Abstract
Objectives: Although a national Pharmacare program ensuring access to and affordability of needed medications has repeatedly been cited as a priority to policymakers, 20% of families remain either uninsured or under-insured. The Hospital for Sick Children’s Patient Amenities Fund (PAF) covers out-of-pocket medication expenses for inpatient and outpatient children. The research objectives were to 1) examine family demographics and socio-economic status (SES), the types of medications requested and government program process issues of PAF applicants in 1998 and 1999, and 2) describe trends in PAF requests from 1998 to 2000.
Methods: Data were extracted retrospectively from fund requests, charts and social work and discharge planning reports. Descriptive statistics were used to summarize the data and to examine time trends.
Results: Eighty-six applicants submitted 112 requests from 1998–1999. Most were for children with cancer, neurological disorders and transplant patients. Medication expenditures were $22,408 in 1999, a 39% increase over 1998. Most requests came from two-parent nuclear families where one or both parents were employed. High deductibles, waiting time, application form complexity and request denials were cited as problems encountered with government drug plans.
Discussion: The findings suggest that for provinces that do not provide universal drug insurance programs, relying on a patchwork of government plans and community agencies may not be effective in ensuring easy and timely access to necessary medications for children.
Résumé
Objectifs: Bien que les décideurs évoquent périodiquement l’urgence d’avoir un programme national d’assurance-médicaments universellement accessible et à prix abordable, 20 % des familles demeurent inassurées ou sous-assurées. Le fonds de commodités pour les patients (PAF) du Hospital for Sick Children rembourse aux familles les dépenses en médicaments pour les enfants malades hospitalisés et ambulatoires. Notre étude visait 1) à examiner les données démographiques et le statut socio-économique des familles, le genre de médicaments demandés et les problèmes rencontrés par les demandeurs du PAF en 1998 à l’égard des formalités administratives du programme gouvernemental; et 2) à décrire les tendances des demandes PAF de 1998 à 2000.
Méthode: Les données ont été extraites rétroactivement des demandes PAF et des diagrammes et rapports de planification des services de travail social et des autorisations de sortie. Nous avons fait appel à la statistique descriptive pour résumer les données et en étudier l’évolution dans le temps.
Résultats: Quatre-vingt-six personnes ont présenté 112 demandes en 1998 et 1999. La plupart concernaient des enfants greffés ou atteints de cancers ou de troubles neurologiques. Les dépenses en médicaments représentaient 22 408 $ en 1999, en hausse de 39 % par rapport à 1998. La plupart des demandes venaient de familles nucléaires où au moins un des deux parents travaillait. Les franchises élevées, la période d’attente, la complexité du formulaire de demande et les demandes refusées comptaient parmi les obstacles à surmonter pour se prévaloir des régimes gouvernementaux d’assurance-médicaments.
Discussion: Ces résultats portent à croire que les provinces qui n’offrent pas de programme universel d’assurance-médicaments doivent se fier à des régimes gouvernementaux et à des organismes communautaires disparates, ce qui n’est peut-être pas une manière efficace d’assurer un accès facile et rapide aux médicaments dont les enfants ont besoin.
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