Next, Coombes, Morgan, Barer and Pagliccia at the University of British Columbia address the very important question of which provincial pharmacare model would best protect Canadians against catastrophic drug costs. In February 2003, the First Ministers' Accord on Health Care Renewal indicated a commitment to ensure that all Canadians have reasonable access to catastrophic drug coverage. The study by the current authors compared the private financial burdens from prescription drugs that Canadian households would face if any of the provincial pharmacare models were adopted as the national standard. By simulation modeling, the authors calculated household private financial burden by applying the cost-sharing rules from provincial drug plans to a nationally representative set of 4,860 household types differing in size, age composition, income and drug expense levels. The proportions of households that would face private out-ofpocket payments exceeding critical, or catastrophic, percentages of household income were calculated. The results showed that the provincial pharmacare models are quite varied in the financial burden due to prescription drug costs. Coombes at al. suggest that comprehensive, tax-financed pharmacare models that limit out-of-pocket expenditures to a given percentage of income, such as those found in British Columbia, Saskatchewan, Manitoba and Ontario, provide the greatest protection against catastrophic prescription drug costs. This suggests that a standard approach would be more in keeping with the National Health Insurance program in Canada.
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