The Development and Pilot-Testing of an Instrument to Measure Out-Of-Pocket Costs for Rural Patients Accessing Surgical Services in British Columbia

Project Summary

This project studied out-of-pocket costs for rural BC patients seeking health care outside their home community.

We wanted to:

  1. Explore the themes and categories of these out-of-pocket costs
  2. Develop and use a survey tool to get data about the nature and extent of these out-of-pocket costs, including absence-related costs such as childcare or lost wages.

 

To do this, we:

  1. Conducted focus groups and connected with other research projects at the Centre for Rural Health Research, and
  2. Developed and used a survey tool, in collaboration with our patient partners

Project Findings

From our focus groups and investigations in to other research projects, we found that themes highlighted out-of-pocket costs of:

  • Transportation
  • accommodation and meals
  • Traveling with a companion
  • Lost wages
  • Child/animal care

 

From our survey, we found that:

  • On average, rural residents pay $2,234 per person on travel related out-of-pocket spending for health.
  • The majority of respondents reported difficulty in paying for the costs of accessing care outside their community.
  • For many respondents, time spent away from home meant losing out on wages.
  • Very few respondents received any type of system-level financial support to help cover costs.
  • Those who reported spending more on traveling for health care also reported experiencing higher levels of stress and anxiety.
  • Higher-income respondents experienced less stress on average.

 

These findings underscore just how significant traveling for health care is for rural residents, both financially as well as psychologically and emotionally. Low-wage, elderly and other marginalized rural residents are particularly impacted by the costs of traveling, with few supports available to them.

Overall, this study closes the knowledge gap about out-of-pocket costs for rural residents accessing health services in BC.

Publications

Kornelsen, J., Khowaja, A.R., Av-Gay, G. et al. The rural tax: comprehensive out-of-pocket costs associated with patient travel in British Columbia. BMC Health Serv Res 21, 854 (2021). https://doi.org/10.1186/s12913-021-06833-2

This project is part of the Health Economics and Simulation Modelling Cluster.

Team

Jude Kornelsen, Co-PI
Asif Khowaja, Co-PI
Amy Prangnell
Eva Sullivan
Gal Av-Gay
Anshu Parajulee
Louloua Waliji