Canada’s twotier health care
The doctor shortage is slowly improving across Ontario, but that is small comfort to the many people still struggling to find one. A new study indicating that some doctors choose patients in a way that favours those with higher incomes is certain to increase the frustration levels of many of those doctorless patients. And it should.
The study, which appeared in the Canadian Medical Association Journal, found that wealthier patients were 50 per cent more likely to get taken on as a new patient by doctors than welfare recipients — or at least researchers posing as them. Its author, Dr. Stephen Hwang, notes that since the research involved talking to receptionists or assistants it is not clear whether they were responding to their own biases or instructions from physicians, but it still represents a barrier because potential patients must go through staff to see a doctor.
The College of Physicians and Surgeons of Ontario passed a policy in 2008 forbidding patient screening. It has told physicians that they must take new patients on a first-come, first-served basis, except in exceptional circumstances. Physicians, for example, can refuse patients if their medical needs are beyond their clinical competence or scope of practice. Physicians can also, according to the College, prioritize patients on the basis of need, something Hwang’s study suggests is happening. Those posing as patients with chronic health conditions as part of the study were more likely to receive an appointment than those without.
It is worrisome, however, to find an apparent bias against poor patients within the system. Not only do they have fewer resources than wealthier patients but they also face other barriers to good health and are likely to benefit the most from access to a physician.
It’s no secret that there isn’t really equality of access in the Canadian medical system, as those with better educations and better connections can more effectively navigate their way to prompt treatment (if anyone can). But there’s no reason for physicians to exacerbate this by letting biases, even subconscious ones, creep into decisions about accepting patients.
The growth of community health centres in Ontario, which combine primary health care with community health promotion and other services, might ward against income bias because patients there are assigned a primary caregiver and do not apply to specific physicians.
But the real issue is the ongoing doctor shortage in Ontario and across the country, which creates a necessity to ration care. Until that becomes a thing of the past — and that will not be for the foreseeable future — all Canadians must have the best assurance possible that they’ll have a chance to find a doctor when they need one.