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Inhalt:
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Countries with highly decentralized health systems such as Canada, the United States, and Spain, where the 'regions' hold the large share of responsibility for health care funding, provision and administration, face a trade off between decentralized policy making with regional inequalities. This study addresses one policy area in the Canadian context, equity in health care use, where differences in the formulation and implementation of policy may give rise to regional variations. Canada is a federal dominion of ten provinces and three territories. By 1972 all provinces and territories provided universal public insurance for hospital and physician care. Responsibility for the administration and delivery of most public health care services is held by the provinces in Canada. There is some variation across the country in health care financing, resource allocation and payment mechanisms, benefits, and supply of health services. This study quantifies the extent of provincial variation in health care use by income and determines its impact on equity. Income-related inequity in use of any physician, GP, specialist, inpatient and dental care is measured using the indirect standardization approach to calculating concentration indices. The needs-predicted level of health care use is compared with the observed distribution of health care use by income to generate an index of horizontal inequity (HI) that falls between -1 and 1 (negative values indicate a distribution of health care favouring lower income groups after standardizing for need, and vice versa). Results reveal some variation across provinces in inequity; however, national trends reveal pro-rich inequity in the probability of a GP, specialist, and dentist visit, and either no significant evidence of inequity or pro-poor inequity in inpatient care. When total number of visits are examined, the pro-rich inequity in GP disappears in all provinces, while specialist and dentist care remain pro-rich. A small island province - Prince Edward Island - comes out with relatively low levels of inequity, while two other Maritime provinces that are more remote and sparsely populated- Newfoundland and New Brunswick, appear to have greater inequity favouring the better off. Some of the variation across provinces may relate to differences in access barriers related to geography and complementary insurance coverage. While inequity differences are observed across the provinces, national trends suggest that despite being 'provincial' health systems, they are more similar than different |
