Canada’s health system: struggling to modernize a half-century old system

Canada receives worldwide attention for its single-payer and single-tier universal health coverage system, with hospital, diagnostic and primary care services free of user fees. The level of health spending and overall population health outcomes are comparable to other high-income countries such as France and Australia, but compared to the US Canada spends half as much on health care and achieves significantly better health outcomes. Nevertheless, it faces several challenges. One is providing financial access to other services. Pharmaceutical coverage is uneven and less generous than in comparable countries globally. Access to dental care, not covered for the general population, is challenging for the roughly one-third of the population lacking supplemental coverage, which nearly always is obtained through the workplace. The 2016 Commonwealth Fund international population surveys of 11 countries found that 41% of Canadians said they skipped dental care/check-ups in the past year due to costs - second highest among after the US. A second challenge is waiting for services. Canada shows the longest waits for specialist and surgical services. The third is stasis regarding adapting to changes in medicine and service delivery to improve quality and address major gaps in health across sub-populations such as Indigenous peoples. Innovations such as managed care and pay-for-performance lag behind most countries. Reform efforts aim to address fragmented care across providers, increase coverage, and reduce pharmaceutical costs. There are efforts to strengthen primary care, better coordinate across sectors, and reduce costly specialized care. There has also been increasing momentum to address financial barriers to accessing prescription drugs and containing pharmaceutical costs through a national “pharmacare” plan.

How Grief, Funerals, and Poverty Affect Bereaved Health, Productivity, and Medical Dependence in Japan

Grief has been shown to weaken bereaved persons' health, but measurements of their lost time and medical expense remain rare. Funerals traditionally managed and assuaged grief through ritual expression, approval, and social support. Research suggests that satisfying funeral participation reduces grief, while poverty exacerbates it. We hypothesized that: (1) psycho-physical symptoms of grief, (2) abbreviation/dissatisfaction in the funeral, and (3) poverty, correlate with decreased productivity and increased medical and social services use. We collected data from 165 mourning families about their grief, funerals, and subsequent medical conditions. (1) Deeper grief after bereavement in Japan correlated with more physical problems, more down time, and more medical dependency. (2) Low satisfaction with funerals correlated with higher hospital, pharmacy, and counseling costs. (3) Low income families lost more time, while declining incomes showed increased pharmaceutical costs. This suggests that satisfying funerals and income safeguards may reduce costs of low productivity and increased public services dependency.

Twelve year trajectories of physical activity and health costs in mid-age Australian women

Background: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women.Methods : Data from 6,953 participants in the Australian Longitudinal Study on Women’s Health (born in 1946–1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013-2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs.Results: Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443-3013) and AUD578 (95%CI: 426-729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49-360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232-545).Conclusion: Maintaining ‘active’ PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

Twelve year trajectories of physical activity and health costs in mid-age Australian women

Background: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women. Methods: Data from 6,953 participants in the Australian Longitudinal Study on Women’s Health (born in 1946–1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013-2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs.Results: Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443-3013) and AUD578 (95%CI: 426-729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49-360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232-545).Conclusion: Maintaining ‘active’ PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

Gambaran Pembiayaan Farmasi di Rumah Sakit Pemerintah dengan Pengelolaan BLU/BLUD

