Price Survey of Assistive Devices and Supports for Persons with Disabilities - December 2003

In this chapter, exploratory analyses of the effect of three factors which can affect pricing are examined for a subset of aids, devices and services: region, area size and supplier pricing (see Chapter II for details and for a description of the methodology used).

Descriptions of the various aids/devices and services sampled can be found in the previous chapter.

1. Hearing Related Assistive Devices and Services

1.1 Devices used by the Hearing Impaired²⁶

Sufficient data was available to undertake analysis for hearings aids (8 brands) and average repair costs. Table IV.1 provides average prices by region.²⁷

Table IV.1
Average Prices—Hearing Aids, Hearing Device Repairs by Region

	Atlantic		Quebec		Ontario		Manitoba/Saskatchewan		Alberta		British Columbia
Device	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price
CIC A	8	$2,307	15	$2,438	33	$2,036	8	$2,114	9	$2,412	11	$2,543
CIC C	12	$1,926	13	$2,081	32	$1,644	8	$1,543	15	$1,931	10	$2,038
ITC A	11	$2,102	10	$2,287	31	$1,880	8	$1,859	11	$2,421	9	$2,348
ITC C	8	$1,241	12	$1,753	30	$1,121	x	x	x	x	11	$1,352
ITE D	10	$884	13	$1,316	31	$897	7	$878	10	$1,216	8	$1,050
ITC A	7	$2,098	9	$2,387	29	$1,942	7	$2,104	7	$2,264	8	$2,286
ITE C	7	$1,466	13	$1,837	31	$1,265	8	$1,412	6	$1,455	9	$1,513
ITE D	x	x	7	$1,553	30	$1,231	6	$1,317	x	x	7	$1,293
BTE A	6	$1,551	11	$1,790	29	$1,408	x	x	x	x	10	$1,950
BTE C	8	$845	15	$737	31	$826	6	$769	9	$1,024	9	$899
Av. Repair	7	$299	12	$287	24	$261	x	x	7	$339	6	$306

Average prices for hearing aids and repairs were:

• Lower in Ontario and Manitoba/Saskatchewan in comparison to other parts of the country. On average, prices in these provinces were about 9% lower than the national average;
• Highest in Quebec, averaging 15% above national average;
• Prices were an average of 8.5% higher than the national average in Alberta; and
• Within 1% of the national average in Atlantic Canada

On average, regional differences in prices accounted for just under a third of the total differences in the costs of these devices/services.

Another fifteen percent of price differences is a result of the tendency for suppliers to consistently charge high, medium or low prices, irrespective of the product and the region.

1.2 Interpreters/Interveners for the Deaf/Blind

There were no discernable differences in price on the basis of the population size of the communities where the distributors were located. Table IV.2 shows some price difference in the averages across the regions but there is insufficient statistical evidence to infer that these were not caused by random variation. Further, there was no evidence of differences in rates by size of community.

Table IV.2
Average Daily Tariff, Interpreters for Blind/Deaf Persons by Region

Region	Count	Average Price
Atlantic	11	$401.36
Quebec	13	$379.23
Ontario	21	$406.86
Manitoba/Saskatchewan.	6	$383.33
Alberta	15	$400.67
British Columbia	9	$433.33

2. Mobility Related Devices Services

2.1 Mobility Aid and Devices

There was sufficient data to analyse price patterns for 7 types/brands of mobility aids and devices—canes, fore-arm crutches, 3 types of scooters, 1 type of manual wheel chair (a low-cost "hospital" model) and one model of lift chair. Prices from a total of 105 suppliers were used for this part of the analysis (12 from British Columbia/Yukon, 11 from Alberta, 18 from Manitoba/Saskatchewan, 27 from Ontario, 23 from Quebec and 15 from Atlantic Canada). Average prices are provided by region in Table IV.3.

