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Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014

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Abstract

Equity in healthcare utilization is a globally accepted measurement of health system performance. In Canada, equity is included as a policy goal in the Federal health legislation that governs healthcare systems. This study used ten cycles of the Statistics Canada Canadian Community Health Survey (CCHS, n = 664,548) to examine the trends in income-related inequities in healthcare utilization in Canada from 2000 to 2014. The horizontal inequity (HI) index was used to quantify inequity in healthcare utilization for general practitioner (GP) visits, specialist physician (SP) visits and hospital admissions (HA) nationally, in urban and rural areas, and for all provinces. Nationally, GP and SP visits show pro-rich inequity, while HA demonstrates pro-poor inequity. This pattern is consistent in the provincial and urban and rural areas results. Trend analysis suggested that inequity in GP visits became more pro-poor in New Brunswick, but more pro-rich in Prince Edward Island and Quebec. Despite the inclusion of equity as a main policy goal, this study demonstrated that inequity in healthcare utilization remains a persistent issue in the Canadian healthcare system.

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References

  1. Smith, P.C., Papanicolas, I.: Health system performance comparison: an agenda for policy, information and research. Maidenhead, UK (2013)

  2. World Health Organization: Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage. Geneva, Switzerland (2014)

  3. Frenz, P., Vega, J.: Universal health coverage with equity: what we know, don’t know and need to know. Montreux, Switzerland (2010)

  4. Culyer, A.J., Wagstaff, A.: Equity and equality in health and health care. J. Health Econ. 12, 431–457 (1993). https://doi.org/10.1016/0167-6296(93)90004-X

    Article  CAS  PubMed  Google Scholar 

  5. Wagstaff, A., Van Doorslaer, E., Paci, P.: Equity in the finance and delivery of health care: some tentative cross-country comparisons. Oxford Rev. Econ. Policy 5, 89–112 (1989)

    Article  Google Scholar 

  6. O’Donnell, O., van Doorslaer, E., Wagstaff, A., Lindelow, M.: Analyzing health equity using household survey data. The World Bank, Washington DC (2008)

    Google Scholar 

  7. Solar, O., Irwin, A.: A conceptual framework for action on the social determinants of health. (2010)

  8. Birch, S., Gafni, A.: Achievements and challenges of medicare in Canada: are we there yet? Are we on course? Int. J. Heal. Serv. 35, 443–463 (2005). https://doi.org/10.2190/RWA1-C3PB-0KY4-HBUT

    Article  Google Scholar 

  9. Marchildon, G.P., Allin, S.: The public-private mix in the delivery of health-care services: its relevance for lower-income Canadians. Glob. Soc. Welf. 3, 161–170 (2016). https://doi.org/10.1007/s40609-016-0070-4

    Article  Google Scholar 

  10. Mikkonen, J., Raphael, D.: Social determinants of health: the Canadian facts. York University School of Health Policy and Management, Toronto (2010)

    Google Scholar 

  11. Martin, D., Miller, A.P., Quesnel-Vallée, A., Caron, N.R., Vissandjée, B., Marchildon, G.P.: Canada’s universal health-care system: achieving its potential. Lancet 391, 1718–1735 (2018). https://doi.org/10.1016/S0140-6736(18)30181-8

    Article  PubMed  PubMed Central  Google Scholar 

  12. Romanow, R.J.: Commission on the future of health care in Canada. Building on values: the future of health care in Canada. Saskatoon (2002)

  13. Bartram, M.: Income-based inequities in access to mental health services in Canada. Can. J. Public Heal. 110, 395–403 (2019). https://doi.org/10.17269/s41997-019-00204-5

    Article  Google Scholar 

  14. Allin, S.: Does equity in healthcare use vary across Canadian provinces? Healthc. Policy. 3, 83–99 (2008)

    PubMed  PubMed Central  Google Scholar 

  15. Grignon, M., Hurley, J., Wang, L., Allin, S.: Inequity in a market-based health system: evidence from Canada’s dental sector. Health Policy 98, 81–90 (2010). https://doi.org/10.1016/j.healthpol.2010.05.018

