Socioeconomic status and the utilization of diagnostic imaging in an urban setting
By Sandor Demeter, Martin Reed, Lisa Lix, Leonard MacWilliam and William D. Leslie
CMAJ
November 8, 2005
The pillars of the Canada Health Act are that health care should be comprehensive, universal, accessible and publicly administered and that coverage should be portable between provinces. Acknowledging that health care is under provincial jurisdiction, the federal government provides provinces with financial incentives to realize these goals. As such, income level should have no effect on utilization of insured medical services.
We examined over 300,000 diagnostic imaging claims (general radiology, vascular, computed tomography, magnetic resonance, and general and obstetric
ultrasound) made in the Winnipeg Regional Health Authority between Apr. 1, 2001, and Mar. 31, 2002. Using patient postal codes, we assigned socioeconomic status (SES) on the basis of average household incomes in Canada’s 1996 census.
Interpretation: We found a pattern of increased diagnostic imaging utilization in patient groups with a higher SES.
http://www.cmaj.ca/cgi/content/full/173/10/1173
Comment: This study demonstrates that an equitable system of universal health insurance alone will not ensure equitable access to health care services. Obviously, other factors not addressed in this study also play some role.
Opponents of reform will use this study to further condemn the Canadian single payer system as being incapable of providing equitable access to care. They will then renew their call for private insurance options as the solution, in spite of the fact that there is a disconnect in logic.
Canadians need only to look south of their border to see the profound inequities in access that are created by a fragmented private and public system of funding health care.
Much will need to be done in the United States to reduce the barriers to health care caused by socioeconomic status. A crucial first step would be to eliminate financial barriers by enacting universal, comprehensive national health insurance.