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Costs of Ambulatory Medical Care Over the Long Term in the Quebec Medicare System

Published online by Cambridge University Press:  29 November 2010

François Béland
François Béland
Affiliation:
Université de Montréal
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Abstract

This paper examines the question of whether the costs of ambulatory medical care (AMCC) in a universal health care system, such as that in Quebec, are related to household income. Questionnaires completed by 32,000 respondents for the Enquête Santé-Québec, 1987 (ESQ87) were matched with records in the Quebec Medicare system (La Régie d'Assurance-maladie du Québec, RAMQ). Approximately 90 per cent of the individuals were matched. Respondents living in remote regions were excluded from the study since a major portion of medical care in these regions is not reimbursed through fee for service; visits to physicians not on fee for service are not recorded in RAMQ files. At the individual level, the costs of ambulatory medical care over a two-year period decreased slightly with income, but at the household level, costs increased for those with higher incomes since the number of individuals in the households increased with income. These associations disappeared when the age of the respondents was taken into account. State of health is directly related to costs of care. Among health risks, availability of social support decreases costs of AMCC for both children and adults, while unemployment increases costs for adults only. Education of parents is linked with higher levels of costs for children, but AMCC decreases with increased education of adults. Finally, costs are lower for children in larger families compared with those in smaller families. To conclude, income does not affect costs of AMCC in Quebec, although variables associated with income, such as education, unemployment and family size, do have definite effects on costs. The absence of a link between psychological distress and costs for the elderly is a matter of concern since it confirms the difficulty the elderly experience in accessing psychiatric care.

Résumé

Dans un régime d'assurance-maladie universel, comme celui du Québec, est-ce que les coûts des soins médicaux ambulatoires assumés par le régime sont associés aux revenus des ménages? Les questionnaires des 32 000 répondants à l'Enquête Santé-Québec de 1987 (ESQ87) ont été appareillés à leur dossier individuel de la Régie d'assurance-maladie du Québec. Le taux de succès de l'appariement fut de 90 pour cent approximativement. Les répondants des régions éloignées ont été exclus de l'étude puisqu'une partie importante de l'activité des médecins de ces régions n'est pas rémunérée à l'acte, donc absente des fichiers de la RAMQ. Les coûts des services médicaux ambulatoires sur une période de deux ans diminuent légèrement selon le revenu familial pour les individus, mais ils augmentent pour les ménages puisque le nombre de personnes par ménage s'accroît avec leur revenu. Ces associations disparraissent lorsque l'âge des répondants est pris en considération. L'état de santé est significativement associé aux coûts. Parmis les facteurs de risque pour la santé, une fois les variables d'état de santé considérées, le soutien social diminue l'utilisation chez les enfants et les adultes, tandis que le chômage l'augmente chez les adultes seulement. L'éducation des parents est associée à des coûts plus élevés chez les enfants; mais les coûts des services ambulatoires diminuent avec l'augmentation du niveau d'éducation chez les adultes. Enfin, les enfants des familles plus nombreuses ont des coûts inférieures à ceux des petites familles. En somme, le revenu n'a pas d'effet sur les coûts des soins médicaux ambulatoires au Québec, cependant des variables associées au revenu tels l'éducation, le chômage et la taille des ménages ont des effets appréciables sur les coûts. En ce qui concerne les personnes âgées, l'absence d'association entre détresse psychologique et coûts préoccupe dans la mesure où elle confirme leur difficulté d'accès aux soins pour des problèmes psychologiques.

Keywords

AccessAmbulatory CareFamily IncomeMedicare.Accèssoins ambulatoiresrevenu des famillesassurance-maladie.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 14 , Issue 2 , Été/Summer 1995 , pp. 391 - 413
Copyright
Copyright © Canadian Association on Gerontology 1995

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