Elsevier

Health & Place

Volume 12, Issue 2, June 2006, Pages 121-130
Health & Place

‘Reasonable access’ to primary care: assessing the role of individual and system characteristics

https://doi.org/10.1016/j.healthplace.2004.10.010Get rights and content

Abstract

Access to health care continues to be an important issue for health policy makers, researchers, service providers and consumers alike. In countries with universal health care coverage, services are generally free at the point of delivery which is intended to provide equitable access to care for all residents regardless of their individual situations. Past studies have pointed to the importance of individual characteristics such as age, gender, and socioeconomic status in shaping access to health care but much less is known about the role of health system characteristics. The purpose of this study is to explore, by means of qualitative research methods, the extent to which individual and system factors shape access to primary health care services for residents living in two contrasting neighbourhoods in Hamilton, Ont., Canada. Semi-structured, in-depth interviews were conducted with 40 men and women. The interviews probed participants about their experiences with primary care, barriers to receiving care and their general perceptions of the health care system. The interviews demonstrated the existence of many system-related barriers to receiving health care (e.g., wait times, geographic inaccessibility and quality of care) and some individual-related barriers (e.g., work or family responsibilities). While the findings revealed little difference between the neighbourhoods in terms of accessibility problems and barriers, differences between men and women were evident.

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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