Reasonable access? The geographic distribution of physician resources in Ontario, Canada, 1993

Access to physician resources remains an important topic in Canadian health-care planning and research. Evaluation of access as a function of geographic location is critical to identifying areas where physician services are not available in a timely or convenient fashion, and for understanding regional cost and utilization trends. This thesis evaluates geographic access to general practitioner and specialist services in Ontario, Canada by modeling the population's proximity to the physician at three levels of spatial aggregation, using different methods and assumptions. Data for the study is derived from the Canadian Medical Association Physician Database and the 1991 Census of Canada.;To model physician accessibility at low levels of spatial aggregation, this thesis employs a generalized spatial allocation model that matches physician demand to physician supply using a "stepping-stone" optimization routine. Physician accessibility is measured at higher levels of spatial aggregation using the more traditional population per physician ratio and location quotient statistics.;Four important findings emerge from the research. The first is that there is a greater share of the population with poor access to physicians than the literature has suggested. The second finding is that access disparities persist despite the longstanding existence of government-sponsored physician redistribution programs. Third, the study clearly demonstrates that spatial aggregation constrains the ability to discern variations in the pattern of access to physician services. Finally, total accessibility is reduced and geographic disparities are magnified when limitations on physician caseload capacity are introduced into the analysis.;These findings provide evidence to suggest that the government's strategy for addressing the physician distribution problem is only partially effective. The incentive factors that have been relied upon to date, like the Underserviced Area Program, do not appear to provide the full solution. The policy implications of these and other findings are discussed along with suggestions for future research.