Uncovering the cost of care: An examination of extra billing in BC's long-term care facilities

This paper examines three aspects of out-of-pocket charges to residents in BC long-term care facilities. Prior studies documenting variability in extra billing and unintended adverse effects from charging patients for medically necessary items and services provided impetus for this research. Caregiver surveys of staff from eight facilities, family expense diaries from four case studies, and a three-year resident billing history from one facility are employed to test methodology for collecting out-of-pocket cost information, and to test for variability in charges amongst facilities and their potential impacts. The study concludes that: improved accountability mechanisms will eliminate information gaps; standardization will eliminate variability in extra billing; and extra billing sometimes leads to financial hardship, sub-optimal quality of life and negative health impacts for residents. Further study and pilot projects are proposed to determine the efficacy of free public provision of services.