Bibliographic record
Abstract
Universal drug insurance coverage has been endorsed by the National Health Forum and the Liberal government as a means of providing equitable access to prescription medication for Canadians. In 1996, Quebec legislated a universal drug insurance program. To finance extended coverage for approximately 1.2 million previously uninsured beneficiaries, an income-indexed coinsurance and deductible cost-sharing policy was introduced for previously insured beneficiaries (people 65 years of age and older, and those receiving income security allowance). The increase in cost-sharing for previously insured beneficiaries led to a reduction in both essential (senior citizens: 9.1%; income security: 14.4%) and less essential medication (senior citizens: 15.1%; income security: 22.4%). Reductions in the use of essential drugs were associated with an increase in the rate of emergency visits (by 43% in senior citizens and 78% in income security recipients) and adverse events (by over 100% in senior citizens and 88% in income security recipients). The 442 physicians and pharmacists who were surveyed reported that the policy reduced the use of antilipidemics, inhaled steroids and antihypertensives in the previously insured beneficiaries, but improved access to previously unaffordable medications for cardiac disease and asthma in the newly insured beneficiaries. Although universal drug insurance appeared to enhance access to essential medication for the newly insured, these benefits were exacted at a cost of producing unintended health effects in two vulnerable subgroups: senior citizens and income security recipients. Because no prior studies have shown that consumer cost sharing can lead to expected objective of selective reductions in less essential drug use alone, alternate policy approaches for financing universal drug coverage need to be considered.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.006 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".