You are here

An examination of influences on prescription drug use amongst older adults with and without chronic illness in two Canadian provinces

TitleAn examination of influences on prescription drug use amongst older adults with and without chronic illness in two Canadian provinces
Year of Publication2017
AuthorsChan, F. K. I.
UniversityUniversity of British Columbia
CityVancouver, BC
Abstract

Background - Prescription medications, which are a critical component of modern medicine, are not covered under the Canada Health Act. Canadian prescriptions are financed through a combination of public financing, private insurance, and out-of-pocket payments. This leaves potential coverage gaps amongst different segments of the population. There are current discussions of a national pharmacare strategy to address this issue. It remains unclear how such a policy, particularly for seniors, should be financed. Methods – We first studied British Columbia's publicly-funded pharmacare program to examine the impact of income-based deductibles on older adults with chronic obstructive pulmonary disease (COPD) in regards to prescription drug utilization and other health services. This was analyzed utilizing a regression discontinuity design with administrative datasets. The second study used logistic regression to examine the trend in employer-sponsored health insurance (EHI) availability amongst Ontario's retirees from 2005 to 2014 using data from the Canadian Community Health Survey. Results - Deductibles had no effect on prescription utilization amongst a cohort of older adults living with COPD in BC. However, over 40% of the eligible person-years analyzed did not obtain a prescription for COPD treatment, suggesting severe under-treatment in this population. Results also suggest an increased use of inhaled corticosteroids, which may be due to a special authority process and may not be appropriate for COPD. A decline in EHI availability was apparent for Ontario's retirees between 2005 and 2013-2014. EHI availability is strongly linked to household income, with those of a lower income-decile having the lowest odds of having EHI. Conclusion - Imposing a modest income-based deductible was not found to impact prescription utilization or utilization of other health services, even amongst a population with a chronic condition facing comparatively high prescription costs. In contrast, supplemental help in making prescriptions more affordable for the older adult population may be diminishing. A small but statistically significant decrease was observed in EHI – the main source of aid in prescription affordability apart from the public system. These results suggest that a comprehensive strategy to address medication adherence is warranted to minimize future health system burden.

URLhttps://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0362239
DOI10.14288/1.0362239 http://hdl.handle.net/2429/6413
Document URLhttps://open.library.ubc.ca/media/download/pdf/24/1.0362239/4