Table IV.3
Average Prices--Selected Mobility Devices by Region

	Atlantic		Quebec		Ontario		Manitoba/Sask.		Alberta		British Columbia/Yukon
Item	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price
Adult Cane	11	$35	21	$44	16	$56	19	$37	9	$57	11	$42
Forearm Crutch	12	$138	22	$89	20	$149	16	$116	10	$146	11	$154
Scooter F	7	$2,861	7	$3,357	16	$3,180	8	$3,148	X	x	7	$3,283
Scooter B	7	$4,075	7	$4,314	20	$4,200	7	$4,020	X	x	9	$4,261
Scooter C	7	$3,914	7	$4,021	19	$3,992	7	$3,934	X	x	8	$4,122
Manual Wheelchair C	10	$309	14	$328	14	$302	6	$350	X	x	7	$350
3-Position Lift Chair	12	$938	7	$1,067	14	$982	10	$1,046	X	x	5	$1,052

It was found that there was no significant relationship between area and the sales price of either scooter B or the 3-position lift chair. For the other devices:

• Prices were consistently lower, averaging about 5% lower than the national average in Manitoba/ Saskatchewan and the Atlantic provinces.
• Prices were consistently higher in Alberta and British Columbia/Yukon by an average of about 10%.
• There was no consistent pattern in Quebec or Ontario.

Regional differences in prices accounted for approximately one-fifth of the total differences in the costs of these seven devices.

There was a weak tendency for suppliers to consistently provide high, medium or low prices for scooters and wheelchairs only. This accounted for approximately one-sixth of differences in prices reported for these items.

Finally, as in the analysis of this group of mobility devices, there were no discernable differences in cost on the basis of the population size of the communities where the distributors were located.

2.2 Physiotherapy

Sufficient data was available to estimate the effect of regional differences and population size for an assessment and therapy sessions.

Fees tended to be slightly higher in larger population centres. Fees in cities with population of about 1,000,000 were estimated to be on average about $3 (6%) higher per session for an assessment and $2 (5%) higher per hour for a therapy session than cities of 100,000.

Table IV.4 provides average fees charged by region after removing the effects of regional differences in the size distribution of communities. For both services, average prices in Ontario are significantly higher than the national average, followed closely by Alberta. Average assessment fees in Manitoba/Saskatchewan are well below those of Ontario and Alberta but still significantly above those in other parts of the country.

Table IV.4
Average Physiotherapy Fees by Region

Region	Count	Assessment Average Price	Count	Therapy Average Price
Atlantic Canada	51	$43.35	51	$37.54
Quebec	42	$43.14	42	$38.07
Ontario	36	$57.58	32	$44.55
Manitoba/Saskatchewan	31	$49.39	31	$36.83
Alberta	24	$54.44	26	$40.80
British Columbia./Yukon	35	$42.46	35	$36.19

Differences resulting from these factors accounted for about a 20% of price variance in assessment fees and 15% of variance in therapy charges.

3. Supports for Psychiatric Conditions

3.1 Drugs used to treat Psychiatric Conditions

Examination of drug price data indicated a need to separate price data from the territories from that of other areas of the country. As a result, 7 regions—rather than the six used in other regional price difference discussions were used here. Sufficient data was available for all except one of the drugs sampled to make interferences for each of the seven regions—5 for each analysis category. After adjusting for community size differences where applicable, it was found that:

• Average prices were higher by an average of about 25% in the Territories in comparison to the remainder of the country;
• Ontario had average prices that were 8% higher than the national average for Bi-Polar Disorder Medications;
• In Alberta, average prices were consistently below the national average;
• Atlantic Canada, Manitoba/Saskatchewan and Quebec prices tended to straddle the middle. However, Atlantic Canada had the higher average prices for Anti-psychotic agents, averaging 4% above national average prices.

