Measuring equity in the use and financing of prescription medicines

The use of prescription drugs outside of hospitals is not addressed in the Canada Health Act or by any legislation that would ensure national standards for accessibility. As a result, public pharmaceutical insurance programs designed to provide access to prescription medicines outside of hospitals have evolved independently in each province and territory. In May 2003, BC instituted Fair PharmaCare, an income-based catastrophic drug coverage program which links individuals' private financial contributions to the costs of their medicines (either out-of-pocket or through their private insurance), with their household income. Current research suggests that the implementation of income-based drug coverage has shifted the financial burden away from public sources toward private ones, which raises several important questions regarding equity. Using data from three comprehensive, population-level health care databases, namely: 1) the BC PharmaNet; 2) the British Columbia Linked Health Database (BCLHD); and 3) Fair Pharmacare registration files, Ms. Hanley is investigating the degree of income-related inequity in medicine use before and after the BC policy change in the general population, and in specific subpopulations (e.g., drug use after myocardial infarction). The analysis of specific subpopulations will allow for evaluation of the use of essential medicines and of medications known to be safe and effective. Further, it will enable greater needs standardization. Additionally, she is evaluating the redistributive effect of the policy change on income distribution in BC, specifically focusing on determining inequity in pharmaceutical financing among individuals of equivalent incomes. Taken overall, the results of the project will provide timely and relevant evidence to federal and provincial policy makers, as well as all Canadians, when Pharmacare reform is increasingly on the policy agenda.