HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) In Brief TRACK Discussion: Submit a Comment TRACK Discussion: View Comments Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Glazier, R. H. Articles by Sibley, L. M. Search for Related Content PubMed PubMed Citation Articles by Glazier, R. H. Articles by Sibley, L. M. Related Collections Community / population health Quantitative methods Health policy Disparities in health and health care

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

¹ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
² Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ontario, Canada
³ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
⁴ Dalla Lana School of Public Health, Toronto, Ontario, Canada

CORRESPONDING AUTHOR: Richard Glazier, MD, MPH, Institute for Clinical Evaluative Sciences, G1-06, 2075 Bayview Ave, Toronto ON M4N 3M5 Canada, rick.glazier{at}ices.on.ca

PURPOSE 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.

METHODS 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.

RESULTS 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.

CONCLUSIONS 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.

Key Words: Access to health care • healthcare disparities • primary health care • specialist care • health services research • educational status • socioeconomic factors • Canada • health care delivery

This article has been cited by other articles:

				B. Starfield Reinventing Primary Care: Lessons From Canada For The United States Health Aff., May 1, 2010; 29(5): 1030 - 1036. [Abstract] [Full Text] [PDF]

				R. S. Gotler In This Issue: Critical Topics in Primary Care Ann. Fam. Med, September 1, 2009; 7(5): 386 - 387. [Full Text] [PDF]

TRACK Comments: