Inequity in insurance coverage for prescription drugs in New Brunswick, Canada.

OBJECTIVES: To describe the extent to which New Brunswick residents reported having drug insurance coverage supplementary to Canadian Medicare; to examine associations between socioeconomic and demographic characteristics, health status, language identity, and having reported such coverage; and to document any changes in coverage associated with the introduction of the New Brunswick Drug Plan in 2014. METHODS: We used repeated cross-sectional data for New Brunswick from eight cycles of the Canadian Community Health Survey from 2007 to 2017 and undertook logistic regression analysis. RESULTS: We found statistically significant, substantial and policy-relevant socioeconomic differences in the reporting of prescription drug insurance coverage among those 25-64 years and those ≥ 65 years of age, and an increasing reliance on private drug insurance over time. We found that individuals in the second decile of household income were particularly vulnerable to reporting neither public nor private drug coverage. The introduction of the New Brunswick Drug Plan in 2014 does not appear to have led to increased public drug coverage; however, from 2014, the decreasing trend in public drug coverage appears to have ceased. Those who reported lower health status usually had lower odds of reporting private drug coverage but higher odds of reporting public drug coverage. Driven by differences in private coverage, we found that relative to anglophones, francophones were less likely to report any drug coverage. CONCLUSION: Our findings emphasize the shortcomings of drug insurance systems such as that introduced in New Brunswick and substantiate calls for a universal drug program. New Brunswick's increasing reliance on private drug insurance is of concern and warrants additional research.

RéSUMé: OBJECTIFS: Décrire la mesure dans laquelle les résidents du Nouveau-Brunswick ont déclaré avoir une couverture d'assurance médicaments supplémentaire au régime public d'assurance maladie canadien; examiner les associations entre les caractéristiques socioéconomiques et démographiques, l'état de santé, l'identité linguistique et avoir déclaré une telle couverture; et documenter tout changement de couverture associé à l'introduction du Régime médicaments du Nouveau-Brunswick en 2014. MéTHODES: Nous avons utilisé des données transversales répétées du Nouveau-Brunswick de huit cycles de l'Enquête sur la santé dans les collectivités canadiennes de 2007 à 2017 et avons entrepris une analyse de régression logistique. RéSULTATS: Nous avons constaté des différences socioéconomiques statistiquement significatives, substantielles et pertinentes en matière de politiques dans la déclaration de la couverture d'assurance médicaments chez les 25 à 64 ans et les 65 ans et plus, et une dépendance croissante à l'égard de l'assurance médicaments privée au fil du temps. Nous avons constaté que les personnes appartenant au deuxième décile du revenu du ménage étaient particulièrement vulnérables au fait de ne pas avoir déclaré d'assurance médicaments publique ou privée. La mise en place du Régime médicaments du Nouveau-Brunswick en 2014 ne semble pas avoir entraîné une augmentation de la couverture publique des médicaments; cependant, à partir de 2014, la tendance à la baisse de la couverture publique des médicaments semble avoir cessé. Ceux qui ont déclaré un état de santé inférieur avaient généralement une cote exprimant la probabilité plus faible de déclarer une assurance médicaments privée, mais plus élevée de déclarer une couverture publique des médicaments. En raison des différences de couverture privée, nous avons trouvé que, par rapport aux anglophones, les francophones étaient moins susceptibles de déclarer une couverture pour les médicaments. CONCLUSION: Nos résultats mettent en évidence les lacunes des systèmes d'assurance médicaments comme celui mis en place au Nouveau-Brunswick et justifient les appels en faveur d'un programme universel de médicaments. La dépendance croissante du Nouveau-Brunswick à l'égard de l'assurance médicaments privée est préoccupante et justifie des recherches supplémentaires.

Socioeconomic differences in prescription drug supplemental coverage in Canada: A repeated cross-sectional study.

BACKGROUND: Efforts to achieve universal healthcare coverage are fraught with challenges, not only in low- and middle-income countries but also in high-income ones. Canada, for example, is the only high-income country with universal health insurance that does not include universal coverage for prescription drugs. We first described the extent to which Canadians reported supplementary drug insurance coverage (public or private). Second, we examined associations between individuals' socioeconomic and demographic characteristics and self-reported drug insurance coverage. METHODS: We used logistic regressions and repeated cross-sectional data from two national (2015, 2016) and six Ontario (2005, 2008, 2013-2016) cycles of the Canadian Community Health Survey. RESULTS: We found large socioeconomic differences in the reporting of prescription drug insurance coverage. Individuals of lower socioeconomic status had higher odds of reporting public drug coverage or no coverage while those of higher socioeconomic status had higher odds of reporting private coverage. Respondents' reports indicated that public drug plans were more likely to cover those in poorer health while private plans were more likely to cover those in very good or excellent health. We also documented substantial underreporting of public drug coverage. which may also have access implications. INTERPRETATION: Both the lack of prescription drug insurance and misunderstandings about one's insurance coverage point to limits in Canada's drug insurance system.