Study: Accessing first-contact health services

2003

Canadians who do not have a regular family physician were more than twice as likely to report difficulties accessing routine health care compared with those who have a regular doctor, according to a new study conducted by Statistics Canada in collaboration with researchers at McGill University, Department of Geography.

However, the study also showed that respondents with a regular family doctor were just as likely to face difficulties accessing immediate care for a minor health problem as were those without a regular family doctor. While it is important to have a regular doctor, the results of the study indicate that having one does not always guarantee that patients will have access to care for all types of services at all times.

The study also reported that income was not associated with difficulties accessing care. This supports the notion that universal health insurance helps eliminate cost-related barriers to care.

The paper, the first national level analysis of Canadians experiencing difficulties accessing first-contact services, was published recently online in Healthcare Policy. This Canadian publication is targeted at health system managers and administrators, doctors and academics.

The study focused on two types of first contact services: first, routine care provided by a family or general practitioner such as annual examinations or ongoing care for an illness, and secondly, immediate care for a minor, non-life threatening problem, such as a fever or a minor cut or burn.

Those reporting poorer health were also more likely to report difficulties accessing routine care. Since these groups tend to have more contacts with the health care system, they have more opportunities to experience difficulties accessing care and therefore, are at a higher risk compared with those who are less likely to need and use health care services.

Younger respondents were consistently more likely to report difficulties accessing first contact services, while people with less than high school education were less likely to report difficulties. The differences may be the result of different expectations across groups regarding when and how health care services are obtained. Evidence to date suggests that older and less educated patients tend to have more modest expectations and are less likely to be dissatisfied with their care.

Recent immigrants (those living in Canada for less than five years) were almost two and a half times more likely to have difficulties accessing immediate care for a minor health problem. However, immigrants living in Canada for more than five years were less likely to experience difficulties accessing routine care compared with Canadian-born respondents.

Overall, 15% of Canadians reported difficulties accessing routine care and 23% reported difficulties accessing immediate care for a minor health problem in 2003.

The chief reason cited for difficulties in accessing routine care was the availability of a physician or services. In terms of immediate care for minor health problems, the primary barrier was long wait times.

The study was based on data from the 2003 Health Services Access Survey (HSAS) and the Canadian Community Health Survey (CCHS). The HSAS collected information on patients' experiences accessing health care services. The CCHS is a cross-sectional survey containing information on the health status and health care use of Canadians.

This study is unique since it considers issues related to the process of accessing care or potential access. Traditionally, studies on access to health care have focused on the use of services or realized access which, while important, does not provide information regarding patients' experiences accessing the care they need.

The results provide valuable information about the specific factors associated with difficulties accessing first contact services as well as identifies population groups which may be more vulnerable to experiencing difficulties accessing care.

Definitions, data sources and methods: survey numbers, including related surveys, 3226 and 5002.

The study "Experiences accessing first-contact health services in Canada" was published in Healthcare Policy. An abstract is available online (http://www.healthcarepolicy.net).

The HSAS questionnaire is now available online. From the CCHS main page, choose Other reference periods, then 2003 (Cycle 2.1, then Questionnaire and reporting guides.

For more information about the concepts, methods or data, or to obtain a copy contact Claudia Sanmartin (613-951-6059; claudia.sanmartin@statcan.gc.ca) or Jean-Marie Berthelot (613-951-3760; berthel@statcan.gc.ca), Health Analysis and Measurement Group.