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Health Care Utilization in Canada: Twenty-five Years of Evidence


  • Lori J. Curtis
  • William J. MacMinn


A plethora of literature links socioeconomic status (SES) to health and health care utilization. Recent anecdotal evidence indicates that Canadians believe their access to health care is diminishing. This study describes health care utilization patterns for services provided under public health insurance (physicians, specialists, and hospitals) in Canada between 1978 and 2003. The relationship between SES and utilization, controlling for health and demographic characteristics, is examined to investigate whether changes in the equity of utilization have occurred over time. Results indicate that SES inequities in utilization are apparent, appearing to be more relevant in initial contact with the system than in the number of visits. Specialists' services are particularly problematic and becoming more so over time.

Suggested Citation

  • 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.
  • Handle: RePEc:cpp:issued:v:34:y:2008:i:1:p:65-88

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    References listed on IDEAS

    1. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    2. Vincenzo Atella & Francesco Brindisi & Partha Deb & Furio C. Rosati, 2004. "Determinants of access to physician services in Italy: a latent class seemingly unrelated probit approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 657-668.
    3. Janet Currie & Mark Stabile, 2003. "Socioeconomic Status and Child Health: Why Is the Relationship Stronger for Older Children?," American Economic Review, American Economic Association, vol. 93(5), pages 1813-1823, December.
    4. Roshni Mangalore, 2006. "Income, health and health care utilization in the UK," Applied Economics, Taylor & Francis Journals, vol. 38(6), pages 605-617.
    5. Curtis, Lori J. & Dooley, Martin D. & Phipps, Shelley A., 2004. "Child well-being and neighbourhood quality: evidence from the Canadian National Longitudinal Survey of Children and Youth," Social Science & Medicine, Elsevier, vol. 58(10), pages 1917-1927, May.
    6. John Mullahy, 1997. "Instrumental-Variable Estimation Of Count Data Models: Applications To Models Of Cigarette Smoking Behavior," The Review of Economics and Statistics, MIT Press, vol. 79(4), pages 586-593, November.
    7. Mark Stabile, 2001. "Private insurance subsidies and public health care markets: evidence from Canada," Canadian Journal of Economics, Canadian Economics Association, vol. 34(4), pages 921-942, November.
    8. Curtis, Lori & Phipps, Shelley, 2004. "Social transfers and the health status of mothers in Norway and Canada," Social Science & Medicine, Elsevier, vol. 58(12), pages 2499-2507, June.
    9. Sisira Sarma & Wayne Simpson, 2006. "A microeconometric analysis of Canadian health care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 219-239.
    10. Stephen Birch & John Eyles & K. Bruce Newbold, 1993. "Equitable access to health care: Methodological extensions to the analysis of physician utilization in Canada," Health Economics, John Wiley & Sons, Ltd., vol. 2(2), pages 87-101, July.
    11. Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
    12. repec:aph:ajpbhl:1996:86:4:520-524_3 is not listed on IDEAS
    13. repec:aph:ajpbhl:1997:87:5:811-816_2 is not listed on IDEAS
    14. Adam Wagstaff & Eddy van Doorslaer, 2004. "Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 297-301.
    15. McDonald, James Ted & Kennedy, Steven, 2004. "Insights into the 'healthy immigrant effect': health status and health service use of immigrants to Canada," Social Science & Medicine, Elsevier, vol. 59(8), pages 1613-1627, October.
    16. repec:aph:ajpbhl:10.2105/ajph.2004.059402_2 is not listed on IDEAS
    17. Haynes, Robin, 1991. "Inequalities in health and health service use: Evidence from the general household survey," Social Science & Medicine, Elsevier, vol. 33(4), pages 361-368, January.
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    Cited by:

    1. Chung Jen Yang & Ying Che Tsai & Joseph J. Tien, 2017. "The Impacts of Persistent Behaviour and Cost-Sharing Policy on Demand for Outpatient Visits by the Elderly: Evidence from Taiwan’s National Health Insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 42(1), pages 31-52, January.
    2. 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.

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