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.