Equity in health and health care in a decentralised context: evidence from Canada

Jiménez-Rubio, Dolores; Smith, Peter; Doorslaer, Eddy van

doi:10.1002/hec.1272

Cited by 70 publications

(59 citation statements)

References 31 publications

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“…Our findings regarding income-related inequity in physician service use in Ontario, Canada are consistent with previous research (Allin, forthcoming; Asada and Kephart, 2007;Jiménez-Rubio et al, 2007;van Doorslaer et al, 2006) that has also found mild pro-rich inequity in the probability of a GP visit, pro-poor inequity in the conditional number of GP visits, and larger prorich inequity with respect to both the probability of and conditional number of visits to specialists.…”

Section: Discussionsupporting

confidence: 91%

“…Utilization of specialist services in Canada appears to be inequitable favouring the wealthier individuals, while use of GP services tends to be mildly, but significantly, pro-rich for the probability of a visit, and mildly pro-poor for the number of visits conditional on one visit (Allin, forthcoming; Asada and Kephart, 2007;Curtis and MacMinn, 2007;van Doorslaer et al, 2006;Jiménez-Rubio et al, 2007). While inequitable use of specialist care is evidenced in most countries, pro-rich inequity in the probability of a GP visit is unusual internationally (found in only three of 21 OECD countries studied -Canada, Portugal and Finland;van Doorslaer et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

Allin

Hurley

2009

Health Economics

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This study examines the impact that private financing of prescription drugs in Canada has on equity in the utilization of publicly financed physician services. The complementary nature of prescription drugs and physician service use alongside the reliance on private finance for drugs may induce an income gradient in the use of physicians. We use established econometric methods based on concentration curves to measure equity in physician utilization and its contributors in the province of Ontario. We find that individuals with prescription drug insurance make more physician visits than do those without insurance, and the effect on utilization is stronger for the likelihood of a visit than the conditional number of visits, and for individuals with no chronic conditions than those with at least one condition. Results of the equity analyses reveal the most important contributors to the pro-rich inequity in physician utilization are income and private insurance, while public insurance, which covers older people and those on social assistance, has a pro-poor effect. These findings highlight that inequity in access to and use of publicly funded services may arise from the interaction with privately financed health services that are complements to the use of public services. ALLIN S., HURLEY J.CHEPA Working Paper 08-02 2

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

Allin

Hurley

2009

Health Economics

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“…3 Nevertheless, we have to keep in mind that the bulk of the decentralization process occurred in 2002. 4 See, among many others, the collective work of Saltman et al (2007), the reviews of Jiménez-Rubio (2010) andandKolehmainen-Aitken (2005), the works of Bossert et al (2003) and Arreondo and Orozco (2005) for Latin American countries, the analyses of some African experiences by Jepsson and Okuonzi (2000) and Akin et al (2005), Tang and Bloom (2000) on China, Jiménez-Rubio et al (2008) and Zhong (2010) on Canada, Ferrario and Zanardi (2011) on Italy and Cantarero and Pascual (2006) on European Union countries.…”

Section: Introductionmentioning

confidence: 99%

Effects of health care decentralization in Spain from a citizens’ perspective

et al. 2013

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The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens' satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996-2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain, we find that, in general, decentralization has not improved citizens' satisfaction with different features of the health services. In fact, the only significant -though smalleffects found were of the opposite sign, i.e., a reduction in satisfaction as a result of decentralization, regarding the following aspects of medical care: assistance in the primary care centers, waiting time before consultation, ease of getting appointments, confidence transmitted by doctors and the number of persons per hospital room.

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“…Other studies in Canada have pointed to differential health service use by income category, [3][4][5][6][7] but to our knowledge, this is the first valid and reliable direct measure of cost-related barriers to necessary medical services. Although problems with health care affordability were more prevalent in low-than in highincome respondents in our sample, higher-income respondents also reported problems with affordability.…”

Section: Discussionmentioning

confidence: 96%

“…The publicly funded health system is a source of national pride for Canadians, 2 but evidence of health care inequity by socio-economic status in Canada [3][4][5][6][7] suggests that even medically necessary health care is not equally affordable. Health care affordability should be measured directly and monitored systematically.…”

Section: T He Accessibility Principle Enshrined In the 1984 Canadamentioning

confidence: 99%

Development of a measure of health care affordability applicable in a publicly funded universal health care system

Haggerty

Lévesque²

2015

Can J Public Health

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OBJECTIVE: Direct measures of health care affordability from the user perspective are needed to monitor equitable access to publicly funded health care in Canada. The objective of our study was to develop a survey-based measure of health care affordability applicable to the Canadian context. METHODS:We developed items after focus group exploration of access and cost barriers in the health care trajectory. We administered an initial instrument by telephone to a randomly-selected sample of 750 respondents in metropolitan, rural, and remote settings in Quebec. After analysis we developed a new, self-administered version eliciting the frequency of problem access due to five affordability dimensions. This version was mailed to a subset of participants. We conducted exploratory and confirmatory factor analysis. We used ordinal logistic regression modelling to examine how individual items and the subscale score predicted indicators of difficult access. We looked for effect modification by income categories. RESULTS:The five items load on a single construct with good internal consistency (α = 0.77). The overall score, 0 to 5, reflects the sum of problems with health care affordability due to direct and indirect costs. The item and subscale scores are sensitive to income status, with affordability problems more prevalent among low-income than high-income respondents. Each unit increase in the subscale score predicts increased likelihood of unmet needs (OR = 1.54), emergency room use (OR = 1.41), and delay-related health problem aggravation (OR = 1.80).DISCUSSION: This subscale reliably and validly measures cost barriers to medically necessary services in Canada, and can potentially be applied in other settings with publicly funded health systems. It can be used to monitor and compare health care equity.KEY WORDS: Primary health care; accessibility of health services; Canada; health care disparities; outcome and process assessment (health care) La traduction du résumé se trouve à la fin de l'article.

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Equity in health and health care in a decentralised context: evidence from Canada

Cited by 70 publications

References 31 publications

Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

Effects of health care decentralization in Spain from a citizens’ perspective

Development of a measure of health care affordability applicable in a publicly funded universal health care system

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