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Chiu, Candice Man Yee

University of British Columbia

Background： Fair PharmaCare is a catastrophic public drug plan which is available to all the residents of British Columbia. Coverage is determined by income-based deductibles and therefore requires households to self-register and consent to allowing the Canada Revenue Agency to release their income information to the BC Ministry of Health. In the absence of registration, households are assigned the highest deductible of $10,000. In 2019, the government reduced and eliminated deductibles and family maximum for lower income households. It remains unclear why many households are not registered and whether they could derive additional benefit from registering. Methods： This thesis used administrative data to examine the association between household level, area-based, and needs-based characteristics and time until registration using survival analysis. Interrupted time series analysis was performed to evaluate the impacts of the 2019 policy change on registration rates, as well as the association between registration, drug utilization, and drug expenditures. Simulation methods were used to estimate the unrealized benefits from households not registering. Results： We found a strong association between needs-based factors and registration for Fair PharmaCare. The 2019 policy change that lowered deductibles and coinsurance for lower income households did not result in a change in Fair PharmaCare registration rates, suggesting that there are other factors impacting registration amongst the population not registered for Fair PharmaCare. In the year of registration for Fair PharmaCare, a significant increase in drug expenditures and drug utilization was observed, followed by decreasing drug expenditures and a sustained level of drug utilization over time. If full registration for Fair PharmaCare occurred, we estimated there would be only small changes to private payer savings per household and a very small increase to the PharmaCare budget. Conclusion： Households register for Fair PharmaCare when the need arises, and until the need arises, even if deductibles and coinsurance are lowered, further registration does not appear to occur. The province would not face large expenditures if the full population were to register in Fair PharmaCare. However, the incentive to register amongst those not yet registered is likely small as most households have minimal drug expenditures.

Text

2022-08-23

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/82481

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/