Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults.

Pulok, MH; Hajizadeh, M

Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults.

Pulok, MH Hajizadeh, M

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Publisher:: PERGAMON-ELSEVIER SCIENCE LTD
Publication Type:: Journal Article
Citation:: Soc Sci Med, 2022, 307, pp. 115186
Issue Date:: 2022-08

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Field	Value	Language
dc.contributor.author	Pulok, MH
dc.contributor.author	Hajizadeh, M
dc.date.accessioned	2022-10-31T22:15:52Z
dc.date.available	2022-06-27
dc.date.available	2022-10-31T22:15:52Z
dc.date.issued	2022-08
dc.identifier.citation	Soc Sci Med, 2022, 307, pp. 115186
dc.identifier.issn	0277-9536
dc.identifier.issn	1873-5347
dc.identifier.uri	http://hdl.handle.net/10453/163087
dc.description.abstract	This study presents longitudinal evidence on the trends and determinants of income-related inequities in general practitioner (GP), specialist, and any physician visits among older adults (aged 65+) in Canada. Using the Canadian National Population Health Survey between 1998/99 and 2010/11, random effect probit and negative binomial models were employed to model the probability of visit and the total number of visits, respectively. The concentration index-based horizontal inequity (HI) approach was used to measure income-related inequities in physician services. The decomposition technique was applied to explain the factors contributing to the observed inequities. The mobility index (MI) was also calculated to compare short-run and long-run estimates of inequities. The HI indices reveal significant pro-rich inequities in both the probability and the number of specialist visits. Inequities in the likelihood of GP visits and any physician visits were pro-rich but trivial in magnitude. The MI shows that upwardly income mobile individuals contribute to inequity in specialist visits in the long run. After income, education was the most important contributor to inequity in specialist visits, while unobserved heterogeneity explained most of the pro-rich inequity in the total number of GP and any physician visits. Although physician services are free at the point of the provision in Canada, this study demonstrates that poorer older adults utilized fewer specialist services than richer older adults for the same level of need. Specific policies are needed to ensure equity in specialist care use among the older adults in Canada.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	PERGAMON-ELSEVIER SCIENCE LTD
dc.relation.ispartof	Soc Sci Med
dc.relation.isbasedon	10.1016/j.socscimed.2022.115186
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 14 Economics, 16 Studies in Human Society
dc.subject.classification	Public Health
dc.subject.mesh	Aged
dc.subject.mesh	Canada
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Humans
dc.subject.mesh	Income
dc.subject.mesh	Medical Assistance
dc.subject.mesh	Physicians
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Humans
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Aged
dc.subject.mesh	Physicians
dc.subject.mesh	Income
dc.subject.mesh	Medical Assistance
dc.subject.mesh	Canada
dc.subject.mesh	Healthcare Disparities
dc.title	Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults.
dc.type	Journal Article
utslib.citation.volume	307
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
utslib.for	14 Economics
utslib.for	16 Studies in Human Society
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/DVC (International)
utslib.copyright.status	closed_access	*
dc.date.updated	2022-10-31T22:15:50Z
pubs.publication-status	Published
pubs.volume	307

Abstract:

This study presents longitudinal evidence on the trends and determinants of income-related inequities in general practitioner (GP), specialist, and any physician visits among older adults (aged 65+) in Canada. Using the Canadian National Population Health Survey between 1998/99 and 2010/11, random effect probit and negative binomial models were employed to model the probability of visit and the total number of visits, respectively. The concentration index-based horizontal inequity (HI) approach was used to measure income-related inequities in physician services. The decomposition technique was applied to explain the factors contributing to the observed inequities. The mobility index (MI) was also calculated to compare short-run and long-run estimates of inequities. The HI indices reveal significant pro-rich inequities in both the probability and the number of specialist visits. Inequities in the likelihood of GP visits and any physician visits were pro-rich but trivial in magnitude. The MI shows that upwardly income mobile individuals contribute to inequity in specialist visits in the long run. After income, education was the most important contributor to inequity in specialist visits, while unobserved heterogeneity explained most of the pro-rich inequity in the total number of GP and any physician visits. Although physician services are free at the point of the provision in Canada, this study demonstrates that poorer older adults utilized fewer specialist services than richer older adults for the same level of need. Specific policies are needed to ensure equity in specialist care use among the older adults in Canada.

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http://hdl.handle.net/10453/163087