Table IV.5
Average Prices of Drugs used to Treat Psychiatric Conditions by Region

	Atlantic		Quebec		Ontario		Man/Sask		Alberta		BC		Territories
	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price
Anti-depressants
Paroxetine (40 tabs, 20 mg)	26	$81.92	13	$83.44	19	$83.96	15	$80.34	9	$78.45	12	$81.39	x	x
Sertraline (40 tabs, 50 mg)	24	$86.31	12	$81.47	19	$83.17	11	$79.86	9	$76.45	11	$80.34	x	x
Anti-psychotic Agents
Olanzapine (28 tabs, 10 mg)	26	$238.17	13	$228.41	19	$228.03	15	$226.93	9	$222.68	12	$218.37	x	x
Risperidone (40 tabs, 3 mg)	22	$148.86	13	$141.33	19	$143.07	15	$140.05	9	$135.42	12	$137.63	x	x
Attention Deficit Hyperactivity Disorder
Brand A (60 tabs, 20 mg.)	26	$42.94	13	$42.78	19	$43.88	15	$40.23	9	$41.24	12	$41.70	x	x
Brand B (80 tabs, 10 mg.)	26	$23.22	13	$28.07	18	$25.37	15	$22.36	9	$20.60	12	$23.43	x	x
Bi-Polar Disorder Medications
Carbamazepine (80 tabs, 400 mg)	24	$64.98	13	$64.78	18	$65.68	11	$61.33	8	$57.68	12	$61.01	x	x
Lithium Carbonate (90 tabs, 300 mg)	25	$16.79	13	$16.82	18	$20.31	10	$16.76	7	$16.77	12	$18.35	x	x

For two drugs (Carbamazepine, and one brand of methylphenidate), average prices were significantly higher in smaller urban areas. The estimated difference between the price of Carbamazepine in a city of 100,000 and 1,000,000 was about $3.10 (5% of the average national price), for methylphenidate, Brand A $1.65, (3%) Just under half of the total variation in drug prices can be ascribed to regional and population size differences—primarily because of higher prices in the Territories. Another quarter of variance can be ascribed to consistently high or low pricing among individual pharmacies.

3.2 Psychotherapy

Table IV.6 provides average fees charged for psychotherapy region after removing the effect regional differences in community sizes where relevant. It shows large regional differences in average fees. On the one hand, Quebec has significantly lower fees for therapy sessions than anywhere else in Canada. At the other extreme, Ontario fees for both assessment and therapy tend to be the highest in the country. Fees in the remainder of the country tend to sit half way between these two extremes.

Table IV.6
Average Psychotherapy Fees by Region

	Assessment		Therapy
Region	Average Price	Count	Average Price	Count
Atlantic Canada	$108.90	26	$102.69	44
Quebec	$81.09	17	$70.81	44
Ontario	$154.79	19	$137.46	32
Manitoba/Saskatchewan	$117.40	13	$107.16	25
Alberta	$114.61	8	$106.74	11
British Columbia/Yukon	$115.84	13	$120.28	21

There was no discernable difference in assessment fees attributable to community size differences. However, therapy charges tended to increase substantially with city size. It is estimated that fees in cities with population of about 1,000,000 had fees which averaged about $10 (or about 10%) per session higher for a therapy session than cities of about 100,000.

Differences resulting from regional and community size differences accounted for about a third of price variance in assessment fees and just under 60% of variance in therapy charges.

4. Aids for the Vision Impaired--Eye Glasses, Lenses and Contact Lenses

Table IV.7 indicates that there are significant regional differences in eye glass prices, accounting for about 15% of the variations in glasses and eye glass lens prices. Prices tended to be lower than the national average in Atlantic Canada and in Ontario by between 10% and 15% (except for metal frames).

Eye glass prices tended to be lower in smaller centers. In particular, prices for plastic frame glasses increased by an estimated $20.00 (about 10%) as city size increased from 100,000 to 1,000,000.

Finally, there was a very limited influence due to store-related pricing strategies of providing consistently higher or lower prices. However, the supplier prices of plastic and metal framed glasses were highly related.

Table IV.7
Average Eye Glasses and Contact Lenses by Region

	Lenses Only		Glasses/Plastic Frames	Glasses/Metal Frames		Contact Lenses
Region	Count	Average Price	Average Price	Average Price	Count	Average Price
Atlantic Canada	31	$62.38	$143.96	$137.26	31	$89.94
Quebec	15	$75.05	$195.95	$182.96	15	$93.54
Ontario	19	$60.27	$139.48	$167.48	18	$89.83
Manitoba/Sask.	20	$74.48	$185.07	$180.94	19	$95.73
Alberta/NWT	14	$80.87	$172.13	$173.55	14	$115.33
BC/Yukon	17	$79.49	$154.89	$193.08	17	$97.35

Region, community size differences and supplier pricing accounted for about a fifth of the variation in lenses and eye glasses pricing.

