Understanding the Gap: A Pan-Canadian Analysis of Prescription Drug Insurance Coverage

The Conference Board of Canada, 112 pages, December 7, 2017
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The comprehensive analysis in this report describes the design of public programs for prescription drug coverage in Canada, and how their design in each province leads to widely varying out-of-pocket spending.

Cette publication comprend un résumé en français, suivi d'une version anglaise du rapport intégral.

Document Highlights

Currently, the proportion of uninsured Canadians (individuals not eligible for public prescription drug insurance and not enrolled in a private insurance plan) in Canada is 5.2 per cent. However, this number will drop to an estimated 1.8 per cent on January 1, 2018, with the introduction of the expanded Ontario Health Insurance Plan. What is more, over 4 million Canadians are not enrolled for either public or private coverage, despite being eligible.

Understanding the Gap: A Pan Canadian Analysis of Prescription Drug Coverage  describes the design of public programs in each province (including out-of-pocket spending). This out-of-pocket spending varies widely and for different reasons depending on the specific plan design features in each province. The comprehensive analysis in the report also reveals that most Canadians have access to drug insurance through private or public plans, or even both.

Table of Contents

Executive Summary

Chapter 1–Introduction

  • Research Objectives
  • Understanding Canadians’ Prescription Drug Use

Chapter 2–Estimating the Gap in Prescription Drug Coverage

  • Methodology
  • Results of the Pan-Canadian Analysis

Chapter 3–Understanding Out-of-Pocket Spending

  • Canadians Who Experience No Prescription Drug Coverage (Uninsured)
  • The Eligible but Non-Enrolled
  • Enrolled in Public Prescription Drug Program(s) Only
  • Enrolled in Private Prescription Drug Insurance

Chapter 4–Summary

Chapter 5–The Future of Health Care Procurement in Ontario

Appendix A–Methodology

Appendix B–The Insurance Gap

Appendix C–The Non-Enrolled Population Gap

Appendix D–Bibliography

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