Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T08:12:22.075Z Has data issue: false hasContentIssue false
  • English
  • Français

Does Geography Matter? The Health Service Use and Unmet Health Care Needs of Older Canadians*

Published online by Cambridge University Press:  04 March 2010

James Ted McDonald  and
Heather Conde
James Ted McDonald*
Affiliation:
University of New Brunswick
Heather Conde
Affiliation:
University of New Brunswick
*
†Correspondence concerning this article should be addressed to / La correspondance concernant cet article doit être adressées à: James Ted McDonald, Department of Economics, University of New Brunswick, PO Box 4400 Fredericton, New Brunswick, Canada E3B 5A3 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

The rising cost of health care and changing demographic profiles have resulted in the relocation and redistribution of funding and services between rural and urban areas. Most econometric analyses of Canada’s health service use include broad controls by province and rural/urban status, but relatively little econometric work has focused on geographical variation in health service use. Using the Canadian Community Health Survey 2.1, we examined determinants of various measures of health services use by Canadians aged 55 or older across a range of urban and rural areas of residence. Our regression analysis showed that older residents in rural areas made fewer visits to a general practitioner, to a specialist, and to a dentist relative to urban residents. All else being equal, there are no significant differences in hospital nights or in unmet healthcare needs. These differences are significant after controlling for demographic characteristics, socioeconomic status, private health insurance, and health status.

Résumé

Le coût croissant de soins de santé et le changement des profils démographiques ont entraîné le déplacement et la redistribution du financement et des services entre les zones rurales et urbaines. La plupart des analyses économétriques de l’utilisation de services de santé au Canada incluent des contrôles larges selon la province et l’état rural/urbain; mais relativement peu du travail économétrique a porté sur la variation géographique dans l’utilisation de services de santé. À l’aide de l’Enquête sur la santé dans les collectivités canadiennes (ESCC 2.1), nous avons examiné les déterminants de diverses mesures d’utilisation des services de santé par les Canadiens âgés de 55 ou plus d’une gamme de zones urbaines et rurales de résidence. Notre analyse de régression a montré que les anciens résidents dans les zones rurales font moins visites chez un omnipraticien, chez un spécialiste et chez un dentiste par rapport aux résidents urbains. Tout étant égal, il n’existe aucune différence significative parmi nuits passées à l’hôpital ou dans les besoins de soins de santé non satisfaits. Cependant, apres contrôle pour les caractéristiques démographiques, le statut socioéconomique, l’assurance santé privée et l’état de santé, ces différences sont importantes.

Keywords

utilisation de services de santédifférences rurales/urbainesles personnes agéesbesoins de soins de santé non satisfaitshealth service userural/urban differencesolder and aged individualsunmet health care needs
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 29 , Issue 1: Special Issue from the Social and Economic Dimensions of an Aging Population Project (SEDAP) – Caring for an Aging Population: Context, Practice & Policy , March 2010 , pp. 23 - 37
Copyright
Copyright © Canadian Association on Gerontology 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The authors thank Brian Ferguson, Logan McLeod, Carolyn Rosenthal, and Byron Spencer for helpful comments. Conde acknowledges financial support from a Social Sciences and Humanities Research Council master’s fellowship. McDonald acknowledges financial support from SSHRC through the Social and Economic Dimensions of an Aging Population (SEDAP) program at McMaster University. Analysis of confidential Canadian data was conducted at the Canadian Research Institute for Social Policy – University of New Brunswick (CRISP-UNB) Research Data Centre in Fredericton.