Pharmacy costs are one of the components that absorb the largest costs from the hospital's health budget. At present, there is still little information and data on the percentage of pharmaceutical costs to the costs of medical devices and non-medical devices. It is very useful in making financial planning. It can illustrate of pharmaceutical financing against other operational costs in hospitals, as financial planning, as scientific evidence for improving drug policy. This research was an analysis on the Indonesia Health Financing Survey data in the referral health care Facilities (FKRTL) in 2016. Data from 84 hospitals in 3 regions. The details were 9 class A hospitals, 37 class B hospitals, 38 class C hospitals. The analysis used a descriptive statistical approach. Pharmacy costs in 3 types of hospitals were 169.07 Billion, 23.66 Billion, 10.79 Billion. The percentage of the proportion of pharmaceutical costs to the cost of non-medical equipment in 3 types of hospitals is 1073.05%, 665.42%, 292.29%. The proportion of pharmaceutical costs to the cost of medical devices in 3 types of hospitals is 208.12%, 172.20%, 148.96%. In all types of hospitals the total pharmaceutical costs are greater than the costs of medical equipment and non-medical equipment costs. The proportion of pharmaceutical costs to the costs of non-medical devices and medical devices is high. This is due to the depreciation of the cost of medical devices and non-medical devices while the pharmaceutical costs always increase in price from the previous year. Abstrak Biaya farmasi merupakan salah satu komponen yang menyerap biaya terbesar dari anggaran kesehatan Rumah Sakit. Saat ini masih sedikit informasi dan data mengenai prosentase biaya farmasi terhadap biaya alat medis dan alat non-medis. Prosentase biaya di rumah sakit sangat bermanfaat dalam membuat perencanaan pembiayaan. Data penelitian sebagai gambaran pembiayaan farmasi terhadap biaya operasional lain di rumah sakit, sebagai perencanaan pembiayaan, sebagai bukti ilmiah untuk penyempurnaan kebijakan obat. Data riset merupakan analisis lanjut hasil Riset Pembiayaan Kesehatan Fasilitas Kesehatan Rawat Tingkat Lanjut (FKRTL) Tahun 2016. Data dari 84 rumah sakit yang di 3 regional. Dengan rincian adalah 9 rumah sakit kelas A, 37 rumah sakit kelas B, 38 rumah sakit kelas C. Data riset dimasukkan dalam dumy tabel untuk analisa lanjut. Analisis menggunakan pendekatan kuantitatif statistik diskriptif. Biaya farmasi pada 3 tipe RS masing-masing sebesar 169,07 Milyard, 23,66 Milyard, 10,79 Milyard. Prosentase proporsi biaya farmasi terhadap biaya alat non medis pada 3 tipe RS adalah 1073,05%, 665,42%, 292,29%. Prosentase proporsi biaya farmasi terhadap biaya alat medis pada 3 tipe RS adalah 208,12%, 172,20%, 148,96%. Di semua tipe RS total biaya farmasi lebih besar dibanding biaya alat medis dan biaya alat non medis. Prosentase proporsi biaya farmasi terhadap biaya alat non medis dan alat medis menjadi tinggi. Hal ini disebabkan terjadi penyusutan terhadap biaya alat medis dan alat non medis sedangkan biaya farmasi selalu terjadi peningkatan harga dari tahun sebelumnya.

P704 The biennial direct pharmaceutical costs per treatment with biologics for the inflammatory bowel disease in Greece: A comparative calculation study

Background Inflammatory bowel disease (IBD), as a chronic disease with relatively high prevalence worldwide, has undoubtedly resulted in a notable economic burden on health care systems globally. The IBD treatment with biologics (IBD-BT) seems quite complex with various strategies to induce and maintain remission and balance against long-term complications. IBD-BT costs have never been estimated in detail so far in Greece, especially during such a severe 10-years financial crisis experience. Methods Direct pharmaceutical costs for one and two years, both for induction and maintenance, adult treatment diagnosed with Crohn’s disease (CD-BT) or Ulcerative colitis (UC-BT) were estimated. For intravenous agents, the hospital drug prices and one day admission costs were calculated, whereas for subcutaneous biologics the retail ones. It was taken for granted that all patients were fully responders and after the approved induction scheme continued with the standard maintenance strategy. Prototype and biosimilar drug prices were also assessed where available. More specifically, when considering biosimilars, the most affordable one was included to our analysis. Each drug price was estimated based on the data collected from the 2019 Greek official electronic national publication on drug therapy of the Greek national organisation for medicines. Results Table shows the costs in euros of each IBD-BT scheme. The biosimilar adalimumab was proved as the most affordable choice both for CD- and UC-BT. The second most affordable choice for CD revealed to be the prototype Adalimumab and respectively for UC the recently introduced tofacitinib, in the maintenance dose of 5 mg bid after week 8 (with a slight burden when the more intensive scheme with Tofacitinib 10 mg bid for 16 weeks is necessary). The most expensive strategies include Ustekinumab 90 mg (per 8 weeks for body weight—BW &gt; 55 to ≤85 kg and &gt;85 kg) and the prototype Infliximab 5 mg/kg (per 8 weeks for BW&gt;81 kg), whereas Vedolizumab remains expensive regardless BW. It is worthwhile to mention that the hospitalisation expenditures (563€) raise the costs of intravenous agents when compared with the subcutaneous ones. Conclusion The biennial direct pharmaceutical costs for the approved IBD-BT schemes both for induction and maintenance phases in fully responders were estimated thoroughly for the first time in Greece. These results should motivate Governments and European Union policymakers in order to promote cost-benefit and cost-utility studies to offer the best patients’ benefit by evaluating and deciding the most suitable regimen with respect to biologic prices, adverse effects, hospitalisation expenditures, IBD complications and recurrences.

