title: Does socioeconomic status affect lengthy wait time in Canada? Evidence from Canadian Community Health Surveys.
abstract: Reasonable access to health services without financial or other barriers is a primary objective of the Canadian health system. Notwithstanding such concern about accessibility of services, long waiting times for health services have been a prominent health policy issue in recent years. Using pooled data from four nationally representative Canadian Community Health Surveys (CCHSs, 2000/01, 2003, 2005 and 2010; n = 266,962) we examine socioeconomic inequality in lengthy wait time (LWT) to health care among adults (aged 18-65) in Canada. The relative and absolute concentration indices (RC and AC, respectively) are used to quantify income-related inequality in LWT in Canada and for its provinces. Additionally, we decompose the RC and AC indices to identify factors affecting income-related inequality in LWT. Our descriptive results show that, on average, 5% of Canadian adults experienced LWT to access health services in the past 12 months. While 3% of the residents of British Columbia and Saskatchewan reported LWT to access health care services, this figure was 7% in Quebec. Our findings also demonstrated that LWT was mainly concentrated among the poor in Canada [RC = -0.039; 95% confidence interval (CI) -0.049 to -0.028 and AC = -0.067; CI -0.086 to -0.049]. The RC and AC suggested statistically significant pro-rich inequality of LWT in Nova Scotia, New Brunswick, Quebec, Manitoba, Saskatchewan and British Columbia. Decomposition analyses indicate that, besides income itself, health status (measured by a set of 15 chronic condition indicators), immigration status and geographical factors were the most important factors contributing to the concentration of LWT among the poor in Canada. These results provide some evidence that low-income individuals tend to have lengthier wait times for publicly-funded health care in Canada in comparison to their high-income counterparts. The observed negative gradient between income and long waiting time may be interpreted as evidence of socioeconomic inequity within Canadian health care system. Thus, further work is required to understand the mechanisms explaining the concentration of long wait time among the poor in Canada.
authors.affiliation: School of Health Administration, Faculty of Health Professions, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, Canada. m.hajizadeh@dal.ca.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hajizadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012923:Social Class; D012959:Socioeconomic Factors; D014850:Waiting Lists; D055815:Young Adult
keywords: Absolute and relative inequalities; Canada; Decomposition; Socioeconomic status; Wait time