References

Allan, D., & Cloutier-Fisher, D. (2006). Health service utilization among older adults in British Columbia: Making sense of geography. Canadian Journal on Aging, 25(2), 219–232.CrossRefGoogle ScholarPubMed
Andersen, R. (1968). A behavioral model of families’ use of health services. Research Series No. 25. Chicago: Center for Health Administration Studies, University of Chicago.Google Scholar
Andersen, R. (1995). Revisiting the behavioural model and access to medical care: Does it matter? Journal of Health and Social Behaviour, 36, 1–10.CrossRefGoogle ScholarPubMed
Andersen, R., & Newman, J. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 51(1), 95–124.CrossRefGoogle ScholarPubMed
Beaujot, R., & Niu, J. (2005). Aggregate level community characteristics and health. Ottawa: Population Studies Centre Discussion Paper 05-14. University of Ottawa.Google Scholar
Boyle, M., & Willms, D. (1999). Place effects for areas defined by administrative boundaries. American Journal of Epidemiology, 149(6), 577–585.Google Scholar
Buckley, N., Denton, F., Robb, C., & Spencer, B. (2004). The transition from good to poor health: An econometric study of the older population. Journal of Health Economics, 23(5), 1013–1034.CrossRefGoogle ScholarPubMed
Buckley, N., Denton, F., Robb, C., & Spencer, B. (2006). Socio-economic influences on the health of older Canadians. Canadian Public Policy, 32(1), 59–81.CrossRefGoogle Scholar
Case, A., Fertig, A., & Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics, 24(2), 365–389.CrossRefGoogle ScholarPubMed
Chen, J., Hou, F., Sanmartin, C., Houle, C., Tremblay, S., & Berthelot, J. (2002). Unmet health care needs. Canadian Social Trends, 11–008 18–22.Google Scholar
Cloutier-Fisher, D., & Joseph, A. (2000). Long-term care restructuring in rural Ontario: Retrieving community service user and provider narratives. Social Science and Medicine, 50(7-8), 1037–1045.Google Scholar
Dansky, K., Brannon, D., Shea, D., Vasey, J., & Dirani, R. (1998). Profiles of hospital, physician, and home health care service use by older persons in rural areas. The Gerontologist, 38(3), 320–330.CrossRefGoogle ScholarPubMed
Deri, C. (2005). Social networks and health service utilization. Journal of Health Economics, 24(6), 1076–1107.CrossRefGoogle ScholarPubMed
Escarce, J., Shea, J., & Chen, W. (1997). Segmentation of hospital markets: where do HMO enrollees get care? Health Affairs, 16(6), 181–192.CrossRefGoogle ScholarPubMed
Fakhoury, W., & Roos, L. (1996). Access to and use of physician resources by the rural and urban populations in Manitoba. Canadian Journal of Public Health, 87(4), 248–252.Google Scholar
Fuchs, V. (2004). Reflections on the socio-economic correlates of health. Journal of Health Economics, 23(4), 653–661.Google Scholar
Hurd, M., & McGarry, K. (1997). Medical insurance and the use of health care services by the elderly. Journal of Health Economics, 16(2), 129–154.CrossRefGoogle ScholarPubMed
Jennissen, T. (1992). Health issues in rural Canada. Ottawa: Political and Social Affairs Division BP-325E, Government of Canada.Google Scholar
Lassey, M., Lassey, W., & Jinks, M. (1997). Healthcare systems around the world: characteristics, issues, reforms. Upper Saddle River, NJ: Prentice Hall.Google Scholar
Laurent, S., (2002). Rural Canada: Access to health care. Ottawa: Parliamentary Research Branch Occasional Paper. Government of Canada. Retrieved from http://dsp-psd.pwgsc.gc.caGoogle Scholar
Liu, L., Hader, J., Broussart, B., White, R., & Lewis, S. (2001). Impact of rural hospital closures in Saskatchewan, Canada. Social Science and Medicine, 52(12), 1793–1804.CrossRefGoogle ScholarPubMed
Martin-Matthews, A. (2002). Seniors’ health. Sharing the learning: The health transition fund. Ottawa: Synthesis series, Health Canada.Google Scholar
