Canada's universal healthcare may not be so universal after all

You’re more likely to get a doctor’s appointment in Canada if you’re rich than if you’re poor, even though the government pays the bills, according to a new study.

In the spring and summer of 2011, a team of Canadian researchers posing as prospective patients cold-called 375 doctors offices in Ontario to schedule a check-up.

The researchers posed in each call as one of four types: a wealthy banker in good health, a wealthy banker with diabetes and back problems, a welfare recipient in good health, or a welfare recipient with diabetes and back problems.

Overall, the callers were 50% more likely to be offered an appointment when they posed as bankers than when they posed as welfare recipients.

Canada has universal healthcare, and the researchers said they studied Ontario in particular because it has a single public insurer, and patient pay no copayments or deductibles for visiting a physician. In theory, therefore, general physicians in Ontario and their staffs would have no financial incentive to choose a rich patient over a poor one, according to the study, conducted by doctors at the Keenan Research Centre at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto.

Researchers randomly selected the 375 offices out 3,367 family physician and general practitioners in Toronto. Physicians excluded from the study included specialized practices, doctors with disciplinary records and offices that don't offer appointments because they accept only “walk-in” patients.

The callers posing as bankers, sick or healthy, were offered an appointment, a screening visit or placement on a waiting list 37% of the time compared with 24% for welfare recipients. The researchers noted that many times they spoke with administrative assistants, so the apparent bias cannot be exclusively assigned to doctors.

“Staff at physicians’ offices may hold negative attitudes toward this group, especially toward people receiving social assistance,” the authors wrote. “Physicians have been shown to perceive patients with low socioeconomic status more negatively in terms of their personalities, abilities, behavioral tendencies and role demands.”

The study did find that people posing as sick, regardless of how they described their economic status, were more likely to get appointments than were callers posing as healthy.

“Although it is reassuring that patients with chronic health conditions received prioritized access to primary care, our results suggest a need for greater efforts to ensure that physicians and their office staff do not discriminate against people of low socioeconomic status,” the study authors wrote.

The paper was supported by the Ontario Ministry of Health and Long-Term Care.


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