Kratzer Jillian, McGrail Kimberlyn, Strumpf Erin, Law Michael R
Research Assistant, Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC.
Healthc Policy. 2013 Aug;9(1):35-43.
Approximately 68% of Canadians receive prescription drug coverage through an employer-sponsored private plan. However, we have very limited data on the structure of these plans. This study aims to identify and describe the use of cost-control mechanisms in private drug plans in Canada and describe what private coverage looks like for the average Canadian. Using 2010 data from over 113,000 different private drug plans, provided by Applied Management Consultants, we determined the overall use of key cost-control measures, and the cost-control tools that appear to be gaining currency compared to a report on benefits coverage in 1998. We found that the use of common cost-control measures is relatively low among Canadian private benefits programs. Co-insurance is much more common in private coverage plans than co-payments. Deductibles are uncommon in Canada and, when in place, are very small. The use of annual and lifetime maximums is increasing. Canadian private benefits programs use few cost-control measures to respond to increasing costs, particularly in comparison to their public counterparts. These results suggest there are ample opportunities for greater efficiency in private sector drug coverage plans.
大约68%的加拿大人通过雇主赞助的私人保险计划获得处方药保险。然而，我们对这些计划的结构了解的数据非常有限。本研究旨在识别和描述加拿大私人药品计划中成本控制机制的使用情况，并描述普通加拿大人的私人保险情况。我们使用了应用管理顾问公司提供的来自超过113,000个不同私人药品计划的2010年数据，确定了关键成本控制措施的总体使用情况，以及与1998年一份关于福利覆盖范围的报告相比，哪些成本控制工具似乎正在流行起来。我们发现，在加拿大私人福利计划中，常见成本控制措施的使用相对较少。在私人保险计划中，共保比共付更为常见。免赔额在加拿大并不常见，即使有，数额也非常小。年度和终身限额的使用正在增加。加拿大私人福利计划很少使用成本控制措施来应对不断增加的成本，特别是与公共福利计划相比。这些结果表明，在私营部门药品保险计划中提高效率有很大的空间。
