern and warrants additional research.
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Affiliation(s)
- Busola Ayodele
- Centre for Health Economics and Policy Analysis, McMaster University, CRL Building, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | | | - Arthur Sweetman
- Centre for Health Economics and Policy Analysis, McMaster University, CRL Building, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Economics, McMaster University, Hamilton, ON, Canada
| | - G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, CRL Building, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Economics, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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Lexchin J. It's Time to Finally Kill the Zombies Comment on "Universal Pharmacare in Canada". Int J Health Policy Manag 2020; 9:528-530. [PMID: 32610770 PMCID: PMC7947650 DOI: 10.15171/ijhpm.2020.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/05/2020] [Indexed: 11/09/2022] Open
Abstract
The movement for a national pharmacare plan in Canada is growing, but at the same time the multinational pharmaceutical companies and their supporters are critical of such a move. The three major arguments that they make are that all that is needed is to "fill in the gaps," ie, cover those who currently are uninsured or underinsured, that private drug plans are superior to public ones because they cover a larger number of drugs and that Canada cannot afford pharmacare. This commentary examines each of these arguments and makes the case that none of them is valid and that it is time to get on with implementing pharmacare.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Konkor I, Lawson ES, Antabe R, McIntosh MD, Husbands W, Wong J, Luginaah I. An Intersectional Approach to HIV Vulnerabilities and Testing Among Heterosexual African Caribbean and Black Men in London, Ontario: Results From the weSpeak Study. J Racial Ethn Health Disparities 2020; 7:1140-1149. [PMID: 32212106 DOI: 10.1007/s40615-020-00737-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
Heterosexual African, Caribbean and Black (ACB) men are a vulnerable group to HIV infection in Canada, but little is known about their uptake of HIV testing services. Studies on ACB men HIV vulnerabilities have largely focused on behavioural factors. While these studies have contributed to the current HIV prevention success in Canada, little attention has been paid to structural factors that intersect with prevailing behaviours to reinforce vulnerabilities. Drawing insights from intersectionality theory, we examined healthcare access and HIV testing among heterosexual ACB men in London, Ontario. We fitted the negative log-log link function to 155 individuals' survey. Results show that participants, who had difficulty accessing healthcare, experienced discrimination, and were young, were all less likely to test for HIV. Even though the probability of testing for HIV increased after accounting for the effect of structural factors, the marginal impact was higher for those without any difficulty accessing healthcare than those with difficulty. Findings are discussed within the broader theory of intersectionality and recommendations made for public health policy.
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Affiliation(s)
- Irenius Konkor
- Department of Geography, Western University, London, Canada.
| | - Erica S Lawson
- Department of Women's Studies, Western University, London, Canada
| | - Roger Antabe
- Department of Geography, Western University, London, Canada
| | | | | | - Josephine Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
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Guo EX, Sweetman A, Guindon GE. Socioeconomic differences in prescription drug supplemental coverage in Canada: A repeated cross-sectional study. Health Policy 2020; 124:252-260. [DOI: 10.1016/j.healthpol.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023]
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Unger JP, De Paepe P. Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 49:431-456. [PMID: 31067137 PMCID: PMC6560522 DOI: 10.1177/0020731419847113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of “managed care” on care quality are its tight constraints on physicians’ professional autonomy; a large reliance on the physicians’ material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.
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Affiliation(s)
- Jean-Pierre Unger
- 1 Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerp, Belgium
| | - Pierre De Paepe
- 1 Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerp, Belgium
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12
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Chan FKI, McGrail K, Majumdar SR, Law MR. Changes in employer-sponsored private health insurance among retirees in Ontario: a cross-sectional study. CMAJ Open 2019; 7:E15-E22. [PMID: 30665895 PMCID: PMC6342701 DOI: 10.9778/cmajo.20180067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Employer-sponsored health insurance, particularly for retirees with limited incomes, plays a major funding role in Canadian health care, including prescription drugs and dental services. We aimed to investigate the changes in retiree health insurance availability over time. METHODS We performed a secondary analysis of data from the 2005 and 2013-2014 cycles of the Canadian Community Health Survey using multivariate logistic regression to study changes in retiree coverage availability over time in Ontario. We estimated the adjusted odds ratios of having employer coverage for likely retirees (people over age 65 yr who reported not working and those over age 75 yr), adjusting for a number of potential confounders. Sensitivity analysis was also performed for coverage of different treatments separately. RESULTS The response rate was 76% for the 2005 cycle and 66% for 2013-2014 for the entire survey. The characteristics of respondents in the 2 survey cycles were similar, except respondents in 2013-2014 were wealthier. In our adjusted model, respondents in 2013-2014 had lower odds of reporting retiree coverage than respondents in 2005 (adjusted odds ratio 0.87; 95% confidence interval 0.77-0.99). This represents an absolute reduction in the probability of receiving retiree coverage of up to 3.4%. INTERPRETATION Our analysis suggests that the rate of retiree health insurance has declined for Canadians with similar characteristics over the past decade. As we know insurance coverage has a strong association with use of treatments such as prescription drugs and dental care, this decline may result in decreased access to treatment and is an issue that warrants further investigation.
