In the name of transparency, and also to further the ability of policy-makers, interested parties, and the general public to understand where Canadians are at on particular and important issues of the day, we make all of our data and information available to the public at no cost through our website.
What we wanted to do with the study that was conducted in July 2015, in partnership with the Mindset Foundation, representing a general population sample of Canadians in every region and of the main census demographics, was to take the temperature of Canadians and get a sense of the prevalence and incidence of those Canadians facing cost pressures and other access barriers around their prescription drugs.
What we found, to begin with, was that nearly one in four, a quarter of, Canadians say they are either not taking prescription drugs, skipping doses, splitting pills, or finding other ways to reduce cost and access barriers to the prescription medications they are being recommended to take by their doctors and specialists. Right away, we were able to surmise that this is an issue and one that is putting some pressure on a not insignificant segment of Canadians in this country.
In terms of who is struggling most, that national number sits at just under one in four, but we tend to see a little more struggle and a little more cost pressure for those living in British Columbia and Atlantic Canada. There is some variability, and some of that may be attributable to the fact that in British Columbia, for example, provincial governments only have so-called catastrophic drug coverage. In Atlantic Canada there are other limitations to the nature of drug plans relative to other provinces such as Quebec and Ontario. When we use the word “struggle”, we're talking about those who are identifying themselves as not adhering to their prescription drugs by dosage and not necessarily filling their prescriptions as often as they should be because of the costs involved.
Costs and barriers do go hand in hand, and they affect Canadians on two different levels. One is by age. We do see barriers that are a bit worse for the youngest Canadians. This isn't entirely surprising, given that younger Canadians are often those who are dealing with the least stable work. They may not have jobs that offer comprehensive drug coverage or drug benefit plans of any king. For them, access to pharma is a little less stable, and they may be experiencing more pressure, although you do see almost as many Canadians aged 35 to 54 expressing that they are having some struggles as well.
Income is also a driver of that cost barrier. Those who have lower household incomes are expressing higher levels of struggle and problems with filling their prescriptions, but that isn't to say that higher-income earners don't struggle as well. The reason for that is that you can have brand-name drugs and experimental drugs that can be quite costly. Even though some Canadians are earning more, they may still be facing barriers. Indeed, 16% say they are facing those barriers because some drugs are prohibitively expensive. If people are not covered, then they're figuring out how to deal with that themselves.
We wanted to get a sense of how many Canadians are paying out of pocket for their drug expenses. Overall, you see that about 30% say they're paying some amount less than $100 per year. There are about as many saying they're paying $500 or more. Something like one in five, about 20%, are saying they're paying between $1,000 and $3,000 per year.
What's notable here is that those in that $500 or more out-of-pocket expense bucket include about one-third of Quebeckers. This may be attributable to the fact that they are dealing with monthly deductibles and other costs associated with that province's mandatory drug plan. Ontarians, by contrast, have some of the lowest out-of-pocket burdens. Only 14% say they paid $500 a year or more, in the last year, for their prescription drugs.
When we think about access to drugs and access to prescriptions, we also want to ask, “Are you worried about this? Have you been worried, and going forward is this something that's going to be increasingly on your mind?” A routine question we ask of Canadians every three months is, “What are the top issues now facing you, your family, your household?”
Of course, health care is always at the top of that list, along with the economy. But within that subset of health care, what this clearly tells us is that prescription drugs and drug coverage and access are at the top of that health subset.
In the last year, 25% told us they have been worried about how they or their family members would be able to afford prescription medication. Looking ahead, we asked them to think about a decade from now, when they're going to be 10 years older. In response, the level of worry jumped to nearly half, and 46% said they were either very worried or worried about how they were going to pay for their prescription drug costs 10 years from now.
From looking at Canadians' own experiences, at the personal or household level, of accessing drugs and being able to fill their prescriptions, we shifted to some broader opinions on where they stand on the idea of a pharmacare plan. I want to provide a caveat on this. We are experts in measuring public opinion and measuring where Canadians are on particular issues. We are not health policy experts. When we ask this question and present these data, we recognize that without further specifics on what a pharmacare plan might look like, there are some limitations on the interpretation of these findings.
I want to underscore that what I'm presenting is valid as an initial temperature-taking, as opposed to the final word, on public opinion on these issues.
We put a number of value statements in front of Canadians. I'm presenting three that speak to where Canadians are in their general views on pharmacare and access to prescription drugs. These are by no means all the statements that were put in front of Canadians. If more information is wanted, or a greater level of detail, I'm happy to provide that, or you can find it online at angusreid.org. We've provided that link for you.
What you see is that public opinion certainly tilts toward—albeit it's not necessarily a majority—value statements that indicate, on a conceptual level, that Canadians are in favour of access to prescription medication. They favour being able to get the drugs they need for their health.
On support for a pharmacare plan, we asked: “Do you yourself oppose or support adding prescription drugs to the universal health coverage of 'medicare'?” To further explain what we meant, we added: “so that all Canadians have access to prescribed medicines without having to pay out of their own pocket”.
Again you see very strong consensus for this concept. Only 15% oppose or strongly oppose such a plan; nearly a half say that they strongly support it. Again, it is conceptual. I have to underscore that again.
What's notable and significant in this finding is that when you combine it with some other findings, some 70% of Canadians think that the status quo in terms of drug coverage today is in need of improvement. Moreover, when it comes to reform, again, a great majority believe that the pharmacare coverage they face in their country—and, of course, it is a bit of a patchwork when you go from province to province—is better served by having a national plan across the board.
Now, who should pay? It's always easy to find Canadians in support of particular plans, or ideas, or policies, but when it comes to the stickier details of who administers and who pays, this is where we tend to find a little less consensus. On the issue of administration and who should be involved, you see that about a half, a very slight majority, believe this should be something that both the provinces and the federal government should have some involvement in and be working together on. The margins, about one-quarter, say that it should be the federal government that runs the show, about one-quarter say it should be up to the individual provinces.
How should it be funded? You see there at the top for context, again, that's your 87% overall saying that yes, there is support for adding prescription drugs to medicare. That's your reference point on support, but in terms of particular funding costs and funding options, the only funding option that reveals any majority and consensus support is around restoring a federal corporate income tax to its 2010 levels of 18%. Canadians are not particularly warm to an increase in the GST to pay for such an idea. They are not particularly warm to increasing the basic income tax on incomes over $40,000 to 23%. They are, at best, milquetoast on the idea of charging a pharmacare premium of $180 per year for all Canadians over the age of 18.