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Health Reports, April 2014

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Released: 2014-04-16

Trends in out-of-pocket health care expenditures in Canada, by household income, 1997 to 2009

Many Canadian households report expenditures on health care services and products that are not covered by public health plans. Regardless of the level of their household income, Canadians' out-of-pocket health care spending rose between 1997 and 2009. However, the increase was greatest for households in the lowest income quintile.

According to a new study in Health Reports, over this period, out-of-pocket spending on health care rose 63% for households in the lowest-income quintile. The increase for households in the higher income quintiles ranged from 36% to 48%.

In 2009, out-of-pocket health care spending by households in the top fifth of the income distribution averaged almost $3,000, compared with about $1,000 for households in the lowest fifth of the distribution.

However, as a percentage of after-tax income, spending was greatest for lower-income households. In 2009, out-of-pocket health care expenditures represented 5.7% of the total after-tax income of households at the lowest end of the income distribution, compared with 2.6% for households at the highest end.

Lower-income households were more likely than higher-income households to spend more than 5% of their after-tax income on health care services. In 2009, almost 40% of households in the two lowest income quintiles reported this level of out-of-pocket health care expenditures, compared with 14% of households at the top end of the income distribution.

Throughout the 1997-to-2009 period, the three largest components of out-of-pocket health care expenditures were dental services, prescription medications and insurance premiums. In 2009, household spending in these categories averaged $380 (dental), $320 (medications) and $650 (insurance premiums).

Spending on these components differed depending on household income. For example, in 2009, lower-income households spent more on prescription medications than did higher-income households. As well, the lowest-income households spent more on prescription medications than they did on insurance premiums or dental care. For higher-income households, insurance was the leading out-of-pocket health care spending category, followed by dental services.

  Note to readers

Estimates from the Survey of Household Spending (SHS) were used to examine out-of-pocket health care expenditures by household income in the 10 provinces over the 1997-to-2009 period.

The SHS collects information about spending on a range of services and products, including those related to health care. The target population is private households. The SHS excludes residents of institutions, members of the Canadian Forces living on military bases, people residing permanently in hotels or rooming houses and residents of Indian reserves. The survey covers nearly 98% of the population in the 10 provinces.

For this study, SHS data for every second year from 1997 to 2009 were analyzed. Response rates ranged from 64.5% (2009) to 76.0% (1997). The analysis excluded households that reported non-positive after-tax income or whose after-tax income was less than their total health care expenditures.

Total health care spending includes direct expenditures and insurance premiums for a variety of services and products including dental care, eye care and prescription medications. Direct expenditures are those not covered by insurance, such as exclusions, deductibles and expenses over limits, and exclude payments for which households have been or will be reimbursed. Insurance expenditures include premiums for provincial hospital, medical or drug plans, private health insurance plans, dental plans sold as separate policies, and accident or disability insurance.

"Trends in out-of-pocket health care expenditures in Canada, by household income, 1997 to 2009" is available in the April 2014 online issue of Health Reports, Vol. 25, no. 4 (Catalogue number82-003-X). From the Browse by key resource module of our website, choose Publications.

This issue of Health Reports also contains another research article, "Perceived barriers to primary care among western Canadians with chronic conditions."

Contact information

For more information, contact us (toll-free 1-800-263-1136; 514-283-8300;

To enquire about the concepts, methods or data quality of these articles, contact Claudia Sanmartin (613-951-6059;, Health Analysis Division.

For information about Health Reports, contact Janice Felman (613-951-6446;, Health Analysis Division.

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