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Equity in health services use and intensity of use in Canada

DOI: 10.1186/1472-6963-7-41

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We used a nationally representative cross-sectional survey, the 2000/01 Canadian Community Health Survey, which provides a large sample size (about 110,000) and permits more comprehensive adjustment for need indicators than previous studies. We separately examined general practitioner, specialist, and hospital services using two-part hurdle models: use versus non-use by logistic regression, and the intensity of use among users by zero-truncated negative binomial regression.We found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals.Our study unveiled possible socioeconomic inequities in the use of health care services in Canada.Universal health care systems aim to provide health services based on need. Among many forms of the provision of universal health care systems around the world, the Canadian system is one of the most ambitious with public financing for all physician and hospital services deemed medically necessary with no payment at the point of service. Since the establishment of the Canada Health Act in 1984, which set criteria of public administration, comprehensiveness, universality, portability, and accessibility, supporters of the Canadian health care system have been a strong advocate for equal access for equal need. They have striven to remove financial or other barriers to access to physician and hospital services.To what extent has the Canadian health care system met this goal of equitable access? In a comprehensive review of the Canadian literature on equit

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