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Equitable Access to Health Care: Methodological Extensions to the Analysis of Physician Utilization in Canada

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  • S Birch
  • J Eyles
  • KM Newbold

Abstract

In this paper we analyse the distribution of family physician use in Canada to explore whether the stated goal of reasonable access to care has been achieved. We test hypotheses to see whether (a) variations in incidence and quantity of use are independent of need for care as proxied by self‐assessed health status and (b) any observed relationship between variations in use and need is independent of other population characteristics. Previous research has conceptual, statistical and data limitations which bring into question the validity of the findings. These limitations are addressed by using more appropriate data, a conditional model for service utilization and correction for self‐selectivity of users in the statistical analysis. Variations in need are identified as important and significant in explaining variations in both incidence and quantity of use with the estimated relationship between use and need being positive. Other population characteristics were found to be important and significant in explaining variations in use although household income is not among them. The relationship between use and need is associated with other variables including education, social support and region of residence. These findings suggest that analyses of utilization based on simple multivariate techniques and aggregate data can produce a picture of utilization that conceals important, policy relevant relationships while revealing other relationships that are essentially artifacts of inappropriate aggregation in ways which provide a false sense of achievement.
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Suggested Citation

  • S Birch & J Eyles & KM Newbold, 1993. "Equitable Access to Health Care: Methodological Extensions to the Analysis of Physician Utilization in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 1993-03, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    • Handle: RePEc:hpa:wpaper:199303
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    References listed on IDEAS

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    1. S Birch & S Chambers & J Eyles & J Hurley & B Hutchison, 1990. "Development and Application of a Needs-based Methodology for Calculating a Capitation Rate for a Comprehensive Health Organization," Centre for Health Economics and Policy Analysis Working Paper Series 1990-13, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    2. O'Donnell, Owen & Propper, Carol, 1991. "Equity and the distribution of UK National Health Service resources," Journal of Health Economics, Elsevier, vol. 10(1), pages 1-19, May.
    3. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    4. Le Grand, Julian, 1978. "The Distribution of Public Expenditure: The Case of Health Care," Economica, London School of Economics and Political Science, vol. 45(178), pages 125-142, May.
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    1. Giuliana Luca & Michela Ponzo & Antonio Andrés, 2013. "Health care utilization by immigrants in Italy," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 1-31, March.
    2. Raquel Sánchez-Recio & Cristina García-Ael & Gabriela Topa, 2021. "Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law," Administrative Sciences, MDPI, vol. 11(2), pages 1-21, April.
    3. Ignacio Abásolo & Jaime Pinilla & Miguel Negrín, 2008. "Equity in the utilization of public health care services by regions in Spain: a multinivel analysis," Hacienda Pública Española / Review of Public Economics, IEF, vol. 187(4), pages 87-106, December.
    4. Markham, Barbara A. & Hutchison, Brian & Birch, Stephen & Goldsmith, Laurie J. & Evans, C. Edward, 1997. "Casting the screening net: separating big fish from little fish," Health Policy, Elsevier, vol. 42(2), pages 171-184, November.
    5. Jaume Puig & Marc Sáez & Esther Martínez Garcia, 1998. "Health care provider choice in the case of patient-initiated contacts. An extended version of discrete choice of model demand," Working Papers, Research Center on Health and Economics 308, Department of Economics and Business, Universitat Pompeu Fabra.
    6. Devlin, Rose Anne & Sarma, Sisira & Zhang, Qi, 2011. "The role of supplemental coverage in a universal health insurance system: Some Canadian evidence," Health Policy, Elsevier, vol. 100(1), pages 81-90, April.
    7. Okumu, Ibrahim Mike & Bbaale, Edward, 2016. "Realized Access to Antenatal Care Utilization in Uganda: Household Welfare and Governance Implications," African Journal of Economic Review, African Journal of Economic Review, vol. 4(2), July.
    8. Birch, Stephen & Gafni, Amiram, 2003. "Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results," Health Policy, Elsevier, vol. 64(2), pages 207-219, May.
    9. McLeod, Logan, 2011. "A nonparametric vs. latent class model of general practitioner utilization: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 30(6), pages 1261-1279.
    10. Steven G Morgan & Colleen M Cunningham & Gillian E Hanley, 2010. "Individual and Contextual Determinants of Regional Variation in Prescription Drug Use: An Analysis of Administrative Data from British Columbia," PLOS ONE, Public Library of Science, vol. 5(12), pages 1-6, December.
    11. K. Bruce Newbold, 1997. "Aboriginal Physician Use in Canada: Location, Orientation and Identity," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 197-207, March.
    12. Lori J. Curtis & William J. MacMinn, 2008. "Health Care Utilization in Canada: Twenty-five Years of Evidence," Canadian Public Policy, University of Toronto Press, vol. 34(1), pages 65-88, March.
    13. Jeremiah Hurley & Emmanuel Guindon, 2008. "Private Health Insurance in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 2008-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.

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