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Affiliation(s)
- Fiona K I Chan
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta.
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta
| | - Sumit R Majumdar
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health (Chan, McGrail, Law), University of British Columbia, Vancouver, BC; Department of Medicine (Majumdar), University of Alberta, Edmonton, Alta
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Brandt J, Shearer B, Morgan SG. Prescription drug coverage in Canada: a review of the economic, policy and political considerations for universal pharmacare. J Pharm Policy Pract 2018; 11:28. [PMID: 30443371 PMCID: PMC6220568 DOI: 10.1186/s40545-018-0154-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians. METHODS A narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic. MAIN FINDINGS Regarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, 'first-dollar' coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic 'last-dollar' coverage model, more similar to the current "patchwork" state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, 'first-dollar' coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix. CONCLUSION Canada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests.
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Affiliation(s)
- Jaden Brandt
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Brenna Shearer
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- Pharmacists Manitoba, Winnipeg, MB Canada
| | - Steven G. Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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Sharma AM, Ramos Salas X. Obesity Prevention and Management Strategies in Canada: Shifting Paradigms and Putting People First. Curr Obes Rep 2018; 7:89-96. [PMID: 29667158 DOI: 10.1007/s13679-018-0309-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies. RECENT FINDINGS Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.
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Affiliation(s)
- Arya M Sharma
- University of Alberta, Li Ka Shing Building, Rm 1-116, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada
| | - Ximena Ramos Salas
- Canadian Obesity Network, University of Alberta, Li Ka Shing Building, Rm 2-126, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada.
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15
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Martin D, Miller AP, Quesnel-Vallée A, Caron NR, Vissandjée B, Marchildon GP. Canada's universal health-care system: achieving its potential. Lancet 2018; 391:1718-1735. [PMID: 29483027 PMCID: PMC7138369 DOI: 10.1016/s0140-6736(18)30181-8] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 01/05/2023]
Abstract
Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.
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Affiliation(s)
- Danielle Martin
- Women's College Hospital and Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Ashley P Miller
- Division of General Internal Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Amélie Quesnel-Vallée
- McGill Observatory on Health and Social Services Reforms, Department of Epidemiology, Biostatistics and Occupational Health, and Department of Sociology, McGill University, Montréal, QC, Canada
| | - Nadine R Caron
- Department of Surgery, Northern Medical Program and Centre for Excellence in Indigenous Health, University of British Columbia, Prince George, BC, Canada
| | - Bilkis Vissandjée
- School of Nursing and Public Health Research Institute, Université de Montréal, SHERPA Research Centre, Montréal, QC, Canada
| | - Gregory P Marchildon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, Canada
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16
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Tadrous M, Greaves S, Martins D, Mamdani MM, Juurlink DN, Gomes T. Catastrophic drug coverage: utilization insights from the Ontario Trillium Drug Program. CMAJ Open 2018; 6:E132-E138. [PMID: 29581101 PMCID: PMC5878951 DOI: 10.9778/cmajo.20170132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Catastrophic drug coverage programs help those with high drug-costs to reduce the burden of out-of-pocket expenses. We set out to measure changes in utilization, spending and demographic profiles of people accessing Ontario's catastrophic drug program, the Trillium Drug Program. METHODS We conducted a cross-sectional time-series analysis examining quarterly utilization and spending trends among medications reimbursed by the Trillium Drug Program in Ontario, Canada from Jan. 1, 2000, to Dec. 31, 2016. In each of 2000, 2005, 2010 and 2015, we described the population of beneficiaries, including demographic information, health care utilization and medication utilization. RESULTS Over our study period, use of the Trillium Drug Program increased threefold from 3.6 beneficiaries per 1000 to 10.9 beneficiaries per 1000 Ontarians, and total government spending on the program increased by over 700%, reaching $487 million in 2016. Between 2000 and 2015, there was an increase in the number of beneficiaries who were under the age of 35 years (19.6% to 25.3%; p < 0.0001), did not have a hospital admission (68.3% to 80.5%; p < 0.0001) and had medium to high deductibles (2.3% to 8.0%; p < 0.0001). Further, there was a large increase in the percentage of users with drug claims greater than $1000 (3.4% to 10.4%; p < 0.0001) and those dispensed a high-cost biologic drug (1.6% to 5.5%; p < 0.0001). INTERPRETATION Increasing use of Ontario's catastrophic drug program highlights the growing burden of high drug prices for Canadians. With a growing number of expensive drugs being approved in Canada, we anticipate that spending and use of the catastrophic drug program will continue to expand.