    Article  Google Scholar 

  16. Asada, Y., Kephart, G.: Equity in health services use and intensity of use in Canada. BMC Health Serv. Res. 7, 41 (2007). https://doi.org/10.1186/1472-6963-7-41

    Article  PubMed  PubMed Central  Google Scholar 

  17. OECD.: Health for everyone?: social inequalities in health and health systems. Paris (2019)

  18. van Doorslaer, E., Koolman, X., Puffer, F.: Equity in the use of physician visits in OECD countries: has equal treatment for equal need been acheived? In: Measuring up: improving the performance of health systems in OECD countries. pp. 225–248. , Ottawa, Canada (2002)

  19. Devaux, M., de Looper, M.: Income-related inequalities in health service utilisation in 19 OECD countries, 2008–2009. OECD Publishing, Paris (2012)

    Google Scholar 

  20. Sibley, L.M., Weiner, J.P.: An evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Serv. Res. (2011). https://doi.org/10.1186/1472-6963-11-20

    Article  PubMed  PubMed Central  Google Scholar 

  21. Canada Health Act. https://laws-lois.justice.gc.ca/eng/acts/c-6/page-1.html. Accessed 12 Feb 2022

  22. Constitution Act. https://laws-lois.justice.gc.ca/eng/const/page-4.html. Accessed 12 Feb 2022

  23. Marchildon, G.P.: The three dimensions of universal medicare in Canada. Can. Public Adm. 57, 362–382 (2014). https://doi.org/10.1111/capa.12083

    Article  Google Scholar 

  24. Romanow, R.J.: The Canada Health Act (2002)

  25. Statistics Canada: CCHS Cycle 1.1 (2000–2001) Public use micro file documentation (2001)

  26. Statistics Canada.: Summary of changes—surveys and statistical programs—Canadian Community Health Survey (CCHS). https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getMainChange&Id=4995. Accessed 12 Feb 2022

  27. Thomas, S., Wannell, B.: Combining cycles of the Canadian community health survey. Heal. Rep. 20, 53–58 (2009)

    Google Scholar 

  28. Moore, J.C., Loomis, L.S.: Reducing income nonresponse in a topic-based interview. Montreal (2001)

  29. Moore, J.C., Stinson, L.L., Welniak, E.J.: Income measurement error in surveys: a review. J. Offcial Stat. 16, 331–361 (2000)

    Google Scholar 

  30. Aday, L.A., Andersen, R.M.: Equity of access to medical care: a conceptual and empirical overview. Med. Care. 19, 4–27 (2016)

    Article  Google Scholar 

  31. Pulok, M.H., van Gool, K., Hajizadeh, M., Allin, S., Hall, J.: Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates. Eur. J. Heal. Econ. 21, 171–180 (2020). https://doi.org/10.1007/s10198-019-01118-2

    Article  Google Scholar 

  32. Wagstaff, A.: The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 14, 429–432 (2005)

    Article  PubMed  Google Scholar 

  33. StataCorp.: Stata statistical software: release 15, (2017)

  34. McGrail, K.M.: Income-related inequities: cross-sectional analyses of the use of medicare services in British Columbia in 1992 and 2002. Open Med. 2, e91–e98 (2008)

    PubMed  PubMed Central  Google Scholar 

  35. Jiménez-Rubio, D., Smith, P.C., Van Doorslaer, E.: Equity in health and health care in a decentralised context: evidence from Canada. Health Econ. 17, 377–392 (2008)

    Article  PubMed  Google Scholar 

  36. Allin, S., Hurley, J.: Inequity in publicly funded physician care: What is the role of private prescription drug insurance? Health Econ. 18, 1218–1232 (2009)

