Is Canadian Healthcare Affordable? A Comparative Analysis of the Canadian Healthcare System from 2004 to 2014

Soril, Lesley; Adams, Ted D.; Phipps-Taylor, Madeleine; Winblad, Ulrika; Clement, Fiona

doi:10.12927/hcpol.2017.25192

Cited by 11 publications

(16 citation statements)

References 21 publications

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“…Sixty-nine studies were screened in full text with 43 eliminated at this stage, leaving 26 included studies (study details in Table 1 ) [ 2 , 3 , 35 – 58 ]. Since several of these studies used the same source survey [ 3 , 38 , 39 , 43 , 45 – 48 ], the total sample size of unique participants across all 26 studies is uncertain. Assuming that each study’s participant is a unique individual, the total sample size is 497,534.…”

Section: Resultsmentioning

confidence: 99%

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

et al. 2021

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Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. Results Twenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year. Conclusion CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

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Section: Resultsmentioning

confidence: 99%

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

et al. 2021

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“…Finally, as this study only included Canadian patients, these findings apply specifically to Canadian patients with chronic disease. A number of chronic disease patients in other Western nations report facing financial barriers to various aspects of chronic disease care [ 4 ]. Since the USA has an even less comprehensive medication insurance program than Canada, our findings likely apply in the US context.…”

Section: Discussionmentioning

confidence: 99%

“…Patients in countries around the world experience financial barriers to the care they require to manage their chronic conditions [ 4 ]. In Canada, 10–12% of patients with chronic diseases face financial barriers [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study

Campbell

Manns

Weaver

et al. 2017

BMC Med

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BackgroundSome patients with cardiovascular-related chronic diseases such as diabetes and heart disease report financial barriers to achieving optimal health. Previous surveys report that the perception of having a financial barrier is associated with self-reported adverse clinical outcomes. We sought to confirm these findings using linked survey and administrative data to determine, among patients with cardiovascular-related chronic diseases, if there is an association between perceived financial barriers and the outcomes of: (1) disease-related hospitalizations, (2) all-cause mortality and (3) inpatient healthcare costs.MethodsWe used ten cycles of the nationally representative Canadian Community Health Survey (administered between 2000 and 2011) to identify a cohort of adults aged 45 and older with hypertension, diabetes, heart disease or stroke. Perceived financial barriers to various aspects of chronic disease care and self-management were identified (including medications, healthful food and home care) from the survey questions, using similar questions to those used in previous studies. The cohort was linked to administrative data sources for outcome ascertainment (Discharge Abstract Database, Canadian Mortality Database, Patient Cost Estimator). We utilized Poisson regression techniques, adjusting for potential confounding variables (age, sex, education, multimorbidity, smoking status), to assess for associations between perceived financial barriers and disease-related hospitalization and all-cause mortality. We used gross costing methodology and a variety of modelling approaches to assess the impact of financial barriers on hospital costs.ResultsWe identified a cohort of 120,752 individuals over the age of 45 years with one or more of the following: hypertension, diabetes, heart disease or stroke. One in ten experienced financial barriers to at least one aspect of their care, with the two most common being financial barriers to accessing medications and healthful food. Even after adjustment, those with at least one financial barrier had an increased rate of disease-related hospitalization and mortality compared to those without financial barriers with adjusted incidence rate ratios of 1.36 (95% CI: 1.29–1.44) and 1.24 (1.16–1.32), respectively. Furthermore, having a financial barrier to care was associated with 30% higher inpatient costs compared to those without financial barriers.DiscussionThis study, using novel linked national survey and administrative data, demonstrates that chronic disease patients with perceived financial barriers have worse outcomes and higher resource utilization, corroborating the findings from prior self-report studies. The overall exposure remained associated with the primary outcome even in spite of adjustment for income. This suggests that a patient’s perception of a financial barrier might be used in clinical and research settings as an additional measure along with standard measures of socioeconomic status (ie. income, education, social status).ConclusionsAfter adjusting f...

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“…(2,3, Since several of these studies used the same source survey. (3,38,39,43,45,46,54,55) the total sample size of unique participants across all 26 studies is uncertain. Assuming that each study's participant is a unique individual, the total sample size is 497,534.…”

Section: Study Characteristicsmentioning

confidence: 99%

Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

Holbrook

Wang

Lee

et al. 2020

Preprint

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Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, is unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. Results: Twenty-six studies of varying quality (n=483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1% to 10.2%. Factors predicting CRNA included high out of pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at one year. Conclusion: CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

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Is Canadian Healthcare Affordable? A Comparative Analysis of the Canadian Healthcare System from 2004 to 2014

Cited by 11 publications

References 21 publications

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study

Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

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