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Affiliation(s)
- Mina Tadrous
- Affiliations: Li Ka Shing Knowledge Institute (Tadrous, Gomes), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Tadrous, Greaves, Martins, Mamdani, Juurlink, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Institute of Health Policy, Management and Evaluation (Mamdani, Juurlink, Gomes), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Simon Greaves
- Affiliations: Li Ka Shing Knowledge Institute (Tadrous, Gomes), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Tadrous, Greaves, Martins, Mamdani, Juurlink, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Institute of Health Policy, Management and Evaluation (Mamdani, Juurlink, Gomes), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Diana Martins
- Affiliations: Li Ka Shing Knowledge Institute (Tadrous, Gomes), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Tadrous, Greaves, Martins, Mamdani, Juurlink, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Institute of Health Policy, Management and Evaluation (Mamdani, Juurlink, Gomes), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Muhammad M Mamdani
- Affiliations: Li Ka Shing Knowledge Institute (Tadrous, Gomes), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Tadrous, Greaves, Martins, Mamdani, Juurlink, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Institute of Health Policy, Management and Evaluation (Mamdani, Juurlink, Gomes), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - David N Juurlink
- Affiliations: Li Ka Shing Knowledge Institute (Tadrous, Gomes), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Tadrous, Greaves, Martins, Mamdani, Juurlink, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Institute of Health Policy, Management and Evaluation (Mamdani, Juurlink, Gomes), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Tara Gomes
- Affiliations: Li Ka Shing Knowledge Institute (Tadrous, Gomes), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Tadrous, Greaves, Martins, Mamdani, Juurlink, Gomes); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Institute of Health Policy, Management and Evaluation (Mamdani, Juurlink, Gomes), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Sunnybrook Research Institute (Juurlink), Toronto, Ont
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17
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Hagenaars LL, Klazinga NS, Mueller M, Morgan DJ, Jeurissen PP. How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology. Int J Health Plann Manage 2017; 33:e263-e278. [DOI: 10.1002/hpm.2458] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luc L. Hagenaars
- Celsus Academy for Sustainable Healthcare; Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
| | - Niek S. Klazinga
- Department of Social Medicine, Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Michael Mueller
- Organisation for Economic Co-operation and Development; Paris France
| | - David J. Morgan
- Organisation for Economic Co-operation and Development; Paris France
| | - Patrick P.T. Jeurissen
- Celsus Academy for Sustainable Healthcare; Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
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18
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Ranabhat CL, Kim CB, Singh DR, Park MB. A Comparative Study on Outcome of Government and Co-Operative Community-Based Health Insurance in Nepal. Front Public Health 2017; 5:250. [PMID: 29062833 PMCID: PMC5625079 DOI: 10.3389/fpubh.2017.00250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background There are different models for community-based health insurance (CBHI), and in Nepal, among them, the government and the local communities (co-ops) are responsible for operating the CBHI models that are in practice. Aims The aim of this study is to compare the outcomes in relation to benefit packages, population coverage, inclusiveness, healthcare utilization, and promptness of treatment for the two types of CBHI models in Nepal. Methods This study was an observational and interactive descriptive study using the concurrent mixed approach of data collection, framing, and compilation. Quantitative data were collected from records, and qualitative data were collected from key informants in all 12 CBHI groups. Unstructured questionnaires, observation checklists, and memo notepads were used for data collection. Descriptive statistics and the Mann–Whitney U test were used when appropriate. Ethically, written informed consent was obtained from the respondents who participated in the study, and they were told that they could withdraw from the study anytime. Results The study revealed the following: new enrolment did not increase in either group; however, the healthcare utilization rate did (Government 107% and co-ops 137%), while the benefit packages remained almost same for both groups. Overall, inclusiveness was higher for the government group. For the CBHI co-ops, enrollment among the religious minority and the discount negotiated with the hospitals for treatment were significantly higher, and the promptness in reaching a hospital was significantly faster (p < 0.05) than that in the government-operated CBHI. Conclusion Findings indicate that CBHI through co-ops would be a better model because of its lower costs and ability to enhance self-responsiveness and the overall health system. Health insurance coverage is the most important component to achieve universal health coverage.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea.,Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea.,Health Science Foundations and Study Centre, Kathmandu, Nepal
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea.,Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
| | - Dipendra Raman Singh
- Ministry of Health, Public Health, Monitoring and Evaluation Division, Kathmandu, Nepal
