Report 3 - Exploring the Link Between Work-Life Conflict and Demands on Canada's Health Care System

Chapter 7 - Impact of Work-Life Conflict on Prescription Drug Use

This chapter addresses the following questions:

• How much money do Canadian employees spend on prescription drugs?
• What impact does gender, job type, dependent care status and sector of employment have on the amount spent on prescription medicine?
• What is the link between work-life conflict and the amount spent on prescription medicine?

Data related to these questions are presented in Appendices B and C and discussed below.

The chapter is divided into four main sections. Background information on the use of prescription medicine in Canada is given in Section 1. Data on the prescription drug use of Canadian employees responding to our survey are presented and discussed in Section 2. Included in this section is a discussion of how gender, job type, dependent care status and sector of employment are associated with prescription drug use. The link between prescription drug use and work-life conflict is made in Section 3. A summary of the key findings with regard to prescription drug use is provided in Section 4.

7.1 Use of Prescription Medicine in Canada

Prescription and over-the-counter medicines help Canadians in a number of different ways. According to CIHI (2002, p. 77), they can "save lives, reduce the need for surgery, and maintain or improve our quality of life." Millions of Canadians take drugs daily, and most fill at least one prescription each year (CIHI, 2002). In 2000, there were approximately 22,000 drugs on Health Canada's list of drugs approved for human use. Approximately 5,200 of these can be considered prescription drugs (CIHI, 2002). Many of these medicines are considered "halfway technologies" in that they reduce symptoms but do not prevent or cure the underlying condition (CIHI, 2002). The following section provides a short summary of what is known about prescription drug use in Canada.

Most Canadians rely on prescription and non-prescription medicine to treat ill health

CIHI (2002) reports that just over three quarters (78%) of Canadians aged 12 or older said that they had used one or more prescription or over-the-counter medications in the last month of 1998-99. Women and older Canadians are more likely than others to report using medications (CIHI, 2002).

Most Canadians use painkillers

Which medications are used most frequently? According to the 1998-99 National Population Health Survey, the most common drugs taken included painkillers (taken by 65% of Canadians in the month prior to the survey being done), heart medication (13%), stomach remedies (13%), antibiotics (8%), sleeping pills and tranquilizers (5%) and antidepressants (4%) (CIHI, 2002). Duffy (2002) reports similar data for 2001 when Canadians spent an estimated $15 billion on pills for headaches, high blood pressure, high cholesterol, depression, arthritis, asthma and other illnesses (Duffy, 2002). A more generic view of the situation comes from the Patented Medicine Price Review Board (cited in CIHI, 2002). According to this group, manufacturers sold approximately $6.3 billion of patented medicine in Canada in 2000. This works out to almost two thirds (63%) of Canada's total drug sales. By comparison, prescription medication comprised 43% of the total drug sales in 1995. Non-patented medication made up 28% of the rest of the drug sales in Canada in 2000. Generic drug sales accounted for only 9% of the sales in 2000.

Canadians spend an average of $500 per person per year on medication

In 1993, prescription and non-prescription medications were estimated to cost $9.884 billion and to account for 6.3% of the total economic burden of illness in Canada (Statistics Canada, 1999). This had risen to approximately $15.5 billion per year by 2001-an increase of 8.6% over the previous year (Duffy, 2002). The Government of Canada (and hence all taxpayers) pay almost half (43%) of these costs. The rest is paid by private insurance companies and individuals.

Canadians spend more per person on drugs than most other countries

Canada spends more per person on drugs than most other countries. In 1997, only four of the 25 OECD countries that reported their spending on drugs (France, United States, Japan and Belgium) spent more per person than Canada (CIHI, 2002).

Costs for medications have increased dramatically over time

Costs for medications have increased dramatically since 1979 (Statistics Canada, 1999). The available data indicate that, in 2001, Canadians spent more than twice as much per person on retail drug sales than they did in 1990 (unadjusted for inflation) (CIHI, 2002).

Much of this increase can be attributed to an older population, increasing drug prices and a greater dependency on medication

Why is spending on drugs rising? CIHI (2002) offers the following possible reasons: changes in the size of the total population, population demographics, the health of Canadians, increases in the unit prices of patented and non-patented drugs, in retail and wholesale mark-ups, of professional fees, in the prescription habits of physicians, and in the utilization of drugs on a per patient basis (i.e. more medications per patient per year). Other possible reasons for the increased expenditures include the trend toward drug therapy (rather than surgery), the emergence of new diseases for which drugs are the treatment of choice, and the development of new drugs to treat old diseases (CIHI, 2002).

