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Does low income mean reduced access to primary care?

March 21, 2013

A new audit study published in the Canadian Medical Association Journal (CMAJ) reveals that family doctors’ offices seem to discriminate against people of low socio-economic status, even though there is no economic incentive to do so under publicly-funded universal health insurance. Furthermore, physicians’ offices appear to give preference to people with chronic health conditions, according to the research led by Dr. Stephen Hwang of St. Michael’s Hospital, in Toronto.

In this study researchers telephoned a random sample of offices of family physicians and general practitioners in Toronto, and played the role of an individual seeking a primary care physician. Researchers followed a script that indicated they had either high socioeconomic status (a bank employee transferred to the city) or low socioeconomic status (welfare recipient), and the presence or absence of chronic health conditions (diabetes and low back pain).

The number of calls that resulted in the offer of an appointment was significantly higher for people with high socioeconomic status (22.6 per cent) than for people with low socioeconomic status (14.3 per cent). When the offer of a screening visit or a spot on a waiting list is included in the analysis, the difference is even more significant: 37 per cent for people with high status versus 24 per cent for those with low status.

An individual with chronic health issues was also significantly more likely to get an appointment than someone without: 23.5 per cent compared to 12.8 per cent.

The CMAJ abstract, “The effect of socioeconomic status on access to primary care: an audit study” is available at the CMAJ website. You can also read the press release from St. Michael’s Hospital and hear sample audio recordings of the researchers’ conversations with physician offices.

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