Some family physicians' offices discriminate against people of low socio-economic status, even when there is no economic incentive to do so under Canada's system of publicly funded universal health insurance, new research has shown.
At the same time, offices appear to give preference to people with chronic health conditions, according to the research led by Dr. Stephen Hwang of St. Michael's Hospital.
In his study, published today in the Canadian Medical Association Journal, researchers telephoned the offices of family physicians and general practitioners offices in Toronto playing the role of an individual seeking a primary care physician. They followed a script that indicated they had high socio-economic status (a bank employee transferred to the city) or low socio-economic status (welfare recipient) and the presence or absence of chronic health conditions (diabetes and low back pain).
The proportion of calls resulting in an offer of an appointment was significantly higher for people with high socio-economic status (22.6 per cent) than people with low socio-economic status (14.3 per cent). If an offer of a screening visit with the physician or a spot on a waiting list is also counted, the difference is 37 per cent for people with high status with 24 per cent for those with low status.
An individual with chronic health issues was significantly more likely to get an appointments than someone without - 23.5 per cent compared to 12.8 per cent.
"Even in a system where doctors receive the same payment for every patient, regardless of the patient's income or occupation, we see evidence that some offices discriminate against people of low socio-economic status," said Dr. Hwang, a general internal medicine physician at the hospital and a researcher in its Centre for Research on Inner City Health. "This impairs access to primary care, and we don't think this is acceptable."