Duffy (2002) notes that, while Canada's growing drug expenditures can be blamed on the aging of our population and the creation of more and better drugs, demographics and supply are not the only explanations for this phenomenon. He attributes much of the increase to the fact that the price of drugs in Canada does not compare favourably with those in other countries and "the market does not operate in the interest of public health" (Duffy, 2002, B2). He illustrates his case by providing the following data:

• In 1996, the average prescription cost $29.62. In 2000, the average cost had jumped to $37.79.
• In Ontario, the average prescription price jumped 53% between 1993 and 1999, even though the province froze prices for all existing products on its government-insured medicines list.

Duffy also notes that the number of drugs being prescribed per capita increased by 25% between 1996 and 2002. These data are disturbing for, as he observes, "Canada does not have the economic might to continually spend this kind of money on health care."

In Canada, both public and private sectors pay part of the drug bill

In Canada, both public and private sectors pay part of the drug bill. Public sector payments come from governments, Workers' Compensation Boards and other social security systems. Individual Canadians pay some of the drug costs out of their own pockets, while private insurance (often provided through the employer) is the other major source of funds (CIHI, 2002). While public and private sector per capita spending on retail drugs (unadjusted for inflation) has been increasing steadily since 1975, public sector funding has been increasing at a faster pace (16% increase between 2000 and 2001) than private sector funding (increase of 3% during this same time period) (CIHI, 2002).

7.2 Use of Prescription Medicine by Employed Canadians

The research data provide us with additional information on prescription drug use by Canadians employed by the country's largest employers.

One in five employed Canadians makes heavy use of prescription drugs

The typical Canadian employee spent approximately $81.82 in a six-month period on prescription medicine. While 44% of employees did not purchase any prescription drugs, one in five (19%) spent more than $150 in a six-month period on prescription medicines for his or her own personal use. The rest of the respondents (37% of the sample) spent between $1 and $150 in the six-month period prior to the study being done (see Figure 10).

Figure 10
Amount Spent on Prescription Drugs in a Six-Month Period

Most of the costs of these prescription medicines are borne by the employer

In most cases, these prescription drug costs are borne by the employer. Eighty percent of the respondents noted that their employer paid for 100% of their drug costs. Virtually all of the other employees indicated that they and their employer shared the costs of prescription drugs.

Women spend more money on prescription drugs than men

Women spend more on prescription drugs than men. This gender difference could be observed in all job types, all sectors and was true for respondents with and without dependent care responsibilities. This gender difference in prescription drug use is consistent with what has been reported in the literature (CIHI) and is consistent with the fact that women are more likely than men to seek care (e.g. visit physician, see other health care professionals, use the services of mental health professionals, receive outpatient treatment). While spending on medications like birth control pills may explain some of the variance in the data, it is unlikely to explain all. Again, it is hard to tell from these data if these gender differences are due to more appropriate use of the health care system by women (e.g. women are more likely to seek care when they are ill and receive the appropriate treatment at an early stage of the illness) or a tendency on the part of men only to seek care when they are physically unwell.

Women in "other" positions in the organization spend more on prescription drugs

Women in "other" positions spend more money on prescription drugs than their counterparts in managerial and professional positions (21% of the women in the "other" sample spent more than $150 in a six-month period vs. 18% of women in the managerial and professional sample). No such job difference was observed for the men in the sample. These findings are consistent with those observed with respect to perceived health (women in "other" positions are more likely than female professionals to rate their health as fair/poor) and physician use, and reinforce our contention that either managerial and professional jobs offer a health advantage to women or that clerical and administrative jobs (i.e. pink collar jobs) have a more deleterious impact on the health of women than blue collar jobs do on the health of men. It is also possible that this difference reflects a different orientation toward prescription drug use by women in "other" positions within the organization.

Mothers and female caregivers spend more on prescription drugs

Women with dependent care responsibilities spend more money on prescription drugs than women without such responsibilities (21% of women with dependent care responsibilities spent more than $150 in a six-month period on prescription medicine vs. 19% of women without such responsibilites). No such difference was observed for the men in the sample. Employees (both men and women) with dependent care responsibilities were also more likely to visit mental health professionals. When taken together, these data would suggest that women with dependent care responsibilities may be receiving prescription medicine for stress/depression, etc.

Employees in the public sector spend more money on prescription medicine

Findings with respect to amount spent on prescription medicine are virtually identical to those reported with respect to perceived health, visits to a physician, visits to other health care professionals and mental health professionals, and outpatient visits: women in the public sector are the highest users of prescription medicine (23% spent more than $150 on prescription medicine in the six months prior to the study being done) while men in the private sector are the lowest users (only 12% of the men in this group spent this amount on prescription medicine in this time period). In addition to these differences, two other disparities are worth noting. On the one hand, men in the public sector sample were more likely to spend $150 or more on prescription drugs than men in the NFP sector who were, in turn, more likely to spend this amount than men in the private sector. For the female sample, on the other hand, women in the private sector sample were more likely than the women in the NFP sample to spend $150 or more on prescription drugs. In both cases, however, public sector respondents were more likely to spend $150 or more on prescription medicine than employees in the other two sectors. It is difficult from these data to determine why public sector employees spent more money on prescription medicine. Several, not necessarily mutually exclusive, explanations are possible. First, these data may indicate that the benefits packages in the public sector are more generous than those found in other sectors. Alternatively, they may indicate that public sector employees are in poorer health than their counterparts in the private and NFP sectors.

