School of Health Administration, Faculty of Health Professions, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, Canada.
Eur J Health Econ. 2018 Apr;19(3):369-383. doi: 10.1007/s10198-017-0889-3. Epub 2017 Apr 7.
Reasonable access to health services without financial or other barriers is a primary objective of the Canadian health system. Notwithstanding such concern about accessibility of services, long waiting times for health services have been a prominent health policy issue in recent years. Using pooled data from four nationally representative Canadian Community Health Surveys (CCHSs, 2000/01, 2003, 2005 and 2010; n = 266,962) we examine socioeconomic inequality in lengthy wait time (LWT) to health care among adults (aged 18-65) in Canada. The relative and absolute concentration indices (RC and AC, respectively) are used to quantify income-related inequality in LWT in Canada and for its provinces. Additionally, we decompose the RC and AC indices to identify factors affecting income-related inequality in LWT. Our descriptive results show that, on average, 5% of Canadian adults experienced LWT to access health services in the past 12 months. While 3% of the residents of British Columbia and Saskatchewan reported LWT to access health care services, this figure was 7% in Quebec. Our findings also demonstrated that LWT was mainly concentrated among the poor in Canada [RC = -0.039; 95% confidence interval (CI) -0.049 to -0.028 and AC = -0.067; CI -0.086 to -0.049]. The RC and AC suggested statistically significant pro-rich inequality of LWT in Nova Scotia, New Brunswick, Quebec, Manitoba, Saskatchewan and British Columbia. Decomposition analyses indicate that, besides income itself, health status (measured by a set of 15 chronic condition indicators), immigration status and geographical factors were the most important factors contributing to the concentration of LWT among the poor in Canada. These results provide some evidence that low-income individuals tend to have lengthier wait times for publicly-funded health care in Canada in comparison to their high-income counterparts. The observed negative gradient between income and long waiting time may be interpreted as evidence of socioeconomic inequity within Canadian health care system. Thus, further work is required to understand the mechanisms explaining the concentration of long wait time among the poor in Canada.
合理获得无财务或其他障碍的医疗服务是加拿大医疗体系的主要目标之一。尽管人们对服务的可及性表示关注，但近年来，医疗服务的长时间等待一直是一个突出的卫生政策问题。本研究使用四项全国代表性的加拿大社区健康调查（2000/01 年、2003 年、2005 年和 2010 年；n=266962）的汇总数据，考察了加拿大成年人（18-65 岁）在获得医疗服务时较长等待时间（LWT）方面的社会经济不平等。相对集中指数（RC）和绝对集中指数（AC）分别用于量化加拿大及其省份的 LWT 与收入相关的不平等程度。此外，我们对 RC 和 AC 指数进行分解，以确定影响 LWT 与收入相关的不平等的因素。我们的描述性结果表明，在过去 12 个月中，平均有 5%的加拿大成年人经历过较长的等待时间才能获得医疗服务。不列颠哥伦比亚省和萨斯喀彻温省有 3%的居民报告说，他们需要较长的时间才能获得医疗保健服务，而魁北克省则有 7%的居民需要较长的时间。我们的研究结果还表明，LWT 主要集中在加拿大的贫困人口中[RC=-0.039；95%置信区间（CI）-0.049 至-0.028 和 AC=-0.067；CI-0.086 至-0.049]。RC 和 AC 表明，在新斯科舍省、新不伦瑞克省、魁北克省、马尼托巴省、萨斯喀彻温省和不列颠哥伦比亚省，LWT 存在显著的贫富不均等现象。分解分析表明，除收入本身外，健康状况（由 15 种慢性疾病指标衡量）、移民状况和地理因素是导致加拿大贫困人口 LWT 集中的最重要因素。这些结果表明，与高收入人群相比，加拿大低收入人群接受公共资助的医疗保健服务的等待时间往往更长。收入与较长等待时间之间的负梯度可以解释为加拿大医疗保健系统中存在社会经济不平等的证据。因此，需要进一步研究来了解解释加拿大贫困人口长时间等待时间集中的机制。
