thesis

Examining aspects of equality in Canada's health system

Abstract

Canada's health system is based on the firmly-held belief that the receipt of care should be based on need and not ability to pay. This thesis examines three aspects of this equity goal: provincial variations in equity in the receipt of care; the role of private prescription drug insurance in explaining inequity in the use of physician services; and the equity implications of subjective unmet need. Canada's provinces are responsible for planning and funding most publicly insured health services, hence there is variation in health system characteristics across the country. In the context of such variation, the first empirical analysis examines equity in the use of health services across the provinces. The analysis reveals some evidence of inequity in the likelihood of a GP visit, and the likelihood and number of specialist and dentist visits; some variations can also be found across the provinces. The second empirical analysis investigates the role of complementary insurance for prescription drugs in explaining inequity in the use of publicly-funded physician services. Due to the complementary relationship between prescription drugs and physician services, and the unequal distribution of private insurance coverage across income groups, inequity in physician utilisation partly can be explained by the interaction with insurance. The third empirical analysis assesses the equity implications of subjective unmet need. It finds that there are different utilisation patterns among the different types of unmet need, which raises methodological and conceptual challenges. The concluding chapter positions the three empirical studies within the broader policy context, offers an in-depth discussion of their methodological and policy implications, and proposes areas for future research

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