7.3 Link Between Prescription Drug Use and Work-Life Conflict

Three of the four measures of work-life conflict included in this study are strongly associated with prescription drug costs. Key data are shown in Figure 11 and Appendices C and D and discussed below.

Figure 11
Impact of Work-Life Conflict on Prescription Drug Use

Overloaded employees spend more on prescription drugs

Employees with high levels of role overload spend an average of $93 every six months on prescription drugs. This is significantly higher than the $75 spent by those with moderate levels of role overload and the $69 spent by those with low role overload. Extrapolation of these data suggest that companies that pay for 100% of their employees' prescription drug expenditures (80% of the companies in this sample) could save an average of $36 per employee per year if they could reduce role overload to moderate levels and almost $50 per employee per year if they could get role overload to low levels.

The relative risk data can be used to make a similar case. Employees with low levels of role overload are 1.3 times more likely to have spent nothing on prescription drugs in the six months prior to the study being done than employees with high levels of role overload. However, employees with high levels of role overload are almost twice as likely (relative risk of 1.9) as those with low role overload to have spent $150 or more in a six-month period on medications. These data reinforce our conclusion that there are significant bottom line costs to overworking employees-increased benefit expenditures.

Employees who consistently let work interfere with family also spend more on prescription drugs

Employees with high work to family interference are 1.3 times more likely than those with lower levels of interference to spend $150 or more on prescription medication in a six-month period. They spent approximately $94 in a six-month period on medication for their own use, $30 per year more than their counterparts with low interference. We have noted previously that employees who put work ahead of family pay a price for this behaviour in terms of increased stress, depressed mood and lower life satisfaction. It appears from these data that employers also pay a price to their bottom line through increased benefit costs.

Family to work interference is not strongly associated with prescription drug use

Approximately 10% of the sample put family first (i.e. they let family roles and responsibilities take priority over work role demands by refusing to stay late at work, travel for work, take a promotion). It is interesting to note that this type of behaviour does not appear to be strongly associated with prescription drug use. The relative risk of high family to work interference is below 1.3 which is consistent with the fact that respondents with high family to work interference do not make as much use of health care services as their counterparts with high role overload or caregiver strain.

Employees with high levels of caregiver strain spend substantially more on prescription medicine

The other form of work-life conflict associated with higher prescription drug expenditures is caregiver strain. Employees with high caregiver strain are 1.6 times more likely to spend $150 or more in a six-month period than employees with low caregiver strain. The average employee with high caregiver strain spends approximately $118 in a six-month period on prescription medicine compared to $86 spent by those with low caregiver strain. The higher drug expenditures reported by those suffering from this form of work-life conflict are not surprising because they are more likely than respondents with other forms of work-life conflict to have sought care in a hospital setting (either as an inpatient, in the emergency department or on an outpatient basis) in the six months prior to the study being done. It would appear that caregiver strain is associated with an increased incidence of illness that requires medical treatment and prescription drugs.

7.4 Summary

Canada spends more per person on drugs (approximately $15.5 billion per year) than most other countries. In fact, prescription and non-prescription medications were estimated to account for 6.3% of the total economic burden of illness in Canada (Statistics Canada, 1999). The Government of Canada (and hence all taxpayers) pay almost half (43%) of these costs. The rest is paid by private insurance companies and individuals. The findings from this study suggest that these drug costs could be reduced substantially if governments and organizations were to successfully address the issue of work-life conflict.

On average, Canadian employees in this sample spent approximately $82 on prescription medicine in a six-month period. While 44% of employees did not purchase any prescription drugs, one in five (19%) spent more than $150 on prescription medicines for his or her own personal use. In most cases, these prescription drug costs are borne by the employer, as 80% of the respondents noted that their employer paid 100% of their drug costs.

Who spends more money on prescription medication? The data from this study suggest employees in the following groups are "at risk": women in "other" positions, women with dependent care responsibilities, public sector employees, individuals with high levels of role overload, and individuals with high levels of caregiver strain.

The data from this study suggest that organizations and governments that wish to reduce the amount of money spent on prescription medication (and hence company benefit costs) need to focus their attention on reducing two forms of work-life conflict: role overload and caregiver strain.

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