Despite universal health care, a University of Toronto study reveals Canadians with higher incomes and more years of schooling have significantly greater access to specialized health services.
Using figures from Statistics Canada, researchers determined that wealthier and more highly educated Canadians are 40 per cent more likely to see a specialist. "Removing financial barriers in the system doesn't necessarily mean that everybody has equal access to health care in this country," says one of the study's co-authors, Dr. Peter Coyte, a health economist in U of T's Faculty of Medicine. "It appears that a multi-tier health care system exists in Canada even for those services covered under the principle of universal access in the Canada Health Act."
The landmark study -- the first national assessment of primary and specialty care in the 1990s -- found that wealthier Canadians had a 32 per cent likelihood of visiting a specialist, compared to 23 per cent for lower income earners. Despite this discrepancy, however, the wealthier group did not receive more intensive care once reaching the specialist level.
"This is one of the positive findings of this study," says Coyte, also an adjunct senior scientist at the Institute for Clinical Evaluative Sciences. "While richer people have greater access to specialists, it appears they're not receiving more intensive treatment compared to poorer people." The researchers also found that 77 per cent of Canadians reported at least one primary care visit per year while 26 per cent reported at least one visit to a specialist.
Published in the April 25 edition of the journal Social Science and Medicine, the study used responses from a random sample of 17,626 Canadians who completed the Canadian National Population Health Survey administered by Statistics Canada in 1994.
Coyte believes improved referral practices would help reduce costs to the healthcare system. "Primary care physicians need to be more scientific when making referrals and less swayed by the knowledge or expectations of their patients," he says. "They need to depend more on health need and less on the patient's socioeconomic status."
The study's lead author is Sheryl Dunlop, a former U of T student now in Australia who conducted this research as part of her master's thesis. The study's other co-author is Warren McIsaac, associate professor of family and community medicine at U of T and family physician at Mount Sinai Hospital, who conducted a similar study in 1990. That study, which examined specialist use in the province of Ontario, reported a similar 40 per cent margin in the use of specialist services in the province.
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Steven de Sousa
U of T Public Affairs
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Journal
Social Science & Medicine