Does Equity in Healthcare Use Vary across Canadian Provinces?

For over 30 years, Canadian provinces have provided universal public insurance for hospital and physician care; however, evidence points to persisting socio-economic inequity in healthcare use. Because provinces hold the responsibility for planning and funding most publicly insured health services, there is some variation in health system characteristics. In the context of such variation, this study systematically investigated equity in healthcare use across the provinces. Drawing on the 2003 Canadian Community Health Survey, the author applied the indirect standardization approach to create an index of needs-adjusted inequity in the probability, total and conditional number of GP, specialist, hospital and dentist visits. Results reveal some variation in inequity across provinces; however, national trends show pro-rich inequity in the probability of a GP, specialist and dentist visit, and no significant evidence of inequity in inpatient care. Aside from income, the main socio-economic factors associated with inequity are education, complementary insurance for prescription drugs and dental care and, in some cases, region of residence. When total (and conditional) number of visits are examined, the pro-rich inequity in GP care disappears in all provinces. Differences in the extent of and contributors to inequity that are observed across the provinces suggest a need for more in-depth provincial policy analyses.