Socio-economic status and the utilisation of physicians' services: Results from the National Population Health Survey

Objectives. To assess the extent to which Canada's universal health care system eliminates socio-economic barriers in the use of physician services. This is done by examining the role of socio-economic status in the differential use of publicly-insured, primary and specialist health care services.; Methods. Data from the 1994 National Population Health Survey, a nationally representative survey, was analysed using multiple logistic regression. In order to control for correlation between GP utilisation and specialist utilisation, a two-staged least squares method was used for models explaining specialist utilisation.; Results. The factors found to be most consistently associated with increased physician utilisation, for both primary and specialist care, were the indicators of health need. Whereas the likelihood of an individual making at least one visit to a primary care physician was found to be independent of income, those with lower incomes were more likely to become frequent users of primary care, that is, make at least six visits to a primary care physician. After adjusting for the greater utilisation of primary care services by those in lower socio-economic groups, the utilisation of specialist services was greater among those in higher socio-economic groups. Canadians lacking a regular medical doctor were less likely to receive primary and specialist care, even after adjustments for socio-economic variables such as income and education.; Conclusions. Although financial barriers may not directly impede access to health care services in Canada, differentials in the use of physician services with respect to socio-economic status persist. Despite universal health care, after adjusting for differences in health need, Canadians with lower incomes and fewer years of schooling visit specialists at a lower rate than those with moderate or high incomes and higher levels of education attained.