Equity in health services use and intensity of use in Canada.

Yukiko Asada,George Kephart

doi:10.1186/1472-6963-7-41

Abstract

BackgroundThe Canadian health care system has striven to remove financial or other barriers to access to medically necessary health care services since the establishment of the Canada Health Act 20 years ago. Evidence has been conflicting as to what extent the Canadian health care system has met this goal of equitable access. The objective of this study was to examine whether and where socioeconomic inequities in health care utilization occur in Canada.MethodsWe used a nationally representative cross-sectional survey, the 2000/01 Canadian Community Health Survey, which provides a large sample size (about 110,000) and permits more comprehensive adjustment for need indicators than previous studies. We separately examined general practitioner, specialist, and hospital services using two-part hurdle models: use versus non-use by logistic regression, and the intensity of use among users by zero-truncated negative binomial regression.ResultsWe found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals.ConclusionOur study unveiled possible socioeconomic inequities in the use of health care services in Canada.

Highlights

The Canadian health care system has striven to remove financial or other barriers to access to medically necessary health care services since the establishment of the Canada Health Act 20 years ago
At the individual level, using the Nova Scotia Nutrition Survey linked to administrative data Veugelers and Yip found that controlling for age and sex people with lower income were more likely to use general practitioner and hospital services than people with higher income, but there was no statistically significant relationship between income and specialist services [5]
Building on the previous research, this study investigated the unsolved yet crucial question of whether and where socioeconomic differences in the use of health care services occur in the Canadian health care system after adjusting for need for health care

Summary

Introduction

The Canadian health care system has striven to remove financial or other barriers to access to medically necessary health care services since the establishment of the Canada Health Act 20 years ago. Since the establishment of the Canada Health Act in 1984, which set criteria of public administration, comprehensiveness, universality, portability, and accessibility, supporters of the Canadian health care system have been a strong advocate for equal access for equal need. They have striven to remove financial or other barriers to access to physician and hospital services. Given the strong association between socioeconomic status and health, most recent Canadian studies have shown that people in lower socioeconomic status use more health care services than their counterparts. Separate studies using the same data set showed that lower income and education were associated with higher use of physician services after adjusting for age, sex, and region [6] and higher use of physician and hospital services after adjusting for age, sex, death, and neighbourhood income and education [7]

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