An evaluation of access to health care services along the rural-urban continuum in Canada

Abstract

BackgroundStudies comparing the access to health care of rural and urban populations have been contradictory and inconclusive. These studies are complicated by the influence of other factor which have been shown to be related to access and utilization. This study assesses the equity of access to health care services across the rural-urban continuum in Canada before and after taking other determinants of access into account.MethodsThis is a cross-sectional study of the population of the 10 provinces of Canada using data from the Canadian Community Health Survey (CCHS 2.1). Five different measures of access and utilization are compared across the continuum of rural-urban. Known determinants of utilization are taken into account according to Andersen's Health Behaviour Model (HBM); location of residence at the levels of province, health region, and community is also controlled for.ResultsThis study found that residents of small cities not adjacent to major centres, had the highest reported utilisation rates of influenza vaccines and family physician services, were most likely to have a regular medical doctor, and were most likely to report unmet need. Among the rural categories there was a gradient with the most rural being least likely to have had a flu shot, use specialist physicians services, or have a regular medical doctor. Residents of the most urban centres were more likely to report using specialist physician services. Many of these differences are diminished or eliminated once other factors are accounted for. After adjusting for other factors those living in the most urban areas were more likely to have seen a specialist physician. Those in rural communities had a lower odds of receiving a flu shot and having a regular medical doctor. People residing in the most urban and most rural communities were less likely to have a regular medical doctor. Those in any of the rural categories were less likely to report unmet need.ConclusionInequities in access to care along the rural-urban continuum exist and can be masked when evaluation is done at a very large scale with gross indicators of rural-urban. Understanding the relationship between rural-urban and other determinants will help policy makers to target interventions appropriately: to specific demographic, provincial, community, or rural categories.

Income and Regional Gradients in Being without a Regular Doctor: Does the Slope of Gradients Decrease for Those with Greater Health Needs?

“…Consistent with previous findings, econometric results suggest that individuals with no regular doctor were more likely to be male, younger, poor, a recent immigrant and healthy (Hay et al 2010;McIsaac et al 2001;Nabalamba and Millar 2007;Reid et al 2009;Sibley and Weiner 2011;Talbot et al 2001;Viera et al 2006). The presence of chronic conditions reduced the odds of having no regular doctor by 32% for those with one chronic condition and by as much as 53% for those with two or more chronic conditions.…”

Recreational use of prescription medications among Canadian young people: Identifying disparities

“…30 Rates of specialist physician consultations are also higher in these rural areas than in those further away. 30 residents living adjacent to urban cores. This may also relate to the number and influence of illicit suppliers in urban areas.…”

“…30,31 Others have reported that rural residents living adjacent to urban centres are more likely to have a regular medical doctor than those living more remotely (OR: 0.62, 95% CI: 0.53-0.74). 30 Rates of specialist physician consultations are also higher in these rural areas than in those further away. 30 residents living adjacent to urban cores.…”

“…First, because use of some medical services is greater in these proximal rural areas there may be a greater volume of unused medications in home medicine cabinets. 30 Second, older adults are the most likely group to receive controlled medications for chronic conditions and pain, 33 and therefore a greater volume of controlled medications may be present in some rural areas with their relatively older population structures. Third, when rural residents do obtain prescriptions, they may be more likely to save or stockpile excess amounts for future use because of higher dispensing fees in rural areas.…”

Prospective Evaluation of Unmet Needs of Rural and Aboriginal Cancer Survivors in Northern British Columbia

“…Despite the estimated 20% of Canadian cancer survivors residing in rural areas 3 , nearly all cancer survivorship research has focused on people and programs in urban areas 4 . A large body of literature demonstrates that individuals living in rural areas have unique challenges in accessing health care, and it is therefore anticipated that cancer survivors living in rural locations also face unique challenges [5][6][7] .…”