Universal Health Insurance and Equity in Primary Care and Specialist Office Visits: A Population-Based Study

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
The Annals of Family Medicine (Impact Factor: 5.43). 09/2009; 7(5):396-405. DOI: 10.1370/afm.994
Source: PubMed


Universal coverage of physician services should serve to reduce socioeconomic disparities in care, but the degree to which a reduction occurs is unclear. We examined equity in use of physician services in Ontario, Canada, after controlling for health status using both self-reported and diagnosis-based measures.
Ontario respondents to the 2000-2001 Canadian Community Health Survey (CCHS) were linked with physician claim files in 2002-2003 and 2003-2004. Educational attainment and income were based on self-report. The CCHS was used for self-reported health status and Johns Hopkins Adjusted Clinical Groups was used for diagnosis-based health status.
After adjustment, higher education was not associated with at least 1 primary care visit (odds ratio [OR] = 1.05; 95% confidence interval [CI], 0.87-1.24), but it was inversely associated with frequent visits (OR = 0.77; 95% CI, 0.65-0.88). Higher education was directly associated with at least 1 specialist visit (OR = 1.20; 95% CI, 1.07-1.34), with frequent specialist visits (OR = 1.21; 95% CI, 1.03-1.39), and with bypassing primary care to reach specialists (OR = 1.23, 95% CI 1.02-1.44). The largest inequities by education were found for dermatology and ophthalmology. Income was not independently associated with inequities in physician contact or frequency of visits.
After adjusting for health status, we found equity in contact with primary care for educational attainment but inequity in specialist contact, frequent visits, and bypassing primary care. In this setting, universal health insurance appears to be successful in achieving income equity in physician visits. This strategy alone does not eliminate education-related gradients in specialist care.

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    • "In another study it was determined that, higher education was not related to GPs first visit, but it was inversely related to more than one visits. The results displayed that, income did not have any relationship with the GPs visits (Glazier et al., 2009). In a New Zealand study, it was found that low-income groups and Maori had less likely to utilize GPs visits (Scott et al., 2003). "
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    ABSTRACT: Purpose – The purpose of this paper is to study, inequalities between general physicians’ and specialists’ visits in Shiraz. Also, the factors effecting the utilization of visits were determined. Design/methodology/approach – Concentration index and curves, ranked by income and quality of life were used to estimate the amount of inequality in the utilization of services. Health utilization data which had been gathered already were used for this purpose. Poisson regression was used to construct the models. Findings – Results of the study showed that, inequalities in specialists’ visits were higher than GPs’. Complementary insurances users and females used more specialist services. People with higher quality of life utilized fewer GPs’ and specialists’ services. Originality/value – New evidences about inequality in health services utilization and its components in Iran was surveyed.
    Full-text · Article · Sep 2015
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    • "Patient socioeconomic status has been associated with less access to specialist care [8-14] and lower wait times [15]. Women and older patients are less likely to be referred for some specialist care [16-18]. "
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    ABSTRACT: Wait times are an important measure of access to various health care sectors and from a patient's perspective include several stages in their care. While mechanisms to improve wait times from specialty care have been developed across Canada, little is known about wait times from primary to specialty care. Our objectives were to calculate the wait times from when a referral is made by a family physician (FP) to when a patient sees a specialist physician and examine patient and provider factors related to these wait times. Our study used the Electronic Medical Record Administrative data Linked Database (EMRALD) which is a linkage of FP electronic medical record (EMR) data to the Ontario, Canada administrative data. The EMR referral date was linked to the administrative physician claims date to calculate the wait times. Patient age, sex, socioeconomic status, comorbidity and FP continuity of care and physician age, sex, practice location, practice size and participation in a primary care delivery model were examined with respect to wait times. The median waits from medical specialists ranged from 39 to 76 days and for surgical specialists from 33 days to 66 days. With a few exceptions, patient factors were not associated with wait times from primary care to specialty care. Similarly physician factors were not consistently associated with wait times, except for FP practice location. Actual wait times for a referral from a FP to seeing a specialist physician are longer than those reported by physician surveys. Wait times from primary to specialty care need to be included in the calculation of surgical and diagnostic wait time benchmarks in Canada.
    Full-text · Article · Jan 2014 · BMC Family Practice
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    • "The concentration index is close to zero, meaning that there is no need-related inequality in preventive services. The results were similar with other studies [44,45]. The preventive services aim to improve health for all, while other health services aim to “treat” patients. "
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    ABSTRACT: Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.
    Full-text · Article · Jan 2013 · International Journal for Equity in Health
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