The Associations of Prescription Drug Insurance and Cost-Sharing With Drug Use, Health Services Use, and Health: A Systematic Review of Canadian Studies.

OBJECTIVES: In Canada, public insurance for physician and hospital services, without cost-sharing, is provided to all residents. Outpatient prescription drug coverage, however, is provided through a patchwork system of public and private plans, often with substantial cost-sharing, which leaves many underinsured or uninsured. METHODS: We conducted a systematic review to examine the association of drug insurance and cost-sharing with drug use, health services use, and health in Canada. We searched 4 electronic databases, 2 grey literature databases, 5 specialty journals, and 2 working paper repositories. At least 2 reviewers independently screened articles for inclusion, extracted characteristics, and assessed risk of bias. RESULTS: The expansion of drug insurance was associated with increases in drug use, individuals who reported drug insurance generally reported higher drug use, and increases in and higher levels of drug cost-sharing were associated with lower drug use. Although a number of studies found statistically significant associations between drug insurance or cost-sharing and health services use, the magnitudes of these associations were generally fairly small. Among 5 studies that examined the association of drug insurance and cost-sharing with health outcomes, 1 found a statistically significant and clinically meaningful association. We did not find that socioeconomic status or sex were effect modifiers; there was some evidence that health modified the association between drug insurance and cost-sharing and drug use. CONCLUSIONS: Increased cost-sharing is likely to reduce drug use. Universal pharmacare without cost-sharing may reduce inequities because it would likely increase drug use among lower-income populations relative to higher-income populations.

Exploring the Results of the Ontario Home Care Minimum Wage Change.

Background: :In 2014, Ontario increased its "minimum wage" for personal support workers (PSWs) in publicly funded home care. Objective: The objective of this article is to determine the short-term results of this policy for home care PSWs' wages, hours and job stability. Methods: This study uses descriptive graphs and ordinary least squares and unconditional quantile regressions, using PSWs across Canada as comparison groups. Results: Pre-policy nominal wages for Ontario home care PSWs stagnated, whereas real wages declined. The policy increased home care PSWs' wages without noticeably affecting hours or job stability. However, wages were already increasing for low-wage home care workers in the rest of Canada. Conclusions: Ontario exercises monopsony power in the home care market and, before the wage increase, kept nominal wages stable compared to rising real and nominal wages in the rest of Canada. This PSW-specific wage increase did not represent a drastic change relative to market conditions.