At first glance, Table IV.7 indicates a high average price in Alberta/NWT for contact lenses. However because contact lenses prices varied considerably within regions no inference could be made about this regional difference. Overall, no factors were significant in accounting for price variations for this aid.

5. General Support Services—Nursing and Help in Undertaking Daily Activities

5.1 Nursing Services

The potential of regional and city size variations in area were examined for three Registered Nurse (RN) professions where adequate sample size was available.

Table IV.8 provides regional averages for these services. It indicates that irrespective of the service, fees tend to be the lowest in Atlantic Canada—averaging 15% below the national average while Ontario fees tend to be the highest (10%-15% above the national average). Fees for registered nurse and registered nurse special task services in Alberta were also above the average—but below those of Ontario.

There were no significant differences in fees attributable to community size differences.

Table IV.8
Average Nursing Fees by Region

Region	Registered Nurse		Registered Nurse (Special Tasks)		Registered Nurse Assistant
	Count	Average Fee	Count	Average Fee	Count	Average Fee
Atlantic Canada	16	$31.77	14	$32.95	17	$21.56
Quebec	12	$36.72	6	$37.69	12	$26.50
Ontario	22	$40.00	17	$44.51	20	$31.25
Manitoba/Sask	8	$36.52	6	$39.05	x	x
Alberta/NWT	7	$38.09	7	$44.88	7	$26.63
BC/Yukon	x	x	x	x	x	x

Roughly a third of the variance in RN special tasks and RN assistant fees could be attributed to regional differences, but only about a sixth of RN fees.

5.2 Support in Undertaking Daily Activities

As with nursing services, fees in Atlantic Canada averaged well below the national average—in this case by roughly a third. On the other hand, B.C./Yukon had average fees in all three categories above the national average--by about 10%-15%.

There is no significant difference in the price of these services with city size.

Table IV.9
Average Supportive Service Fees by Region

	Personal Supports		Home Services		Companion
Region	Count	Average Fee	Count	Average Fee	Count	Average Fee
Atlantic Canada	19	$12.34	21	$11.34	17	$11.21
Quebec	10	$16.10	12	$15.62	10	$14.79
Ontario	21	$18.85	18	$18.34	15	$16.12
Manitoba/Sask.	6	$18.50	7	$15.83	x	x
Alberta/NWT	7	$18.89	8	$16.24	6	$15.28
BC/Yukon	6	$23.51	6	$21.62	x	x

Roughly a half of the variance in all three personal support services could be attributed to regional differences.

6. Local Transit Fares²⁸

6.1 Public Transit

Table IV.10 shows that generally, public transit fares tend to increase moving west from Atlantic Canada to Ontario and Manitoba/Saskatchewan, and then decline, reaching their lowest levels in Alberta and BC/Yukon. The exceptions are children's cash/ticket fares in Ontario, which on average are below fares elsewhere.

Table IV.10
Public Transit Fares by Region

	Atlantic		Quebec		Ontario		Manitoba/Sask		Alberta/NWT		BC/Yukon
Average by Region	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price	Count	Average Price
Non-Senior Adults
Cash	6	$1.91	12	$2.06	14	$2.18	9	$1.98	7	$1.76	9	$1.72
Tickets/Tokens		$1.80		$1.81		$1.94		$1.93		$1.57		$1.58
Monthly Passes	2	$45.50	7	$51.16	9	$62.67	2	$65.98	4	$51.88	5	$51.60
Students
Cash	6	$1.91	12	$1.98	14	$2.00	9	$1.93	7	$1.66	9	$1.67
Tickets/Tokens		$1.80		$1.63		$1.77		$1.87		$1.50		$1.54
Monthly Passes	2	$42.50	7	$39.51	9	$50.42	2	$50.08	4	$46.00	5	$47.00
Children
Cash	6	$1.83	12	$1.98	14	$1.67	9	$1.93	7	$1.56	9	$1.67
Tickets/Tokens		$1.73		$1.75		$1.51		$1.87		$1.55		$1.54
Monthly Passes	2	$36.00	6	$37.43	6	$44.33	2	$50.08	4	$42.00	5	$47.00
Seniors
Cash	6	$1.83	12	$1.98	14	$2.04	9	$1.93	7	$1.66	9	$1.67
Tickets/Tokens		$1.73		$1.77		$1.77		$1.87		$1.55		$1.54
Monthly Passes	2	$36.00	6	$31.55	9	$45.89	2	$50.08	3	$30.50	5	$47.00

