Academic journal article Canadian Journal of Public Health

Children in Need of Pharmacare

Academic journal article Canadian Journal of Public Health

Children in Need of Pharmacare

Article excerpt

Medication Funding Requests at the Toronto Hospital for

Sick Children

ABSTRACT

Objectives: Although a national Pharmacare program ensuring access to and affordability of needed medications has repeatedly been cited as a priority to policymakers, 20% of families remain either uninsured or under-insured. The Hospital for Sick Children's Patient Amenities Fund (PAF) covers out-of-pocket medication expenses for inpatient and outpatient children. The research objectives were to 1) examine family demographics and socio-economic status (SES), the types of medications requested and government program process issues of PAF applicants in 1998 and 1999, and 2) describe trends in PAF requests from 1998 to 2000.

Methods: Data were extracted retrospectively from fund requests, charts and social work and discharge planning reports. Descriptive statistics were used to summarize the data and to examine time trends.

Results: Eighty-six applicants submitted 112 requests from 1998-1999. Most were for children with cancer, neurological disorders and transplant patients. Medication expenditures were $22,408 in 1999, a 39% increase over 1998. Most requests came from two-parent nuclear families where one or both parents were employed. High deductibles, waiting time, application form complexity and request denials were cited as problems encountered with government drug plans.

Discussion: The findings suggest that for provinces that do not provide universal drug insurance programs, relying on a patchwork of government plans and community agencies may not be effective in ensuring easy and timely access to necessary medications for children.

A national Pharmacare program ensuring access to and affordability of needed medications has repeatedly been cited as a priority to policymakers.1 This goal has yet to be realized and debate continues regarding what constitutes optimal pharmaceutical policy in Canada.2-5 Of particular concern are the needs of vulnerable populations, such as children. A recent Health Canada study observed wide variation across the provinces in the provision of drug coverage to families.2 Families without private drug plans face major financial burdens. Parents who are part-time workers and low income earners are more likely to be uninsured or under-insured. Children from families without private insurance rely on publicly administered plans and community agencies or must pay out of pocket.

Are pharmaceutical policies designed to provide coverage to families without a private drug plan working? In Ontario, gaining access to government plans can be complicated and time-consuming. Barriers to access for families exist in the form of cost-sharing through income-indexed deductibles and/or co-payments. Savings to the Ontario Drug Benefits program (ODB) resulting from cost-sharing may be offset by cost-shifting to the patient's family and to other health care sectors, a phenomenon that has been observed in other jurisdictions with government cost-sharing programs.4,6-9

Few studies have examined the effect of pharmaceutical policies on child health. In the Ontario Bronchial Inhaler study, health service use, health outcomes and costs were investigated in adults and children with asthma, a chronic condition requiring long-term treatment with prescription medications.10,11 In a retrospective analysis which included 42 children from families with no drug plan, a significantly higher proportion of parents without drug plans reported delaying or not filling prescriptions for their children because of cost compared to parents with drug plans (31 % vs. 13%, p=0.002).12 Children from families without drug plans had significantly fewer visits to respiratory specialists with a trend toward fewer prescriptions and more Emergency Department visits. In a study of cost-sharing and medication use by children enrolled in five US drug benefit plans, Hong and Shepherd suggested that increasing the level of cost-sharing may affect a parent's decision to purchase a medication for their child. …

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