COST-SHARING FOR HEALTH CARE SERVICES: AN ALTERNATIVE STRATEGY FOR PHARMACEUTICAL REIMBURSEMENT IN ONTARIO

Main Article Content

Christopher J. Longo

Keywords

Pharmaceutical policy, patient out -of-pocket costs, cost-sharing, insurance coverage

Abstract

In most Canadian provinces many health services outside of the Canada Health Act have some element of cost-sharing, co-payments or service limits. These limitations can have significant financial impacts on patients and families related to both chronic and acute illnesses. Previous published research has shown significant financial burdens for homecare, devices, and pharmaceuticals in diseases like cancer. Examination of existing funding policies raises the question: Can we restructure, or redistribute government funding in a way that minimizes these burdens to the most vulnerable populations (typically those under age 65 and in the lowest income quartile) .


Current Ontario policies related to pharmaceutical reimbursement were reviewed, and an alternate policy strategy that might better address patient level burden is presented using a case study approach, with the goal of mitigating financial burden. Cost neutrality could be obtained via offsets through higher co-payments in other populations to ensure no increase to existing funding envelopes.

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References

1. Longo CJ , Deber R , Fitch M, Williams AP . Financial and family burden associated with cancer treatment in Ontario. Supportive Care in Cancer 2006; 14:1077- 85.
2. Longo CJ, Deber R, Fitch M, et al . An examination of cancer patients’ monthly “out-of-pocket” costs in Ontario”. European Journal of Cancer Care 2007;16:500- 7.
3. Longo CJ, Bereza B G. A comparative analysis of monthly ‘out-of-pocket’ costs for breast cancer patients versus other common cancers in Ontario, Canada. Current Oncology 2011; 18(1):e1- e8.
4. Arozullah AM, Calhoun EA, Wolf M, et al. The financial burden of cancer: Estimates from a study of insured women with breast cancer. J Supportive Oncology 2004;2(3):271- 8.
5. Cohn RJ, Goodenough B, Foreman T, Suneson J. Hidden financial costs in treatment for childhood cancer: an Australian study of lifestyle implications for families absorbing out-of-pocket costs. J Pediatr Hematol Oncol 2003; 25(11):854- 63.
6. Darby K, Davis C, Likes W, Bell J. Exploring the financial impact of breast cancer for African American medically underserved women: a qualitative study. J Health Care for the Poor & Underserved 2009;20(3):721- 8.
7. Di Carlo A . Human and economic burden of stroke. Age and Ageing 2009; 38:4- 5.
8. Dewey H M, Thrift A G, Mihalopoulos C, et al. Out of pocket costs to stroke patients during the first year after stroke – results from the North East Melbourne Stroke Incidence Study. Journal of Clinical Neuroscience 2004; 11(2):134- 7.
9. Lines LM, Lang K, Wallace JF, Menzin J. Out -of- pocket costs among women with breast cancer: Data from the medical expenditure panel survey, 1996- 2005. American Association for Cancer Research 2009; Breast Cancer Symposium, Conference publication: 69(2S) .
10. Gordon LG, Ferguson M, Chambers SK, Dunn J. Fuel, beds, meals and meds: Out-of-pocket expenses for patients with cancer in rural Queensland. Cancer Forum 2009; 33(3): 202 -8.
11. Given BA, Given CW, Stommel M. Family and out-of-pocket costs for women with breast cancer. Cancer Practice 1994 May/June;2(3): 187- 93.
12. Heeley E, Anderson C S, Huang Y, et al . Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke 2009; 40(6):2149 -56.
13. Lauzier S, Mausell E, Drolet M, et al. Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Cancer Inst 2008; 100:321 –32.
14. Finkelstein EA, Tangka FK, Trogdon JG, et al. The personal financial burden of cancer for the working-aged population. Am J Managed Care 2009; 15(11):801 -6.
15. Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Nat Cancer Inst 2002;94(7):490- 6.
16. Canadia n Institute for Health Information, Drug Use Among Seniors on Public Drug Programs in Canada, 2002 to 2008 (Ottawa, Ont.: CIHI, 2010).
17. Kapral MK, Wang H, Ma mdani M, et al. Effect of socioeconomic status on treatment and mortality after stroke. Stroke 2002; 33:268- 75.
18. Thomas D, Frankenberg E. Health, nutrition and prosperity: a microeconomic perspective. Bull World Health Organ 2002; 80(2) :106- 13.