Approximately a third of the total variation in fares can be attributed to regional variations.

6.2 Taxi Fares

Table IV.11 shows the regional averages for taxi services. Average fares increase from east to west from a low of $6.15 in Atlantic Canada and $6.33 in Quebec to a peak of $9.71 in Alberta/NWT.

Table IV.11
Average Taxi Fares, average Trip by Region

	Count	Average Price
Atlantic Canada	17	$6.15
Quebec	8	$6.33
Ontario	9	$7.79
Manitoba/Saskatchewan	11	$7.93
Alberta/NWT	4	$9.71
BC/Yukon	8	$8.13

7. Broad Trends in Price Variations in Selected Aid, Devices and Services

Table IV.12 provides a summary of the pricing trends reported above. Broadly speaking it shows that price variations are in line with the following general trends:

• Fees for support services tend to be highest in the high-cost labour markets of Ontario and Alberta, and for physiotherapy and psychotherapy in larger urban areas;
• The costs of goods where there are relatively large markets and significant competition—hearing aids and eye glasses--tend to be lower (in particular Ontario);
• Atlantic Canada, with relatively low labour costs tended to have the lowest fees for nursing and supports in undertaking daily living tasks. Costs also tended to be lower for public transportation, mobility aids and eye glasses.
• In one area where there was sufficient sample to examine prices in the territories (drugs used in treating psychiatric disorders) prices were considerably higher.

 

Table IV.12
Summary of the Estimated Effects of Region, Community Size and Supplier on the Prices of Selected Aids, Devices and Services

	Region							Other Factors
Aid/Device/Services	Atlantic	Quebec	Ontario	Man/Sask	Alberta	BC	Territories	Community Size	Supplier Pricing
Hearing
Hearing Devices		High	Low	Low	High	High	—	No	Yes
Hearing/Sight Interpreters	No Significant Differences Found Related to Region or Area Size
Mobility and Agility
Mobility Devices	Low for most aids			Low for most aids	High for most aids	High for most aids	—	No	Yes—Scooters, Wheelchairs only
Physiotherapy			High	High—Assessment fees only	High		—	Yes—higher in large centers	—
Psychiatric Conditions
Medication	High for one type of med.		High for one type of medic.		Low		High	No
Psychoanalysis		Low	High				—	Yes—Therapy higher in large centers	—
Sight Impaired
Eye Glasses, Lenses	Low		Low					Yes— plaster frame glasses higher in large centers	No
Contact Lenses	No Significant Differences Found Related to Region or Area Size
General Support Services
Nursing Services	Low		High		High		—	No	—
Support in Undertaking Daily Living Tasks	Low					High	—	No	—
Public Transportation
Bus Fares			High (except for children's fares)	High	Low	Low	—	—	—
Taxi Fares	Low	Low			High		—	—	—

• ²⁶Prices from a total of 105 suppliers were used for this part of the analysis (12 from British Columbia, 14 from Alberta, 11 from Manitoba/Saskatchewan, 37 from Ontario, 18 from Quebec and 13 from Atlantic Canada).
• ²⁷Here and below regional averages are reported where there are more than 5 observations. Where sample sizes are five or fewer, an "x" is shown rather than the count and average prices.
• ²⁸The information provided in this section is publicly available. As a result, data are presented in this section for samples of five or fewer. Note also that no data was made available concerning area population size for these services.