    Article  PubMed  Google Scholar 

  37. Devaux, M.: Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur. J. Heal. Econ. 16, 21–33 (2015)

    Article  Google Scholar 

  38. Hajizadeh, M., Connelly, L.B., Butler, J.R.G.: Health policy and horizontal inequities of health-care utilization in Australia: 1983–2005. Appl. Econ. Lett. 19, 1765–1775 (2012)

    Article  Google Scholar 

  39. Pulok, M.H., van Gool, K., Hall, J.: Inequity in physician visits: the case of the unregulated fee market in Australia. Soc. Sci. Med. 255, 113004 (2020). https://doi.org/10.1016/j.socscimed.2020.113004

    Article  PubMed  Google Scholar 

  40. Pulok, M.H., van Gool, K., Hall, J.: Horizontal inequity in the utilisation of healthcare services in Australia. Health Policy 124, 1263–1271 (2020). https://doi.org/10.1016/j.healthpol.2020.08.012

    Article  Google Scholar 

  41. World Health Organization.: Primary health care (now more than ever). Geneva, Switzerland (2008)

  42. Gemmill, M.C., Thomson, S., Mossialos, E.: What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries. Int. J. Equity Health. 7, 13–16 (2008). https://doi.org/10.1186/1475-9276-7-12

    Article  Google Scholar 

  43. Levesque, J.F., Harris, M.F., Russell, G.: Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int. J. Equity Health. 12, 1–9 (2013). https://doi.org/10.1186/1475-9276-12-18

    Article  Google Scholar 

  44. Tang, S.Y., Browne, A.J., Mussell, B., Smye, V.L., Rodney, P.: “Underclassism” and access to healthcare in urban centres. Sociol. Heal. Illn. 37, 698–714 (2015). https://doi.org/10.1111/1467-9566.12236

    Article  Google Scholar 

  45. van Doorslaer, E., Koolman, X., Jones, A.M.: Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 13, 629–647 (2004)

    Article  PubMed  Google Scholar 

  46. O’Donnell, O., van Doorslaer, E., Wagstaff, A., Lindelow, M.: Analyzing health equity using household survey data: a guide to techniques and their implementation. Analyzing Health Equity Using Household Survey Data. (2008). https://doi.org/10.1596/978-0-8213-6933-3

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Acknowledgements

The data for this study were accessed through the Statistics Canada’s Atlantic Research Data Centre (ARDC) at Dalhousie University, which is part of the Canadian Research Data Centre Network (CRDCN). We would like to thank the CRDCN for facilitating access to the CCHS and the ARDC analyst Heather Hobson for her assistance. We also thank Drs Catherine Mah, Jeanna Parsons Leigh, and Daniel Dutton for their valuable comments on the study.

Funding

Laura Hirello was funded by a postgraduate bursary from the Dalhousie Division of Emergency Medical Services and a Nova Scotia Research Scholar Award. Mohammad Hajizadeh acknowledges the funding provided by the Faculty of Health Research Development Grant, Dalhousie University, and the support of the Canada Research Chairs Program.

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Authors and Affiliations

  1. School of Health Administration, Dalhousie University, Halifax, Canada

    Laura Hirello

  2. Geriatric Medicine Research, Nova Scotia Health Authority and School of Health Administration, Dalhousie University, Halifax, Canada

    Mohammad Habibullah Pulok

  3. School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, B3H 4R2, Canada

    Mohammad Hajizadeh

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  1. Laura Hirello
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  2. Mohammad Habibullah Pulok
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  3. Mohammad Hajizadeh
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Correspondence to Mohammad Hajizadeh.

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We declare that we have no conflict of interest.

Ethical approval

We accessed the CCHS through Statistics Canada’s ARDC. Data accessed through the ARDC, which follows strict disclosure protocols according to the Statistics Canada Acts, is exempt from the research ethics review board based on the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2) article 2.2 (a).

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Hirello, L., Pulok, M.H. & Hajizadeh, M. Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014. Eur J Health Econ 23, 1519–1533 (2022). https://doi.org/10.1007/s10198-022-01441-1

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