By: Michael Manning MSAH Graduate Program East Tennessee State University ALHE 5500

1. Cost Related Prescription Non-Adherence among the Elderly: A Comparison Study of the United States and Canadian Healthcare Systems-a brief summary- By: Michael Manning MSAH Graduate Program East Tennessee State University ALHE 5500

2. The Study: NONADHERENCE As directed use of prescribed medications is the most effective way to treat related pathologies. However, due to cost and health coverage issues, non-adherence of prescription regiments due to unaffordability and high out-of-pocket expense is an increasing clinical concern and a potential health hazard for many of the elderly within the U.S. Several attempts to offset this epidemic have been set in motion through government intervention, but the ultimate forecast is very dismal due to the increasing drug market inflation and an aging population. A review of the universal healthcare model currently operational within the federal and provincial governments of Canada may possibly influence policy makers and government leaders to create new avenues to help the senior populations gain better access to healthcare and service coverage.

3. The STATS “The sample included 3505 adults in Canada and 5183 adults in the United States…Residents of Canada were much less likely than residents of the United States to report cost-associated nonadherence (5.1% vs. 9.9%; P<0.0001). Americans without health insurance (28.2%) and Americans and Canadians without prescription-drug coverage (16.2%) were significantly more likely than those with insurance (6.2%) to report cost-associated nonadherence (P< 0.0001)” (Kennedy and Morgan, 2006, p. 1217).

4. CANADA Though, the Canadian system boasts a national health plan, its funding is controlled and divided among the provinces resulting in varying coverage for provincial residents related to prescription medications. This is further progressed by the fact that outpatient prescription medications are not covered under the Canada Health Act or any other healthcare policy. Therefore, the determining factor for prescription cost is directly related to one’s place of residence.

5. The United States The major factor contributing to the cost of medication within the U.S. is the poorly regulated pharmaceutical industry. The U.S. and its many lobbyists and special interest groups have actually helped progress the inflation within the pharmaceutical market with little effort to decrease prescription costs. With this pattern set in motion, the pharmaceutical inflation is expected to rise and continued financial strain will be placed on the Medicare system and its participants.

6. The Results With a direct comparison of nonadherence, the review of the U.S. populations revealed greater prescription nonadherence than that of Canada. However, neither system provided full coverage for all those eligible to participate in the Medicare and government programs. Though, the U.S. showed greater nonadherence related to cost, out-of-pocket costs were still a concern within certain provinces of Canada due to the provincial control of national health programs. It can be theorized that a hybrid of the two systems would result in better prescription coverage for the elderly populations by utilizing Canada’s pharmaceutical regulation practices and the national eligibility and coverage access within the U.S.

7. References: Kennedy, Jae, Morgan, Steve (2006). A cross-national study of prescription non-adherence due to cost: data from the joint Canada-United States survey of health, Clinical Therapeutics, 28(8), 1217-1224.