Grant: Commonwealth Fund Dissemination Award 2015-2016

Healthcare in Canada is largely provided through a universal, publicly-funded system. However, not all medical treatments and services are in fact universally paid for in this system (e.g. prescription drugs out of hospital, dental services), leaving many Canadians to pay out of their own pockets for any unmet healthcare needs. Previous research has shown that having to pay out-of-pocket for drugs can prevent patients from filling their prescriptions. If people are willing to forego their medical care due to costs, this begs the question of whether healthcare in Canada is affordable. The aim of this study is to use data from the Commonwealth Fund International Health Policy (IHP) survey, which has patients in 11 different countries, including Canada, about the performance of their healthcare systems since 1998. We examined the responses to questions asking patients about possible cost-related issues with healthcare. The IHP survey results from 1998 to 2014 in Canada were then compared to the United Kingdom (UK), the United States (US), Australia and New Zealand. We found that, over time, nearly 10% of Canadian respondents on average reported problems paying for care or filling prescriptions, in comparison to 3-8% of UK and 6-37% of US respondents. More than half of Canadians reported having additional private health insurance paid for by their employers or out-of-pocket, which was the highest among healthcare systems across all survey years. Canadians also reported paying high, and steadily increasing, out-of-pocket costs for their care. Overall, the UK reported the lowest financial burden. Financial barriers to care in Canada were similar to Australia and New Zealand, and still lower than in the US. The present findings uncover important areas for improvement and new opportunities for research in the Canadian healthcare system.