Prescription drug access and affordability an issue for nearly a quarter of all Canadian households

by Angus Reid | July 14, 2015 10:30 pm

Significant public support for “pharmacare” over status quo, but concerns about costs remain.


July 15, 2015 – A significant – and apparently increasing – number of Canadians are unable to afford the medications being prescribed to them, and they’re compensating by skipping doses, splitting pills, or simply not filling their prescriptions.

According to a wide-ranging new angus reid institutestudy by the Angus Reid Institute – in partnership with the Mindset Social Innovation Foundation[1] – more than one-in-five (23%) Canadians report that they or someone in their household has taken one or more of these approaches to saving money on medication in the last 12 months. And over one-in-three say they have friends or family members who have financial difficulty paying for their prescriptions.

This new national survey also finds a strong public consensus on some fundamental value questions associated with the issue of prescription drug access and affordability — a large majority of Canadians share the view that “medicine should be part of medicare”.

Given this context, it should perhaps not come as a surprise that this new study finds widespread support for a national “pharmacare” system that would cover the cost of prescription drugs. There is decidedly less consensus on what the program should look like and – especially – how it should be funded.

Key Findings:

 

PART 1: Access to Prescriptions

Many Canadians cannot afford their prescribed meds

More than one-in-five (23%) Canadians report that, in the past 12 months, they or someone in their household did not take their medicines as prescribed, if at all, because of cost. Specifically:

A 2007 Statistics Canada Survey[2] found one-in-ten Canadian individuals did not take their medicines as prescribed, if at all, because of cost. This Angus Reid Institute survey asked the same questions about use of medicines, but at the household level. While household figures would be expected to be larger, the 23 per cent figure in the current research suggests a widening of this problem over the intervening eight years.

These new survey results highlight access barriers in all provinces, with variations that may reflect public coverage policy.

canada prescription drug poll

Cost barriers affect all ages and income levels

All age groups experience some difficulty filling prescription drugs.

medicare canada poll

Household income also makes a big difference in rates of non-adherence to prescriptions. Higher income Canadians are somewhat insulated from financial barriers to accessing medicines, though not completely.

Drug coverage is a big factor

The availability and extent of drug coverage is a strong predictor of access to prescribed medicines. (Survey findings regarding how many have drug coverage and who they are can be found in summary form near the end of this report.)

This is consistent with other research[5] that shows that direct charges to patients can create barriers to filling prescriptions. For example, even among relatively well insured groups (such as employment groups in the USA or seniors in Canada), studies have shown[6] that increasing co-payments for prescriptions reduces the use of medicines. (Many studies[7] also show this results in higher cost elsewhere in the health care system.)

Out-of-pocket drug costs

What are Canadians spending on drugs out-of-pocket? These expenditures vary massively depending on health factors and, of course, on drug coverage. The ARI survey’s overall findings on this are broadly consistent with two 2007 surveys (Commonwealth Fund[8], CD Howe[9]) (one of which showed Canadians are more likely to face high drug costs ($1,000 or more) than people in comparable countries).

The results from the ARI survey yield the following highlights on out-of-pocket drug spending:

public opinion canada

Drug costs also a source of worry

The results of this new Angus Reid Institute survey also show pharmaceutical drug costs pose other burdens for Canadians in addition to prescription non-adherence.

Many know vulnerable people in their network

These issues of access and affordability affect Canadians indirectly as well in that many are exposed to the issue in the form of vulnerability within their social network. Specifically:

This indirect awareness of people’s struggle with medication costs is in evidence across all main population groups, but most common in Atlantic Canada and in lower income groups.

 

PART 2: Canadians’ Values are Aligned

One of the objectives of this research was to explore the values underpinning prescription drug access in Canada — particularly, values associated with “fairness” and also with how medicines should fit with the traditional consensus on universal access to health care. The results will be encouraging to advocates of change in this area as they highlight strong shared values on these fundamental aspects. These values, in turn, are a central part of the overall context when Canadians consider possible policy proposals to address prescription drug access and affordability.

