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Clin Ther. 2009 Jan;31(1):213-9. doi: 10.1016/j.clinthera.2009.01.006.

Cost-related prescription nonadherence in the United States and Canada: a system-level comparison using the 2007 International Health Policy Survey in Seven Countries.

Author information

1
Department of Health Policy and Administration, Washington State University, Spokane, Washington, USA. jjkennedy@wsu.edu

Abstract

BACKGROUND:

Prior research indicates that residents of the United States are nearly twice as likely as Canadian residents to report cost-related nonadherence (CRNA) (ie, being unable to fill > or =1 prescription due to cost). However, these kinds of national comparisons obscure important within-country differences in insurance coverage.

OBJECTIVE:

This study was designed to compare rates of CRNA across major financing systems for prescription drugs in the United States and Canada.

METHODS:

This study used the 2007 International Health Policy Survey in Seven Countries (supported by the US Commonwealth Fund) to estimate rates of CRNA in the following health systems: Canadian compulsory coverage (Quebec), Canadian senior and social assistance coverage (Ontario), Canadian income-based coverage (British Columbia, Manitoba, and Saskatchewan), Canadian mixed coverage (all other provinces), US private coverage (employer-based or individual insurance), US senior and social assistance coverage (Medicare and/or Medicaid), and US no coverage (uninsured).

RESULTS:

Adults in the United States were far more likely than adults in Canada to report CRNA (23.1% vs 8.0%; chi(2) = 147.4; P < 0.001). Seniors (> or =65 years of age) were less likely than younger adults (<65 years) to report CRNA in both the United States (9.2% vs 25.8%; chi(2) = 64.3; P < 0.001) and Canada (4.6% vs 8.7%; chi(2) = 14.9; P < 0.001), presumably due to categorical eligibility for prescription drug insurance. Comparative analyses therefore focused on working-age adults (<65 years). Adults in Quebec (who have compulsory drug coverage) were only half as likely as those in Ontario to report CRNA (odds ratio [OR] = 0.5; 95% CI, 0.3-0.8). Uninsured adults in the United States were >7 times as likely to report CRNA (OR =7.2; 95% CI, 5.0-10.5), and adults with public insurance (OR = 2.2; 95% CI, 1.4-3.5) and private insurance (OR = 2.2; 95% CI, 1.6-3.0) were >2 times as likely to report CRNA.

CONCLUSIONS:

After stratifying by age and simultaneously adjusting for sex, household income, and chronic illness, large differences in CRNA were found between and within countries. Even in a compulsory prescription insurance system like that in Quebec, 4.4% of working-age adults reported CRNA. However, these rates were low compared with CRNA rates for working-age adults in the United States who lack any health insurance (43.3%).

PMID:
19243719
DOI:
10.1016/j.clinthera.2009.01.006
[Indexed for MEDLINE]

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