Health Care Co-payments in Alberta
Date
2021-06-30
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Abstract
Healthcare in Alberta has a clear and documented problem of waste in primary care, which presents a challenge for the provincial government to provide adequate health care at a reasonable cost for the entire population. Overuse of primary care is seen predominantly in emergency rooms, where individuals present with medical conditions that could be treated in more cost and medically appropriate settings. Other countries have also documented a similar problem of health care waste, and have taken policy interventions to attempt to make healthcare users to change their behaviour and reduce their unnecessary health care consumption. While not used in Canada for physician visits in family clinics or emergency departments, copayments have ben used in numerous countries in those settings. The result(s) of co-payment use has been mixed, with a noted decrease in healthcare consumption recorded in the area targeted by each of the countries in this paper. However, it has also caused many patients to defer care that otherwise would have been received without a co-payment system. Co-payment usage in the aforementioned international jurisdictions has shown that patients will seek care in alternate areas of the health system where there is not a financial barrier to access in order to escape the co-payment cost. In several of these countries, total health care costs increased when users decided to forgo primary care and an increase in hospital admissions was recorded. Although Alberta has legal constraints in how it can impose costs on health care users due to the Canada Health Act, it does have certain mechanisms at its disposal to incentivize change in how citizens use health services. This capstone recommends 3 potential options for the Alberta government to consider implementing; with the benefits and disadvantages of each option examined based on relevant international and Canadian literature and evidence. Option 2 will be the recommended policy choice that this paper presents to the Alberta government, which is the adoption of medical savings accounts (MSA) for Albertans. This would require the Alberta government to set up health accounts for individuals to partially contribute towards their own primary care use. An MSA program would discourage unnecessary medical use in emergency rooms for those who can seek care in more medically appropriate settings, while ensuring that persons with chronic conditions and lower-socioeconomic individuals would be exempt from making MSA payments. Most importantly, this approach would be legally compliant with the CHA and be unlikely to result in any financial penalty to the government of Alberta.
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Stewart, M. (2021). Health Care Co-payments in Alberta (Unpublished master's project). University of Calgary, Calgary, AB.