Even in Canada, wealth affects medical treatment access: study


Poorer people have a harder time getting a doctor’s appointment in Canada, even though the country’s universal health insurance pays doctors the same amount regardless of the type of patient they see, according to a Canadian study. Researchers who called primary care practices and pretended to be a bank employee were 80 percent more likely to be offered an appointment than when they called pretending to be on welfare. “We expected that we would find the result that we did, which was that there would be preferential treatment,” said Stephen Hwang, who worked on the study at St. Michael’s Hospital and the University of Toronto. “As a physician who provides care for people who are marginalized or disadvantaged, they not infrequently tell me that they feel like they’ve been treated poorly by health care providers in the past simply because they’re poor,” he told Reuters Health.

Hwang, whose team published their findings in the Canadian Medical Association Journal, expects the disparity to be due more to doctors’ and receptionists’ unconscious biases than an explicit policy to pick wealthier patients. Members of his team called 375 family physicians and general practitioners in Toronto pretending to be looking for a primary care doctor. Half of the time the caller pretended to be a bank employee recently transferred to the city, and for the other half of the calls, the caller took on the persona of a welfare recipient. Researchers impersonating the bank employee were offered an appointment almost 23 percent of the time. In the other cases, a receptionist put the caller on a waitlist or said the doctor wasn’t taking new patients. In comparison, callers pretending to be on welfare were offered an appointment at just 14 percent of offices. Receptionists were more likely to offer an appointment to a caller posing as someone with diabetes or low back pain than one without a chronic condition. That, at least, suggests patients who need care the most are being “appropriately prioritized,” Hwang and his colleagues wrote. Past studies suggest patient discrimination based on income is an even bigger problem in the United States, where doctors tend to be reimbursed more for treating a person with private insurance than one on Medicare or Medicaid. “When people have no health insurance or if they have health insurance that pays less than more general coverage does, they’re much more likely to get turned away by physicians,” Hwang said. “But that’s hardly surprising.” “The fact that they found the results they did in a universal health insurance population is particularly interesting,” said Karin Rhodes, who has studied access to care at the Perelman School of Medicine, University of Pennsylvania, but wasn’t involved in the research. “Everything I’ve seen has been economically driven,” she told Reuters Health, referring to the U.S. system where doctors’ reimbursements would be affected by which patients they saw. Rhodes added that the next step should be research to identify the reasons behind the research findings, though Hwang said it may just be human nature or unconscious bias that health care workers need to guard against. “In the realm of health care, I feel strongly that we should be providing care on the basis of people’s need and not their wallet,” he said.