June 14, 2005

Even in Canada’s Universal Health Plan, Wealth Effects Hospitalization

Canada's universal health care plan is designed to provide equal access to care, independent of the patient's income level. A study in Health Services Research examined this issue, looking at patients with conditions for which timely care in doctors'offices has traditionally been thought to prevent expensive hospitalization for more serious consequences.

There are nine such health problems, called Ambulatory Care Sensitive (ACS) conditions. Because outpatient care for ACSs could prevent the onset of an illness, control problems that arise during an episode, or manage a chronic disease, researchers use these conditions to assess whether patients are getting access to the kinds of care which may both reduce their disease burden and reduce the overall costs of their treatment.

This paper challenges the paradigm that frequent visits for ACS conditions should be assumed to be associated with lower rates of hospitalization. This was not true in Manitoba-- especially for patients coming from different socioeconomic levels even within a setting designed to promote equal access. The study specifically looked at the hospitalizations, same-day surgery, and outpatient visits to the provider [that is, 'ambulatory care'] for people with ACS conditions from urban areas of Manitoba during 1998-2001. "All conditions showed a socioeconomic gradient with residents of the lowest-income neighborhoods having both more ambulatory care and more hospitalizations than their counterparts in higher income areas," author Leslie Roos states. For six of the nine conditions, individuals living in the lowest income neighborhoods had significantly more ambulatory visits before hospitalization than those living in wealthier neighborhoods-- so poorer access to ambulatory care is not the obvious explanation. Instead, the poor in urban Manitoba had more frequent contact with general practitioners; socioeconomic groups differed little in contact with specialists. Policies and research that tries to assess the "timeliness" and "quality of care" of care received by measuring access to outpatient care for Ambulatory Care Sensitive Conditions need to be further examined in the light of these findings.

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