Canadians with dementia may be getting less than they should from their insurance coverage
Posted On July 22, 2021
CANADIAN CERTIFICATES REQUIRE A MEDICAL ANALYSIS FOR USE ON CHILDREN UNDER THE DIABETES COVERAGE ACT.
A study released Wednesday shows that Canadians under age 18 with dementia are being denied more than half of their insurance premiums for treatment, despite the fact that the act requires them to get a “medical analysis” of the benefits of their coverage.
The analysis may include the cost of prescription medications, hospitalization and care for their dementia, said the Canadian Institute for Health Information.
The study was released just as the Canadian Association of Neurological Surgeons announced it would vote next month on whether to endorse the C.D. Howe Institute’s “National Collaborative Strategy for the Advancement of Alzheimer’s Disease.”
The study, published in the Canadian Journal of Psychiatry, also showed that the rates of the two diseases in Canadians under the age of 65 have declined over the past five years, and that the average cost of treating dementia in the U.S. has declined in the same period.
It said that the CISA was a mistake and that it would be better to invest in treatments.
“It’s been clear for years that the Canadian insurance industry is woefully underfunded,” said Dr. Scott Walker, a professor of neurology at McMaster University in Hamilton.
“[But] it’s been a mistake to put people with dementia on the same footing as people who aren’t.”
The study looked at premiums paid by 4,872 people in Canada who were covered by private insurance between 2011 and 2017, and found that more than 60 per cent of the people who were eligible for premiums were being denied benefits for dementia treatment.
In the past, the researchers calculated that the costs of treatments for people under the ages of 65 were about $10,000 a year for people in the middle of the distribution and about $25,000 for people at the top.
It was not clear how much of that cost was being paid for medications, but the researchers found that in the past year, people with a diagnosis of dementia were being billed almost three times as much for their prescriptions.
While it was not possible to calculate how much the cost was for drugs, Walker said that if people were getting paid less than their full cost, that could explain why they were being rejected.
The researchers say there are many reasons why people with advanced dementia are not receiving the services they need, including that there are gaps in the availability of treatments.
They also point out that there is an ongoing lack of transparency in the insurance industry.
Walker said there is no evidence to suggest that insurance companies are discriminating against people with severe dementia.
CISA was passed in 2016 as a response to concerns about the increasing cost of caring for patients with dementia, which is estimated to cost about $11 billion a year.
Health experts have long called for a national strategy to tackle the rising cost of care for people with the disease.