Access to health care services along the rural-urban continuum in Canada: The role of place of residence

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Résumé (anglais)

Statement of the problem . It is unknown if observed variations of access to health care in Canada are equitably distributed along the rural-urban continuum. The overarching goal of this research is to assess the determinants of health care services utilization along the rural-urban continuum, particularly any independent effect of place of residence. Methods . This is a cross-sectional study of the population of Canada using data from the 2003 Canadian Community Health Survey. The population was divided in to five cohorts based on the level of rurality of their community. Using multilevel logistic regression models the cohorts were compared in terms of their utilization of health care services, self-reported unmet need, and having a regular medical doctor and to identify what proportion of the variation is associated with place of residence. Results . Little difference was found in utilization of services with the exception of residents of the most rural communities being less likely to have had an influenza vaccination and residents of major urban centers being more likely to report consulting a specialist physician. Residents of rural communities were less likely to report having unmet needs, and residents of the most urban and most rural communities were least likely to have a regular medical doctor. The results of this study show that place of residence definitely has an effect independent of other determinants of access and of rural-urban status. In general the health region of residence contributes little to the observed variation in each outcome. There is a great deal of variation by province, particularly in influenza vaccination rates and physician utilization. The municipality of residence is attributed with some level of variation in each of the outcomes, most marked being having a regular medical doctor. Conclusions . These results are encouraging as they suggest that observed variations in utilization are equitably distributed. However some inequity was observed, the greatest degree of inequity is in utilization of specialist physician services. Further research is needed to assess what factors are associated with having a regular medical doctor. The observed differences in self-reported unmet need present interesting questions about expectations.