Carleton University's School of Public Policy and Administration, Ottawa, Canada.
Faculty of Law and the Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada.
Can J Public Health. 2019 Aug;110(4):395-403. doi: 10.17269/s41997-019-00204-5. Epub 2019 Apr 15.
While mental health services provided by general practitioners and psychiatrists can be billed to public health insurance programs in Canada, services provided by psychologists, social workers and other non-physician providers cannot. This study assesses the extent to which access to mental health services varies by income after first taking into account the higher concentration of mental health needs at lower income levels.
Data from the Canadian Community Health Survey 2013-2014 are used to calculate need-standardized concentration indices for access to mental health services.
More pro-rich utilization of mental health services provided by non-physicians and more equitable utilization of physician services is found for psychologists and general practitioners, but not for social workers, nurses and psychiatrists. Unmet need for healthcare for mental health problems is found to be more pro-poor than unmet need for physical health problems.
By standardizing for inequitable distribution of mental health need, this study provides strong evidence that income-based inequity in access to mental health services is an issue under Canada's two-tier system, particularly with regard to general practitioners and psychologists. For other types of providers, the results suggest that inequities in service utilization vary not just by Medicare coverage but also by service settings and target populations. Despite these variations, greater inequities in unmet need for mental health care than for physical health care suggest that inequity is the dominant reality for Canadians. The results provide a baseline that could be used to assess the equity impacts of policy reforms.
在加拿大，全科医生和精神科医生提供的心理健康服务可以通过公共医疗保险计划报销，而心理学家、社会工作者和其他非医师提供者提供的服务则不能。本研究评估了在首先考虑到较低收入水平下心理健康需求更为集中的情况下，收入对获得心理健康服务的影响程度。
本研究使用 2013-2014 年加拿大社区健康调查的数据来计算心理健康服务获得情况的需要标准化集中指数。
发现非医师提供的心理健康服务更多地偏向于富裕人群，而医生服务的利用则更为公平，对于心理学家和全科医生而言是如此，但对于社会工作者、护士和精神科医生则不然。对于心理健康问题的医疗保健需求未得到满足的情况比身体心理健康问题更为贫困。
通过对心理健康需求分配不均进行标准化处理，本研究提供了有力证据表明，在加拿大的双层医疗体系下，收入对获得心理健康服务的不公平现象是一个问题，特别是对于全科医生和心理学家而言。对于其他类型的提供者，结果表明服务利用的不公平性不仅取决于医疗保险覆盖范围，还取决于服务设置和目标人群。尽管存在这些差异，但心理健康护理未满足需求的不公平程度大于身体心理健康护理的不公平程度，这表明不公平是加拿大人的主要现实。结果提供了一个基准，可以用来评估政策改革对公平性的影响。
