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Universal access to healthcare is not enough to ensure Canadians get and stay healthy


Lower socioeconomic status is commonly related to worse health. But if poor access to healthcare were the only explanation, universal access to care such as that available in Ontario should eliminate the association. Researchers at the Institute for Clinical Evaluative Sciences (ICES) studied patients with access to Canada’s universal healthcare system who were initially free of cardiac disease, tracking them more than a decade. The results appear in this month’s issue of Health Affairs.

“We found that patients from disadvantaged groups used healthcare services more than their wealthier and more educated counterparts because they were sicker. But greater use of healthcare services by people from disadvantaged groups did not translate into better outcomes, particularly with respect to mortality. We need to start thinking about health and not just healthcare,” says principal investigator and ICES Scientist, Dr. David Alter.

The study of 14,800 patients who were all initially free of cardiac disease found:

  • Socially disadvantaged patients used healthcare services more than their counterparts with higher incomes and education.
  • Patients regardless of their socioeconomic status accessed healthcare more 'reactively' in response to symptoms and/or the onset of disease-related complications rather than proactively in preventative fashion prior to symptoms or the onset of disease.
  • Service use by people with lower incomes and less education had little impact on their poorer health outcomes, particularly mortality.

“Countries contemplating national health insurance cannot rely on universal healthcare to eliminate, but rather only to reduce, historical disparities in outcomes suffered by disadvantaged groups. Our findings suggest the need to introduce large-scale preventive strategies early in patients’ lives to help change unhealthy behaviors,” says Alter.

Author affiliations: ICES (Alter, D.A., Stukel, T., Chong, A., Henry, A.); Cardiac and Secondary Prevention Program of Toronto Rehabilitation Institute (Alter, D.A.); Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Alter, D.A.); Department of Public Health Science (Chong, A), University of Toronto.

The study "Lesson from Canada’s universal care: Socially disadvantaged patients use more health services, still have poorer health" is in the February 2011 issue of Health Affairs.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


Read the Journal Article