Pharmaceutical use and costs in patients with coronary artery disease, using Australian observational data

ObjectivesWe aimed to estimate the annual pharmaceutical costs for patients with stable coronary artery disease, using Australian administrative data, comparing patients who had undergone interventional treatment with those had not. We also aimed to compare the duration of dual antiplatelet therapy (DAPT) prescription in the real-world, with recommended guidelines.DesignAn observational study using administrative data.ParticipantsWe used data from the QSkin study, a population-based prospective study assessing skin cancer risk. Participants were invited from the Queensland population, not based on perceived skin cancer risk, and had consented to future use of their data for approved research projects.Main outcome measuresWe calculated 12-month costs of pharmaceutical therapy for coronary artery disease for patients in each of three clinically relevant groups: medical therapy only, following coronary stent implantation and following coronary artery bypass graft surgery. We measured the duration of DAPT following stent implantation and total duration of DAPT, where it was prescribed, in the medical therapy only group.ResultsEstimated mean annual pharmaceutical costs were highest in the stent group at AUD$1920, compared with AUD$1481 in the medical therapy group, and AUD$881 in the coronary artery bypass group. There were similar rates of prescriptions of symptom relief drugs following stent insertion, compared with the medical therapy only group. The median duration of DAPT in the stent group was 16, and 31 months in the medical therapy group.ConclusionsOur results suggest that despite the common expectation that the burden of medical therapy is reduced following coronary stent insertion for stable coronary artery disease, this does not occur in practice. Many patients also appear to continue DAPT longer than guidelines recommend, which may put them at unnecessarily elevated risk of bleeding events.

Abstract P069: Modifiable Risk Factors as Drivers of Pharmaceutical Expenditures Among US Adults with Atherosclerotic Heart Disease: 2012 Medical Expenditure Panel Survey

Background: Atherosclerotic Cardiovascular disease (ASCVD) remains the leading cause of deaths and costs in the US. Despite advancements in therapies, no study has evaluated drivers of pharmaceutical expenditures among individuals with ASCVD. We aimed to assess the economic impact of modifiable risk factors (MRF) on overall pharmaceutical expenditures among ASCVD patients. Methods: We studied the 2012 Medical Expenditure Panel Survey (MEPS) data of adults aged ≥40 years with Body Mass Index ≥18.5Kg/m2 and ICD-9 diagnosis of ASCVD (410, 413, 414, 433, 434, 435, 436, 437, 440, 443, and 447). Using total pharmacy expenditure variable in MEPS as our primary outcome, marginal and actual expenditures associated with predictors were estimated using a two-part econometric model with probit and glm, family(gamma) link (log). Results: Based on the 2012 MEPS, an estimated 140.7 million people in US are aged ≥40 years. An estimated 15.4 million had ASCVD (69±15 years; 41% female). Overall, total pharmaceutical expenditure among those with ASCVD was $52.7 billion (95% CI: $44.2-62.0 billion), which accounted for 33.7% of total pharmaceutical expenditures. Individuals with ASCVD had $1,847 (95% CI: $1,655 - 2,038) incremental pharmaceutical expenditure vs. those without it (p<0.001). The two-part econometric model showed that all MRF independently impacted incremental expenditure. By aggregates of MRF, 50% had 2-3; 39% had 4-6; and the rest (11%) had one or none. The estimated pharmaceutical expenditures was lower with favorable MRF status irrespective of comorbid conditions. In adjusted analyses, as compared to those with ≥4 MRF, those with 2-3 had $1,881 (95% CI: $1,242 -2,521) and those with 0-1 MRF had $2,669 (95% CI: $2,317 - 3,020) lower pharmaceutical costs, respectively. Conclusion: Our study results suggest attainment of favorable modifiable risk status as delineated in AHA 2020 Impact goals can have a beneficial impact on pharmaceutical costs, which accounts for significant proportion of overall healthcare expenditure.