A matter of fairness

For the vast majority of Canadians, drug access and affordability are viewed as issues of fairness. For example:

The same number (88%) agree that “It’s simply not right that some Canadians have to struggle to pay for the drugs they need”.

pharmacare canada poll

The survey results show a strong consensus on these values statements among Canadians from all walks of life. In both cases, a full majority indicate strong agreement, and overall agreement is shared by over four-in-five Canadians from all major population sub-groups.

Most believe medicines should be part of medicare

There is ongoing debate about whether the principles of universal healthcare should also apply to necessary drugs (along with dental and eye care, etc). This new survey’s broad attitudinal gauge also finds strong shared values on this count:

 

PART 3: Prescription Drug Policy

This Angus Reid Institute/Mindset Social Innovation Foundation study is by no means the final word on Canadian public opinion on pharmaceutical affordability and its place in the nation’s health care policy — indeed, the research design was focused first and foremost on exploring the scale of the underlying problem of access barriers. That said, this study does serve as a useful initial temperature-taking on the concept of pharmacare in Canada.

Overall, on the policy side, the survey finds extremely high levels of support for the concept of a universal pharmacare program, though there is considerably less consensus among Canadians around the particulars of such a program and the cost of paying for it.

Most Canadians think status quo is flawed

This survey examined public opinion regarding the overall policy context surrounding this issue of prescription drug access and affordability – beginning with assessments of the status quo. The highlights here include the following:

Reform a priority, but there are others

prescription drug poll

canadian public opinion

A national pharmacare program

Fully nine-in-ten (91%) Canadians surveyed indicated overall support for “the concept of having “pharmacare” in Canada, providing universal access to prescription drugs” (51% voiced strong support).This support is essentially “across the board” – noted across provinces, age groups, sexes, education levels, and income levels. Indeed, broad support for the concept only goes as “low” as the high 80’s among federal Conservative party supporters.

This level of support for pharmacare remained high when at the end of the survey the policy option was described as “adding prescription drugs to the universal health coverage of ‘medicare’ so all Canadians have access to prescribed medicines without having to pay out of their own pocket.” In this case, almost nine-in-ten (87%) supported such a policy (39% strongly, 46% moderately). Again, this support was largely consistent “across the board” regionally, and by age groups, sexes, education levels, and income levels.

medicare poll

Overall support remains over the 80 per cent level among those who already have all of their drug costs covered by government or private insurance and among those who paid nothing for medicines in the past year, and stays over 90 per cent among those who did not receive any prescriptions last year.

Even many of those who oppose universal pharmacare say they would support other, less significant changes to the system. Those surveyed were asked to choose between two detailed opposing viewpoints, one in favour of a national pharmacare program and one opposed:

The quarter who chose the latter option were asked whether they would prefer to keep the current system intact or would support some changes that stop short of a full pharmacare program. Roughly half (51%) of this group indicated they would support some changes, meaning that even a sizeable proportion of those opposed to pharmacare believe the current system could be improved.

Less consensus on specific elements of a pharmacare program

Notwithstanding the high levels of overall support for the concept of a universal drug program in Canada, this research also highlights a much lower degree of consensus in terms of what the specific elements of such a program might look like.

First of all, which level of government would be running such a program? Just over half (52%) of Canadians surveyed opted for “both the provinces and the federal government” – while the other half are evenly split as to whether it should be entirely or mostly the provinces (24%) or entirely or mostly the federal government (25%). A plurality or more of each major population group would opt for a federal-provincial combination, with significant minorities saying one or the other level of government should take the lead.

angus reid institute

This survey also looked at Canadians’ views of two possible drug plan options, asking if each is perceived to be better or worse than the current system.

Many Canadians are cautious about cost

Canadians are cautious that pharmacare will cost more than the status quo, and concerns on this count vary considerably across different constituencies.

Perhaps reflecting this belief, support for a variety of means of funding pharmacare is tepid at best, especially when compared to the very substantial majorities who support such a plan in concept:

angus reid institute

Canadians’ preferred method for funding a national pharmacare program would be to restore the federal corporate income tax to its 2010 rate of 18 per cent. More than three-in-five (62%) indicated they would support a pharmacare system being brought in with this corporate-based funding source.

