To what extent does poor health precede welfare?

BACKGROUND: It is well known that individuals receiving social assistance have more health problems than those with higher incomes. In this paper, we estimate the proportion of social assistance recipients who were on welfare following a drop in health status. METHODS: The study population consisted of Saskatchewan adults who had been continuously off social assistance for 12 consecutive months followed by 6 months on social assistance. Health status was measured by the use of physician services. We examined changes in physician service rates during the 18-month period. RESULTS: Forty-nine percent of individuals in the study population had increases in the number of physician services over the 18-month period. For these individuals, 53% of the increase in service use occurred during the 12 months prior to receiving social assistance. CONCLUSIONS: Deteriorating health, as measured by increased physician service use, seems to be one factor that precedes many people's receipt of welfare. A focus on improving health status may be one way to keep people off welfare.

An investigation of the impact of supplementary health benefits for low-income families in Saskatchewan.

OBJECTIVES: To examine the changes in health service use by recipients of Family Health Benefits, a supplementary benefits program that was introduced to lower-income, working families in Saskatchewan beginning in July 1998. These benefits reduced or eliminated fees for prescription drugs and for chiropractic, optometric and dental services. METHODS: The study population included program beneficiaries between July 1998 and January 2000. Administrative data maintained by Saskatchewan Health were used to capture information on changes in benefits coverage and use of hospital, physician, prescription drug, chiropractic and optometric services from 1997 to 2000. Demographic characteristics of the study population were described. Utilization rates were compared for periods prior to and following introduction of the program. RESULTS: Almost three quarters of Family Health Benefit beneficiaries had not had any form of prior supplementary health coverage in the previous year. A large proportion of these beneficiaries lived in rural Saskatchewan. Distinct demographic characteristics were observed for rural and urban beneficiaries. While utilization of physician and hospitalization services was lower following the introduction of the program, utilization of prescription drugs, and both chiropractic and optometric services increased. CONCLUSIONS: The reduction in user fees for non-insured services resulted in an increased use of these health services, suggesting that user fees can act as a barrier to the use of medical services by low-income families.