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.


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).

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


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