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

Project Status: Active

Project Summary


  1. To explore thematic areas surrounding out of pocket costs relevant to rural BC patients seeking health care outside their home community. 

  2. To develop and administer an instrument to gain empirical evidence on the nature and extent of out-of-pocket costs for rural residents of BC who have to travel for health care, including absence-related costs such as childcare of lost wages. 


  1. In phase one, qualitative themes highlighted key out-of-pocket costs pertinent to transportation, accommodation and meals, travelling with a companion, lost wages, and child/animal care.
  2. From survey findings, 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. Further, those who reported spending more on travelling for health care also reported experiencing higher levels of stress and anxiety. In addition, higher-income respondents experienced less stress on average. These findings underscore just how significant travelling 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 travelling, with few supports available to them. Overall, this study closes the knowledge gap about OOP costs for rural residents accessing health services in BC.

Project Leads: Asif Raza Khowaja and Jude Kornelsen

Project Themes


Diversity and Underserved Populations
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Theoretical Foundations



Health Economics and Simulation Modelling
This project is a part of the Health Economics and Simulation Modelling cluster to learn more about this cluster, please click here.