Trends in out-of-pocket health care expenditures in Canada, by household income, 1997 to 2009.

BACKGROUND Canadian households are spending an increasing share of their household income on health care not covered by public plans. This study investigates trends in out-of-pocket expenditures for health care services and products by household income quintile from 1997 to 2009. DATA AND METHODS Biennial estimates from the Survey of Household Spending between 1997 and 2009 were used to examine changes in out-of-pocket health care expenditures, by household income quintile. The statistical significance of these changes was assessed using linear and logistic regression. RESULTS In 2009, the percentage of after-tax household income spent on health care among low-income households (5.7%) was nearly twice that of high-income households (2.6%). Approximately 40% of households in the two lowest income quintiles spent more than 5% of their total after-tax income on health care services and products, compared with 14% of households in the highest income quintile. The increase in spending between 1997 and 2009 was greatest for households in the lowest income quintile (63%). INTERPRETATION Out-of-pocket health care expenditures have increased for households in all income quintiles, but the relative increase was greatest among households in lower income quintiles.