Cost-sharing for health care services: An alternative strategy for pharmaceutical reimbursement in ontario

In most Canadian provinces many health services outside of the Canada Health Act have some element of cost-sharing, co-payments or service limits. These limitations can have significant financial impacts on patients and families related to both chronic and acute illnesses. Previous published research has shown significant financial burdens for homecare, devices and pharmaceuticals in diseases like cancer. Examination of existing funding policies raises the question: Can we restructure, or redistribute government funding in a way that minimizes these burdens to the most vulnerable populations (typically those under age 65 and in the lowest income quartile).Current Ontario policies related to pharmaceutical reimbursement were reviewed, and an alternate policy strategy that might better address patient level burden is presented using a case study approach, with the goal of mitigating financial burden. Cost neutrality could be obtained via offsets through higher co-payments in other populations to ensure no increase to existing funding envelopes.