| | - Myung Bae Park
- Department of Gerontology, Health and Welfare, Pai Chai University, Daejeon, South Korea
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19
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Weil TP. The Canadian healthcare system: It needs enhancement. Health Serv Manage Res 2016. [DOI: 10.1177/0951484816673668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although Canadian healthcare is commonly referred to as a single-payer system providing universal coverage for only hospital and physician benefits, it is argued herein that their plan actually functions as a multi-payer model; and, it provides a far lesser breadth of coverage than available among most western European countries. Of concern is that in addition to their mandated plan, only 60% of their residents are covered by private insurance for pharmaceuticals, dental care, and eye services most often paid for as a fringe benefit by their employers. In addition, based on their medical loss ratios (74% for group coverage; 38% for individual insurance), these investor-owned, private insurance plans cannot be considered as an effective approach to protect the public against these medical expenditures. An obvious solution is to mandate these benefits as enhancements to the Canada Health Act of 1985, but this alternative is currently thought to be unrealistic for both political and economic reasons. Major issues now facing the Canadian healthcare system, in terms of its routine delivery of patient care, are not the single- versus multi-payer question or the inefficiencies of their supplementary insurance, but (a) the extended patient waits for non-emergent surgical services; (b) the lack of appropriate fiscal incentives when reimbursing their hospitals; and (c) their resident physicians currently completing approved programs in general surgery and the surgical sub-specialties frequently being unable to secure appropriate medical staff appointments. Maybe the Canadian healthcare system, although providing universal hospital and physician services, is not as idyllic as perceived by many throughout the world.
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Affiliation(s)
- Thomas P Weil
- Bedford Health Associates, Inc., Management Consultants for Health and Hospital Services, Asheville, NC, USA
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20
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Morgan SG, Boothe K. Universal prescription drug coverage in Canada: Long-promised yet undelivered. Healthc Manage Forum 2016; 29:247-254. [PMID: 27744279 PMCID: PMC5094297 DOI: 10.1177/0840470416658907] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Canada's universal public healthcare system is unique among developed countries insofar as it does not include universal coverage of prescription drugs. Universal, public coverage of prescription drugs has been recommended by major national commissions in Canada dating back to the 1960s. It has not, however, been implemented. In this article, we extend research on the failure of early proposals for universal drug coverage in Canada to explain failures of calls for reform over the past 20 years. We describe the confluence of barriers to reform stemming from Canadian policy institutions, ideas held by federal policy-makers, and electoral incentives for necessary reforms. Though universal "pharmacare" is once again on the policy agenda in Canada, arguably at higher levels of policy discourse than ever before, the frequently recommended option of universal, public coverage of prescription drugs remains unlikely to be implemented without political leadership necessary to overcome these policy barriers.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Katherine Boothe
- Department of Political Science, McMaster University, Hamilton, Ontario, Canada
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21
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Weil TP. What can the Canadians and Americans learn from each other's health care systems? Int J Health Plann Manage 2016; 31:349-70. [PMID: 27469581 DOI: 10.1002/hpm.2374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/27/2016] [Indexed: 11/11/2022] Open
Abstract
Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single-payer system to save 12-20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32.0 million (2015) Americans still uninsured would have at least minimal coverage when incurring medical expenditures. Also, the USA could use smart cards to evaluate eligibility and to process health insurance claims; these changes resulting in an estimated 15% reduction in US health expenditures without adversely effecting access or quality of care. Such a strategy would result in the eventual loss of 2.5 million white-collar jobs at hospitals, physician offices and insurance companies, a long-term economic gain. Only a few would agree with the statement that Canada already functions with a multi-payer reimbursement system as evidenced by (1) a federal-provincial, tax-supported plan, administered by each of the provinces, providing universal coverage for hospital and physician services and (2) roughly 60% of its residents receiving employer-paid health insurance benefits, underwritten primarily by investor-owned plans, that are less than effective to reimburse for pharmaceuticals, dental and other healthcare services. What could be learned from the USA and particularly from Western European countries is possibly implementing an approach, whereby at least upper-income Canadians could opt out of their federal-provincial plan and purchase private insurance coverage - being eligible for far more comprehensive "private" benefits for hospital, physician, pharmaceutical, dental and other healthcare services. Aside from generating billions of additional needed revenues from the private sector, it could (1) help eliminate