Canadians' out-of-pocket spending for prescription drugs, dental care and insurance premiums rose over a 12-year period for all families, especially people with lower incomes who may have reduced their use of health-care services, a new report suggests.
Statistics Canada's report, "Trends in out-of-pocket health care expenditures in Canada, by household income, 1997 to 2009," released Wednesday shows the increase in these expenses was greatest for households in the lowest one-fifth of income.
"What we saw in the data was for the poorest households, the amount that they spent out of pocket, after adjusting for inflation, went from $600 to over $1,000," said study co-author Michael Law of the Centre for Health Services and Policy Research at the University of British Columbia.
Lower-income households were more likely than higher-income households to spend more than five per cent of their after-tax income on health care services, Law and his co-authors found.
About 40 per cent of households in the two lowest income groups spent more than five per cent of their total after-tax income on health-care services, compared with 14 per cent of those in the highest income group. The spending increase between 1997 and 2009 was greatest for households in the lowest-income group, at 63 per cent.
"I think without a doubt we're seeing less equity in the system," Law told CBC News.
"The people that I worry about the most in this are actually the working poor," he said. "I worry about their ability to access prescription drugs," since they have a "relatively low income" and probably don't have benefits through their work.
Throughout the study period, the three largest components of out-of-pocket health-care expenditures were:
- Dental services.
- Prescription medications.
- Insurance premiums.
In 2009, household spending in those categories averaged $380 (dental), $320 (medications) and $650 (insurance premiums).
"Faster increases in out-of-pocket spending for lower-income households may have implications for access to health care," the report says."Lack of insurance and the burden of out-of-pocket expenditures have been associated with inequitable use of services such as dental care and prescription medications."
Earlier this month, Robyn Tamblyn of Montreal's McGill University published a study in the Annals of Internal Medicine of nearly 1,600 patients in Quebec who received a first prescription between 2006 and 2009. Overall, 31 per cent of the prescriptions weren't filled within nine months and drugs that cost the most were the least likely to be filled.
Skimping on prescriptions
Tamblyn, scientific director for the Institute of Health Services and Policy Research at the Canadian Institutes
of Health Research, said Statistics Canada's findings on paying out of pocket make sense.
"For people who are poor, they're more likely to have chronic conditions, they're more likely to experience poorer health than people who are better off," Tamblyn said. "The implications are that they're going to skimp or not fill their prescriptions."
Laurie Bradley of Oshawa, Ont., called the new findings "disconcerting." Bradley considers herself to be lucky to have some coverage, but she postponed a dental appointment over cost concerns.
"It resulted in me having to have a tooth pulled out or have a bunch of bridge work and things like that done and I simply couldn't afford to get it fixed. So I had to have it pulled out," Bradley said.
The new survey of self-reported data covered nearly 98 per cent of the population in the 10 provinces.
Direct expenditures are those not covered by insurance, such as exclusions, deductibles and expenses over limits. The researchers also excluded reimbursed payments.
Insurance expenditures included premiums for provincial hospital, medical or drug plans, private health insurance plans, dental plans sold as separate policies, and accident or disability insurance.