Other possible funding sources – such as increasing the GST or the basic income tax rate for incomes over $40,000 – get a “thumbs down”, with most Canadians surveyed indicating they would oppose a pharmacare system being brought in via these modes of funding.

Despite these cost concerns, eight-in-ten Canadians (80%) surveyed agreed that “it would be more efficient if there is one single system for drug coverage in Canada”.

Many Canadians worry that “having free prescription drugs will lead to abuse.” Half (51%) agreed with that statement – including nearly four-in-five Saskatchewan residents (79%) and two-thirds (66%) of past Conservative voters. Perhaps ironically, Canadians whose drug costs are mostly or entirely paid for by government or private insurance were slightly more likely to believe that having free prescription drugs will lead to abuse than Canadians who paid for most or all of their drug costs themselves.

 

PART 4: Additional Findings on Prescription Use and Coverage

This wide-ranging survey gathered additional data on Canadian households’ experience with prescription drugs. Some of these findings have been discussed earlier (for example, out-of-pocket drug spending), and some are briefly highlighted below.

Prescription use

Canadians use a lot of prescriptions; indeed, nearly nine-in-ten of those surveyed (89%) reported they or someone in their household had received a prescription in the past year. This is about the same as the number who visited a doctor’s office or clinic.

More than one-in-four Canadian households (27%) are very routine users of prescription drugs, reporting filling six or more prescriptions in the past year (about the same number as reported this many doctor visits).

This share of population receiving a prescription is far more than the number who received care in a hospital (29%), or received some kind of diagnostic test (61%).

Drug coverage

Most Canadians have some drug coverage, but this coverage is incomplete for the almost three-in-ten (27%) Canadians who either pay for all of their drugs (11%), pay for most (10%) or have a roughly 50/50 plan (6%).

On the other hand, fully two-thirds (69%) of Canadians have most (54%) or all (15%) of their prescription costs paid for by government or an insurance plan. As discussed earlier, the extent of one’s drug coverage is highly related to the incidence of cost-related non-adherence to prescriptions.

There are some important differences in drug coverage across the population:

 

Click here for the full report including related tables and methodology[11]

Click here for fully detailed tables[12]

Click here for the questionnaire used in this survey[13]

MEDIA CONTACT:
Shachi Kurl, Senior Vice President: 604.908.1693
shachi.kurl@angusreid.org[14]

Image Credit – Charles Williams

Endnotes:
  1. Mindset Social Innovation Foundation: http://mindsetfoundation.com/
  2. Statistics Canada Survey: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SurvId=50653&InstaId=29539&SDDS=3226
  3. Details can be found here: https://www.cihi.ca/en/spending-and-health-workforce/spending/national-health-expenditure-trends
  4. Commonwealth Fund International Health Policy Survey of Older Adults: http://www.commonwealthfund.org/publications/surveys/2014/2014-commonwealth-fund-international-health-policy-survey
  5. other research: http://jama.jamanetwork.com/article.aspx?articleid=207805
  6. studies have shown: http://www.nejm.org/doi/full/10.1056/NEJMsa1107913
  7. Many studies: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302240
  8. Commonwealth Fund: http://www.commonwealthfund.org/publications/surveys/2007/2007-international-health-policy-survey-in-seven-countries
  9. CD Howe: https://www.cdhowe.org/rethinking-pharmacare-in-canada/22009
  10. Figures from CIHI, NHEX: https://www.cihi.ca/en/spending-and-health-workforce/spending/national-health-expenditure-trends
  11. Click here for the full report including related tables and methodology: http://angusreid.org/wp-content/uploads/2015/07/2015.07.09-Pharma.pdf
  12. Click here for fully detailed tables: http://angusreid.org/wp-content/uploads/2015/07/2015.07.14_FormattedPharmaTables.pdf
  13. Click here for the questionnaire used in this survey: http://angusreid.org/wp-content/uploads/2015/07/2015.06.30-Pharma.pdf
  14. shachi.kurl@angusreid.org: mailto:shachi.kurl@angusreid.org

Source URL: http://angusreid.org/prescription-drugs-canada/