Prescription drug insurance and unmet need for health care: a cross-sectional analysis

BACKGROUND Despite Canada's universal health insurance coverage, many Canadians still report an unmet need for health care. I investigated whether not having prescription drug insurance increases the likelihood of reporting an unmet need for health care. I hypothesized that people without prescription drug insurance would be more likely than those with insurance to report an unmet health care need. METHODS I included 31 630 people in Ontario 64 years of age or younger who had participated in the Canadian Community Health Survey Cycle 3.1. Multivariate logistic regression models were used to obtain an adjusted odds ratio (OR) for the association between having prescription drug insurance and reporting an unmet need for health care in the past 12 months, adjusting for age, sex, socio-economic status, health status and having a regular medical doctor. The reasons for reporting an unmet need for care were stratified into reasons related or not related to prescription drug insurance. Three separate multivariate logistic regressions were performed to obtain an adjusted OR for the association between prescription drug insurance and unmet need based on the reasons for reporting unmet need. RESULTS Not having prescription drug insurance that covers all or part of prescription medication costs increased the likelihood of reporting an unmet need for health care services (adjusted OR 1.27, 95% confidence interval [CI] 1.16-1.39). Not having such insurance significantly increased the likelihood of reporting an unmet need for health care for reasons that were related to prescription drug insurance (adjusted OR 2.21, 95% CI 1.80-2.71). This relation was not significant when the analysis was restricted to people who reported unmet need for health care for reasons that did not relate to prescription drug insurance (adjusted OR 1.12, 95% CI 1.00-1.23). CONCLUSIONS These results suggest an association between a lack of prescription drug coverage and reporting an unmet need for health care. This association warrants further investigation.