Family Medicine Centre, Mount Sinai Hospital, Departments of Family and Community Medicine and Public Health Sciences, University of Toronto, Toronto, Ont. murray.finkelstein@utoronto.ca
Universal health care systems seek to ensure access to care on the basis of need, rather than income, but there are concerns about preferential access to cardiovascular and specialist care for high income patients. In this study, I used population-based, individual-level health, income and utilization data to determine whether whether there is evidence for differential access to physician care in relation to household income.
I studied data for 2170 Ontario respondents to the 1995 National Population Health Survey (aged 40 to 79 years) who had approved linkage of their survey responses to the administrative databases of the Ontario Health Insurance Plan and for whom income data were available. I used linear and generalized linear regression to model the mean per capita expenditures on physician care and the probability of referral to a specialist in relation to income and self-reported health status.
Residents of higher income households incurred lower per capita expenditures for physicians' services than those in lower income households; for example, the mean per capita expenditure in the upper middle income group was $220 less (95% confidence interval -$87 to -$334) than the mean per capita expenditure in the lowest income group. Expenditures were significantly related to self-reported health status; for example, the mean per capita expenditure among those reporting fair health status was $590 higher (95% confidence interval $465 to $737) than among those reporting excellent health. After adjustment for health status, there was no association between income and the expenditures on all physician services, out-of-hospital services or specialist care.
Utilization of physicians' services in Ontario is based on need, rather than income.
Notes
Cites: Soc Sci Med. 2000 Jul;51(1):123-3310817475
Cites: CMAJ. 2000 Jan 11;162(1):45-611216197
Cites: CMAJ. 2001 Mar 20;164(6):809-1311276550
Cites: Am J Epidemiol. 1986 Jan;123(1):174-843509965
Cites: Health Serv Res. 1988 Feb;22(6):857-773126165
Cites: N Engl J Med. 1999 Oct 28;341(18):1359-6710536129