Background: Little Canadian research exists which examines equitable access to public pharmaceutical insurance. In order to better understand issues related to access to publicly funded, universal prescription drug insurance in Canada, my thesis examines participation with (and therefore access to) the Fair PharmaCare program in BC. Specifically, my thesis: 1) describes methodologies that can be used to create area-level cultural variables for use with BC administrative data; and 2) studies the impact of household and area-level factors, particularly area-level cultural factors, on non-senior households’ registration for Fair PharmaCare in 2003. I hypothesized that the process of registration may act as a barrier to participation with Fair PharmaCare, particularly for households belonging to various culturally defined communities. Methods: Dissemination area (DA) level census data were obtained from Statistics Canada to create dichotomous, ecological variables which capture the collective ethnic composition, English language capacity and immigration status of residents within each DA. In turn, these variables were employed in multivariate, logistic regression analyses, which also included household-level measures of demographics, enabling resources and health status as well as area-level measures of income and health care resources. The outcome of interest was registration for Fair PharmaCare. Findings: Controlling for area-level income and health care resources, household-level demographics, enabling resources and health status, as well as area-level cultural factors, influenced households’ likelihood of registration for Fair PharmaCare. Households belonging to DAs with a high concentration of individuals reporting a Chinese or Punjabi ethnic background, or DAs that were ethnically homogeneous, regardless of the ethnic background, were more likely to register. In contrast households belonging to DAs consisting of a high concentration of recent immigrants or individuals belonging to ethnic minority groups that are underrepresented in BC were less likely to register. Conclusions: Considering the policy context surrounding the implementation of Fair PharmaCare, the findings from my thesis suggest that specific subpopulations within BC may face difficulties with the registration process, thereby reducing their participation in the program. Government interventions however, appear to have improved registration amongst other subpopulations. Consideration should be given to interventions that may reduce inequities in participation amongst other subgroups.

Background: Little Canadian research exists which examines equitable access to public pharmaceutical insurance. In order to better understand issues related to access to publicly funded, universal prescription drug insurance in Canada, my thesis examines participation with (and therefore access to) the Fair PharmaCare program in BC. Specifically, my thesis: 1) describes methodologies that can be used to create area-level cultural variables for use with BC administrative data; and 2) studies the impact of household and area-level factors, particularly area-level cultural factors, on non-senior households’ registration for Fair PharmaCare in 2003. I hypothesized that the process of registration may act as a barrier to participation with Fair PharmaCare, particularly for households belonging to various culturally defined communities. Methods: Dissemination area (DA) level census data were obtained from Statistics Canada to create dichotomous, ecological variables which capture the collective ethnic composition, English language capacity and immigration status of residents within each DA. In turn, these variables were employed in multivariate, logistic regression analyses, which also included household-level measures of demographics, enabling resources and health status as well as area-level measures of income and health care resources. The outcome of interest was registration for Fair PharmaCare. Findings: Controlling for area-level income and health care resources, household-level demographics, enabling resources and health status, as well as area-level cultural factors, influenced households’ likelihood of registration for Fair PharmaCare. Households belonging to DAs with a high concentration of individuals reporting a Chinese or Punjabi ethnic background, or DAs that were ethnically homogeneous, regardless of the ethnic background, were more likely to register. In contrast households belonging to DAs consisting of a high concentration of recent immigrants or individuals belonging to ethnic minority groups that are underrepresented in BC were less likely to register. Conclusions: Considering the policy context surrounding the implementation of Fair PharmaCare, the findings from my thesis suggest that specific subpopulations within BC may face difficulties with the registration process, thereby reducing their participation in the program. Government interventions however, appear to have improved registration amongst other subpopulations. Consideration should be given to interventions that may reduce inequities in participation amongst other subgroups.

Background: Little Canadian research exists which examines equitable access to public pharmaceutical insurance. In order to better understand issues related to access to publicly funded, universal prescription drug insurance in Canada, my thesis examines participation with (and therefore access to) the Fair PharmaCare program in BC. Specifically, my thesis: 1) describes methodologies that can be used to create area-level cultural variables for use with BC administrative data; and 2) studies the impact of household and area-level factors, particularly area-level cultural factors, on non-senior households’ registration for Fair PharmaCare in 2003. I hypothesized that the process of registration may act as a barrier to participation with Fair PharmaCare, particularly for households belonging to various culturally defined communities. Methods: Dissemination area (DA) level census data were obtained from Statistics Canada to create dichotomous, ecological variables which capture the collective ethnic composition, English language capacity and immigration status of residents within each DA. In turn, these variables were employed in multivariate, logistic regression analyses, which also included household-level measures of demographics, enabling resources and health status as well as area-level measures of income and health care resources. The outcome of interest was registration for Fair PharmaCare. Findings: Controlling for area-level income and health care resources, household-level demographics, enabling resources and health status, as well as area-level cultural factors, influenced households’ likelihood of registration for Fair PharmaCare. Households belonging to DAs with a high concentration of individuals reporting a Chinese or Punjabi ethnic background, or DAs that were ethnically homogeneous, regardless of the ethnic background, were more likely to register. In contrast households belonging to DAs consisting of a high concentration of recent immigrants or individuals belonging to ethnic minority groups that are underrepresented in BC were less likely to register. Conclusions: Considering the policy context surrounding the implementation of Fair PharmaCare, the findings from my thesis suggest that specific subpopulations within BC may face difficulties with the registration process, thereby reducing their participation in the program. Government interventions however, appear to have improved registration amongst other subpopulations. Consideration should be given to interventions that may reduce inequities in participation amongst other subgroups. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate