‘Reasonable access’ to primary care: assessing the role of individual and system characteristics
Section snippets
Introduction and background
Health debates in Canada have been typically contextualized within a population health perspective that recognizes the role of a broad range of determinants, beyond the health care system, that shape health (Hertzman et al., 1994). The population health perspective has been reviewed extensively elsewhere (Hayes and Dunn, 1998) and has become a persuasive and pervasive health policy framework (Eyles et al., 2001). In fact, Health Canada now identifies 12 determinants of population health. Thus,
Methods
Residents living in two contrasting neighbourhoods in Hamilton, Ont., were chosen for the study. The selection of the neighbourhoods was based on the preliminary findings of a larger health survey designed to examine determinants of health at the neighbourhood level (see Luginaah et al., 2001). The goal for the health survey was to select neighbourhoods with a range of characteristics representing various combinations of economic wealth and social diversity. Four such neighbourhoods were
Results
Almost all participants in the study reported having a regular family doctor and during the interview they were asked about their experiences in seeking care from their doctor. Of the 41 participants interviewed, 32 mentioned either system or individual barriers in trying to access care through their family doctors. System barriers were overwhelmingly the most mentioned problem. In fact, they were mentioned more than twice as often as individual barriers. There were also more women than men who
Discussion and conclusions
The purpose of this research was to explore individuals’ experiences in accessing primary health care to provide some commentary on whether ‘reasonable access’ exists in Hamilton, Ontario. The results indicate that system-related factors are the most prominent barriers to accessing primary care. In particular, waiting times were the most highly mentioned barrier followed by the geographic location of doctors’ offices relative to respondents’ residences. In terms of individual barriers,
Acknowledgements
This paper gratefully acknowledges the Social Sciences and Humanities Research Council of Canada for funding under its Society, Culture and the Health of Canadians strategic area and other members of the research team. We would like to thank Graham Moon for his insight and assistance and are grateful for comments and suggestions provided by anonymous reviewers.
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