title: Beyond access: who reports that health care is not being received when needed in a publicly-funded health care system?
abstract: OBJECTIVE
  To examine the relationship between reporting that health care was not received when needed in Canada's publicly-funded health care system and contact with the health care system, and to explore whether there is a differential impact of specific chronic conditions.
  
  
  METHODS
  Analyses were carried out on the 2000/2001 Canadian Community Health Survey. The proportion of survey respondents who reported that they had not received health care when it was needed was determined overall, and for individuals with selected socio-demographic, health status, and health care utilization characteristics, as well as stratified by various chronic conditions. Multivariate logistic regression was then employed to examine possible predictors of having reported that health care was not received when it was needed during the previous year.
  
  
  RESULTS
  Approximately 13% of Canadians reported that health care was not received when they felt it was needed during the previous year. These individuals reported higher rates of health care utilization, worse health status, were more likely to have chronic health conditions (particularly conditions such as fibromyalgia, Crohn's disease, and chronic bronchitis for which there is no effective treatment), and were more likely to be female, younger, white, have higher education and lower income.
  
  
  CONCLUSIONS
  Reporting that health care was not received when it was needed may not be related to accessibility but rather to a perceived failure of the system to meet the individual's needs.
authors.affiliation: Arthritis Community Research and Evaluation Unit, Department of Outcomes and Population Health, Toronto Western Hospital Research Institute and the University Health Network, Ontario.
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Kasman
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards / Q000706:statistics & numerical data*; D020380:Needs Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors