Lucy Cheng

The effect of cost on adherence to prescription medications in Canada

Background: Many patients do not adhere to treatment because they cannot afford their prescription medications, putting them at increased risk of adverse health outcomes. We determined the prevalence of cost-related nonadherence and investigated its associated characteristics, including whether a person has drug insurance. Methods: Using data from the 2007 Canada Community Health Survey, we analyzed the responses of 5732 people who answered questions about cost-related nonadherence to treatment. We determined the national prevalence of cost-related nonadherence and used logistic regression to evaluate the association between cost-related nonadherence and a series of demographic and socioeconomic variables, including province of residence, age, sex, household income, health status and having drug insurance. Results: Cost-related nonadherence was reported by 9.6% (95% confidence interval [CI] 8.5%–10.6%) of Canadians who had received a prescription in the past year. In our adjusted model, we found that people in poor health (odds ratio [OR] 2.64, 95% CI 1.77–3.94), those with lower income (OR 3.29, 95% CI 2.03–5.33), those without drug insurance (OR 4.52, 95% CI 3.29–6.20) and those who live in British Columbia (OR 2.56, 95% CI 1.49–4.42) were more likely to report cost-related nonadherence. Predicted rates of cost-related nonadherence ranged from 3.6% (95% CI 2.4–4.5) among people with insurance and high household incomes to 35.6% (95% CI 26.1%–44.9%) among people with no insurance and low household incomes. Interpretation: About 1 in 10 Canadians who receive a prescription report cost-related nonadherence. The variability in insurance coverage for prescription medications appears to be a key reason behind this phenomenon.

Growth in private payments for health care by Canadian households

INTRODUCTION Despite first-dollar public coverage for hospital and physician services, Canadians spend more privately on health care than citizens of most other developed countries. We quantified recent growth in private payments by Canadian households for health care. METHODS Using data from 163,081 respondents to Statistics Canadas annual Survey of Household Spending from 1998 to 2009, we calculated inflation-adjusted per-household spending on private health insurance premiums and out-of-pocket payments on six types of health care services. Further, we estimated the prevalence and some socio-economic determinants of households spending over 10% of after-tax income on health care using logistic regression. RESULTS We found that Canadian households spent

Patterns of physician retirement and pre-retirement activity: a population-based cohort study

19.8 billion on private payments for health care in 2009. This represents an average of

Impact of allowing pharmacists to independently renew prescriptions: A population-based study

1523 per household-a 37% increase over 1998. The top three spending categories in 2009 were private health insurance premiums (

The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey

5.9 billion), dental (

Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis

4.9 billion) and prescription drugs (

Impact of income-based deductibles on drug use and health care utilization among older adults

4.2 billion). Even after adjusting for inflation, expenditure on every category of health care spending increased between 1998 and 2009. The proportion of households spending more than 10% of after-tax income on health care increased by 56% (from 3.3% to 5.2%). Households including a senior, with a low income, and in British Columbia or the Atlantic Provinces were significantly more likely to reach this threshold. INTERPRETATION Over the period studied, the burden of private health care expenditures increased substantially for Canadian households. As direct charges reduce the use of necessary health care services, investigation into the health consequences of these increases is warranted.

The impact of a physician detailing and sampling program for generic atorvastatin: an interrupted time series analysis

BACKGROUND: Knowing when physicians retire and how they practise in the pre-retirement years is important information for health human resource planning. We identified patterns of retirement for physicians in British Columbia and the determinants of when and how physicians retire. METHODS: For this population-based retrospective cohort study, we used administrative data to examine activity levels and to identify retirements among BC’s practising physicians. We included all physicians who were at least 50 years of age as of March 2006 and who had received payments for clinical services in at least 1 year between 2005/06 and 2011/12. We defined retirement as a permanent drop in monthly payments to less than

The impact of medication reviews by community pharmacists

1667/month (

Utilization patterns and reimbursement options for diabetes test strips in British Columbia

20 000/yr). We examined the patterns and timing of retirement by age, sex, specialty and location using linear and logistic regression models. RESULTS: Of the 4572 physicians who met the inclusion criteria, 1717 (37.6%) retired during the study period. The average age at retirement was 65.1 (standard deviation 7.8) years. Controlling for other demographic and practice characteristics, we found that women and physicians working in rural areas retired earlier, by 4.1 (95% confidence interval [CI] −4.9 to −3.2) years and 2.3 (95% CI −3.4 to −1.1) years, respectively. We found no difference in retirement age by specialty. We identified 4 patterns of pre-retirement activity: slow decline, rapid decline, maintenance and increasing activity. About 40% of physicians (440/1107) reduced their activity levels by at least 10% in the 3 years preceding retirement. INTERPRETATION: During the study period, physicians in BC — particularly women and those in rural areas — retired earlier than indicated by licensure and survey data. Many physicians reduced their practice activity in the pre-retirement years. These trends indicate that forecasts relying on licensure “head counts” are likely overestimating current and future physician supply.