McLean, G., Guthrie, B., & Sutton, M. (2007). Differences in the quality of primary medical care services by remoteness from urban settlements. Quality and Safety in Health Care, 16(6), 446–449.CrossRefGoogle ScholarPubMed
Mitura, C., & Bollman, R. (2003). The health of rural Canadians: A rural-urban comparison of health indicators (Catalogue No. 21-006-XIE). Rural and Small Town Canada Analysis Bulletin, 4(6). 1–23.Google Scholar
Nagarajan, K., (2004). Rural and remote community health care in Canada: Beyond the Kirby Panel Report, the Romanow Report and the federal budget of 2003. Canadian Journal of Rural Medicine, 9(4), 245–251.Google Scholar
Nelson, C., & Park, J. (2006). The nature and correlates of unmet health care needs in Ontario, Canada. Social Science and Medicine, 62(9), 2291–2300.Google Scholar
Newbold, B., Eyles, J., & Birch, S. (1995). Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada. Social Science and Medicine, 40(9), 1181–1192.Google Scholar
Omariba, D., & Rasugu, W. (2006). Neighbourhood characteristics, individual and household attributes and health perception among elderly Canadians. Ottawa: Population Studies Centre Discussion Paper 06-01, University of Ottawa.Google Scholar
Peckins, C. (2006). Annual doctor visits: Many benefits. Cambridge, MA: Mount Auburn Hospital Review, Winter Edition, Mount Auburn Hospital, 1–3.Google Scholar
Peterson, S., Shapiro, E., & Roos, N. (2005). Regional variation in home care use in Manitoba. Canadian Journal on Aging, 24(Suppl. 1), 69–80.Google Scholar
Propper, C., Damiani, M., Leckie, G., & Dixon, J. (2007). Impact of patients’ socioeconomic status on the distance travelled for hospital admission in the English National Health Service. Journal of Health Services Research & Policy, 12, 153–159.CrossRefGoogle ScholarPubMed
Richard, L., Gauvin, L., Ducharme, F., Gosselin, C., Sapinski, J.P., & Trudel, M. (2005). Health promotion and disease prevention for older adults: Intervention themes and strategies used in Quebec local community health centres and seniors’ day centres. Canadian Journal of Public Health, 96(6), 467–470.CrossRefGoogle ScholarPubMed
Romanow, R. (2001). Building our values: The future of health care in Canada. Ottawa: Commission on the Future of Health Care in Canada, Government of Canada.Google Scholar
Rosenberg, M., & James, A. (2000). Medical services utilization patterns by seniors. Canadian Journal on Aging, 19(Suppl. 1), 125–142.CrossRefGoogle Scholar
Rosenberg, M., & Wilson, K. (2000). Gender, poverty and location: How much difference do they make in the geography of health inequalities. Social Science and Medicine, 51(2), 275–587.CrossRefGoogle ScholarPubMed
Shields, M., & Tremblay, S. (2002). The health of Canada’s communities. Supplement to Health Reports, 13, 1–24.Google Scholar
Statistics Canada. (2006). Geographic units. Ottawa: Statistics Canada. Retrieved August 20, 2006, from http://www12.statcan.ca/english/census01/products/reference/dict/geo049.htmlGoogle Scholar
Tremblay, S., Ross, N., & Berthelot, J.-M. (2002). Regional socio-economic context and health. Ottawa: Supplement to Health Reports 13, Statistics Canada, Catalogue 82-003.Google Scholar
Van Houtven, C., & Norton, E. (2004). Informal care and health care use of older adults. Journal of Health Economics, 23(6), 1159–1180.Google Scholar
Wilson, K., & Rosenberg, M. (2004). Accessibility and the Canadian health care system: Squaring perceptions and realities. Health Policy, 67(2), 137–148.Google Scholar
Wolinsky, F. (1994). Health services utilization among older adults: Conceptual, measurement and modeling issues in secondary analysis. The Gerontologist, 34(4), 470–475.Google Scholar
Wolinsky, F., & Johnson, R. (1991). The use of health services by older adults. Journal of Gerontology: Social Sciences, 46(6), S345–S357.Google Scholar