long waits for non-emergent physicians' care by appointing newly minted specialists to their medical staffs; (2) offer prompt admissions for elective cases to "private" wings of hospitals; (3) increase available funding for what is currently an undercapitalized system; (4) enhance the system's sluggish operations; and (5) encourage more competition among various providers. Although such a two-tier approach, such as available in the USA and elsewhere, is politically dead on arrival in Canada today, private insurance being already legal and commonly available there. Interestingly, this recommended solution is utilized in most western European countries where there is a higher percentage than in Canada of public (versus private) funding of their total health expenditures. Because of various vested interests, attempts to implement any of the aforementioned proposals will undoubtedly result in considerable political rancor. There is greater likelihood, however, that the Canadians because their need to be more effective and efficient in their delivery of care, and their overall long-term fiscal outlook will agree to the further privatization of their healthcare system before the Americans will mandate universal access, use the smart card to process insurance eligibility and claims or will impose price controls on high-tech services and on pharmaceuticals. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Thomas P Weil
- Bedford Health Associates, Inc., Management Consultants for Health and Hospital Services, Asheville, North Carolina, USA
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22
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Salehi L. National pharmacare: Time to move forward. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:544-546. [PMID: 27412200 PMCID: PMC4955075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Leila Salehi
- Adjunct Assistant Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario and at Northwestern University Feinberg School of Medicine in Chicago, Ill, and is completing a Masters in Health Policy and Management at Columbia University Mailman School of Public Health in New York, NY.
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23
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Salehi L. [Assurance-médicaments nationale: Le moment d'aller de l'avant]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e361-e363. [PMID: 27412223 PMCID: PMC4955099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Leila Salehi
- Professeure adjointe au Département de médecine familiale et communautaire de l'Université de Toronto, en Ontario, et à la Faculté de médecine Feinberg de l'Université Northwestern à Chicago, en Illinois (É.-U.), et elle poursuit une maîtrise en politiques et en gestion de la santé à la Faculté de santé publique de l'Université Columbia à New York, New York (É.-U.).
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Kratzer J, Cheng L, Allin S, Law MR. The Impact of Private Insurance Coverage on Prescription Drug Use in Ontario, Canada. Healthc Policy 2015; 10:62-74. [PMID: 26142359 PMCID: PMC4748350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Canadians obtain prescription drug coverage through a patchwork of public insurance, private benefit plans and out-of-pocket payments. Prior evidence suggests that insurance coverage, in general, leads to higher utilization rates of essential medicines; it is unclear whether individuals with private insurance have better access to medicines. Using data from the 2008 Canadian Community Health Survey, we identified cohorts from Ontario who reported having been diagnosed by a physician with asthma, high blood pressure or diabetes. Using propensity score stratification techniques, we compared drug utilization of individuals holding private insurance with that of individuals holding either public insurance (for those aged over 65 years) or no insurance (aged under 65 years). In five out of six comparisons, individuals with private insurance were more likely to take prescribed drugs than those without. Raw differences in the percentage of patients taking medicines ranged from 0.1 to 8.1%. Ontarians with chronic conditions holding private drug insurance are more likely to use prescription drugs than those who do not. Whether these inequities result in health outcome differences remains unknown.
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Affiliation(s)
- Jillian Kratzer
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
| | - Lucy Cheng
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
| | - Sara Allin
- School of Public Policy & Governance, University of Toronto, Toronto, ON
| | - Michael R Law
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
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25
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Affiliation(s)
- Stephen Frank
- Policy Development and Health, Canadian Life and Health Insurance Association, Toronto, Ont
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26
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Law M, Kratzer J, Dhalla I. Correcting the record. CMAJ 2014; 186:779. [PMID: 25002744 DOI: 10.1503/cmaj.114-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Law, Kratzer), The University of British Columbia, Vancouver, BC; Department of Medicine, University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Jillian Kratzer
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Law, Kratzer), The University of British Columbia, Vancouver, BC; Department of Medicine, University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
| | - Irfan Dhalla
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Law, Kratzer), The University of British Columbia, Vancouver, BC; Department of Medicine, University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont
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