Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Nov;2(2):e170-86.

Income-based drug coverage in British Columbia: the impact on the distribution of financial burden

Gillian E Hanley  1 , Steve Morgan, Lixiang Yan
Affiliations

Income-based drug coverage in British Columbia: the impact on the distribution of financial burden

Gillian E Hanley et al. Healthc Policy. 2006 Nov.

Abstract
in English, French

Background and objectives: In May 2003, the government of British Columbia adopted an income-based pharmacare program, replacing the previous age-based program. Stated policy goals included improving the distribution of pharmaceutical payments across incomes. This analysis assesses the policy's effect on the distribution across incomes of both private payments and public subsidy for prescription drugs.

Methods: This analysis focuses on how the 2003 policy change affected the extent to which higher-income households pay a larger share of private drug expenditures and/or receive a smaller share of available public subsidies. Demographic information and drug spending data were extracted from BC PharmaNet and the BC PharmaCare Program for the years 2001-2004. These data were then graphed to assess (using concentration curves) changes in the progressivity of private and public pharmaceutical financing.

Results: Overall, the move to Fair PharmaCare resulted in larger but slightly less regressive private payments and smaller but slightly more progressive public subsidies. Because total drug spending increased while the total subsidy available decreased, average private household spending as a proportion of household income increased across virtually all age and income levels.

Discussion: The PharmaCare Program redistributed public subsidies in a manner that was more progressive than previous programs; this reduced the regressivity of private pharmaceutical payments. However, total public subsidy decreased, and private spending increased by a commensurate amount. This makes the program's overall financial impact on BC households somewhat ambiguous. Income-based pharmacare could improve financial equity unambiguously if public shares of drug spending are expanded.

Contexte et objectifs :: En mai 2003, le gouvernement de la Colombie-Britannique a instauré un régime d’assurance-médicaments fondé sur le revenu pour remplacer l’ancien régime fondé sur l’âge. Parmi les objectifs visés, mentionnons une meilleure répartition des dépenses en médicaments selon le revenu. L’analyse évalue l’effet de la politique sur la répartition, en fonction du revenu, des dépenses privées et publiques en médicaments d’ordonnance.

Méthodes :: Cette analyse cherche principalement à déterminer dans quelle mesure les foyers à revenu plus élevé paient une plus grande portion des dépenses en médicaments et/ou reçoivent une plus petite portion des fonds publics disponibles, suite au changement de politique effectué en 2003. Nous avons extrait des renseignements démographiques et des données sur les dépenses en médicaments de PharmaNet et du Régime d’assurance-médicaments de la C.-B. pour les années 2001 à 2004. Nous avons ensuite converti ces données en un diagramme afin d’évaluer (à l’aide de courbes de concentration) les changements survenus dans le financement privé et public des médicaments.

Résultats :: Dans l’ensemble, la mise en oeuvre d’un régime équitable d’assurance-médicaments a entraîné des paiements légèrement moins régressifs et plus faibles dans le privé, mais des subventions publiques légèrement plus progressives. Étant donné que les dépenses totales en médicaments ont augmenté alors que les subventions totales disponibles ont diminué, les dépenses moyennes par foyer – en tant que proportion du revenu du foyer – ont augmenté pour presque tous les âges et niveaux de revenu.

Discussion :: Le régime d’assurance-médicaments a eu pour effet de redistribuer les subventions publiques d’une manière plus progressive que les programmes précédents, ce qui a réduit le caractère régressif des paiements privés à ce chapitre. Cependant, les subventions publiques totales ont diminué et les dépenses privées ont augmenté de façon proportionnelle, ce qui rend l’incidence financière globale du programme sur les foyers de la C.-B. quelque peu ambiguë. L’assurance-médicaments fondée sur le revenu pourrait améliorer l’équité financière de façon plus nette si la portion publique des dépenses en médicaments est maintenue ou augmentée.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Total drug expenditures and public subsidy, senior households, stratified by income percentiles, 2001–2004
FIGURE 2.
FIGURE 2.
Total drug expenditures and public subsidy, non-senior households, stratified by income percentiles, 2001–2004
FIGURE 3.
FIGURE 3.
Average share of household income spent privately on prescription drugs, senior and non-senior households, stratified by income percentiles, 2001–2004
FIGURE 4.
FIGURE 4.
Concentration curves for public subsidy of drug expenditures for senior households, 2001–2004 (magnified below)
FIGURE 5.
FIGURE 5.
Concentration curves for public subsidy of drug expenditures for non-senior households, 2001–2004 (magnified below)
FIGURE 6.
FIGURE 6.
Concentration curves for private drug expenditures, senior and non-senior households, 2001, 2004 and hypothetical policy scenarios
None
Comparison of seniors’ results using neighbourhood-defined versus household-registration–based income data
None
See this image and copyright information in PMC

References

    1. Aronson J.R., Johnson P., Lambert P. J. Redistributive Effect and Unequal Tax Treatment. Economic Journal. 1994;104(423):262–70.
    1. Caetano P., Raymond C., Morgan S., Yan L. Income-Based Drug Coverage in British Columbia: The Impact on Access to Medicines. Healthcare Policy. 2006. http://www.longwoods.com/product.php?productid=18513&cat=458 . - PMC - PubMed
    1. Castano R.A., Arbelaez J.J., Giedion U.B., Morales L.G. Equitable Financing, Out-of-Pocket Payments and the Role of Health Care Reform in Colombia. Health Policy and Planning. 2002. pp. 5–11. Retrieved September 11, 2006. http://heapol.oxfordjournals.org/cgi/content/abstract/17/suppl_1/5 . - PubMed
    1. Daniels N., Bryant J., Castano R.A., Dantes O.G., Khan K.S., Pannarunothai S. Benchmarks of Fairness for Health Care Reform: A Policy Tool for Developing Countries. Bulletin of the World Health Organization. 2000;78(6):740–50. - PMC - PubMed
    1. Morgan S., Coombes M. Income-Based Drug Coverage in British Columbia: Towards an Understanding of the Policy. Healthcare Policy. 2006;2(2):92–108. - PMC - PubMed

LinkOut - more resources