title: Access granted! barriers endure: determinants of difficulties accessing specialist care when required in Ontario, Canada.
abstract: BACKGROUND
  In the Canadian context, health care services are governed by the Canada Health Act, which ensures that primary care doctors, specialists, hospitals and dental surgeries are covered through provincial health insurance plans. This ensures access to medically necessary health care services for all Canadians regardless of ability to pay. Despite this important piece of legislation, research has shown persistent inequalities in access between and within socio-demographic groups, and geographic areas. To date, most research has focused on access to primary care, with much less attention paid to specialist care as an important component of the health care continuum. Thus, the objectives of this research are to address this gap in knowledge by examining the factors associated with difficulty accessing specialist services, and the reasons why particular subpopulation groups report experiencing difficulties.
  
  
  METHODS
  This research uses multivariate logistic regression to analyze data from the Canadian Community Health Surveys' optional content from the province of Ontario (n=21,526) related to accessing specialist health care services. The multivariate logistic regression model identifies several subpopulation groups that are more likely to report difficulty accessing specialist care when required. Cross-tabulations are subsequently used to establish the main reasons why difficulties are faced.
  
  
  RESULTS
  Over 26% of respondents required a specialist visit in the 12 months preceding administration of the survey. Of these, 22% reported difficulty accessing specialist care. Those with difficulties were more likely to be immigrants, post-secondary educated, and have one or more chronic conditions. People living in urban health regions were also more likely to report difficulties accessing care. Primarily wait times were cited as reasons for these difficulties, followed by a perceived lack of availability.
  
  
  CONCLUSIONS
  There are difficulties faced by the general population as a whole (e.g., wait times) as well as particular difficulties experienced more frequently by certain groups (e.g., transportation, language, and cost barriers for newcomers). These issues are important, as they may discourage individuals from using necessary health care services, and may contribute to feelings of dissatisfaction with the health care system.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Harrington
authors.forename: Kathi
authors.initials: K
authors.lastname: Wilson
authors.forename: Mark
authors.initials: M
authors.lastname: Rosenberg
authors.forename: Scott
authors.initials: S
authors.lastname: Bell
mesh_terms: D000328:Adult; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D014850:Waiting Lists