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Analysis

Evaluating the effects of Quebec’s private–public drug insurance system

Steven G. Morgan, Marc-André Gagnon, Mathieu Charbonneau and Alain Vadeboncoeur
CMAJ October 10, 2017 189 (40) E1259-E1263; DOI: https://doi.org/10.1503/cmaj.170726
Steven G. Morgan
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que.
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  • For correspondence: steve.morgan@ubc.ca
Marc-André Gagnon
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que.
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Mathieu Charbonneau
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que.
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Alain Vadeboncoeur
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que.
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    Figure 1:

    Expenditure per capita on prescription drugs from 1985 to 2016 in Quebec and the rest of Canada, (A) tax-financed versus (B) household- and employer-financed. Source: Authors’ calculations-based data from Canadian Institute for Health Information National Health Expenditure Trends, 1975 to 2016.23 Tax-financed expenditures are those paid through government general revenues; household- and employer-financed expenditures are those paid out of pocket or through premium contributions to mandatory private or public insurance plans. Quebec data for 2015 and 2016 projected based on five-year average growth rates.

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    Table 1:

    Cost-related nonadherence to prescription drugs, total out-of-pocket payments and total pharmaceutical expenditure per capita for Canada, Quebec and 9 comparable high-income countries with universal health insurance*

    JurisdictionCost-related nonadherence: % of adult population reporting they did not fill a prescription or skipped doses because of the cost in 2016Out-of-pocket costs: % of adult population reporting their household spent $1000 or more in out-of-pocket costs in 2007Total pharmaceutical expenditure per capita in 2014, Canadian dollars (purchasing power parity), $
    Quebec8.88.71087
    Rest of Canada10.74.8912
     Population-weighted average for Canada10.25.7952
    Australia6.35.3753†
    New Zealand5.72.4369‡
    Norway3.4–564
    Sweden5.7–603
    United Kingdom2.11.2598
     Population-weighted average for universal public systems3.6–621
    France3.9–809
    Germany3.22.8900
    Netherlands4.40.9494
    Switzerland8.9–914
     Population-weighted average for social insurance systems3.8–826
    • ↵* Authors’ calculations based on the Commonwealth Fund’s 2016 International Health Policy Survey; the Commonwealth Fund’s 2007 International Health Policy Survey; Statistics Canada’s 2007 Survey of Household Spending; and the Organisation for Economic Co-operation and Development’s Health Data 2016 data sets.13–15

    • ↵† Projected from 2013 based on growth rates in other comparator countries.

    • ↵‡ Projected from 2007 based on growth rates in other comparator countries.

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Canadian Medical Association Journal: 189 (40)
CMAJ
Vol. 189, Issue 40
10 Oct 2017
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Evaluating the effects of Quebec’s private–public drug insurance system
Steven G. Morgan, Marc-André Gagnon, Mathieu Charbonneau, Alain Vadeboncoeur
CMAJ Oct 2017, 189 (40) E1259-E1263; DOI: 10.1503/cmaj.170726

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Evaluating the effects of Quebec’s private–public drug insurance system
Steven G. Morgan, Marc-André Gagnon, Mathieu Charbonneau, Alain Vadeboncoeur
CMAJ Oct 2017, 189 (40) E1259-E1263; DOI: 10.1503/cmaj.170726
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