Completed Projects
EEPC
Evidence for innovations that improve Equity in access to Primary Care: Cross-jurisdictional comparative analysis of longitudinal national survey data, policy review and synthesis
Funding
Summary
Primary care — access to doctors, nurses and other health care providers for general health concerns — forms the backbone of health care systems. Ideally access to primary care should be equitable - this means all people with similar needs for primary care should get similar access, regardless of their social or economic position.
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Over the past 20 years, provinces and territories have made different policy choices with the goal of improving Canadians’ access to primary care. Some research suggests that people experiencing social or economic marginalization may have been less likely to benefit from policy changes. There is data showing that equity in access to primary care has gotten worse in some provinces, but we don’t have information about the whole country. Differences across provinces and territories in whether resources are aligned with peoples’ needs and whether equity is considered in tracking health system goals may help explain where we have and have not seen changes in equity. This project:
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Uses national data from the Canadian Community Health Survey to describe how equity in access to primary care has changed between 2007/08 and 2017/18 within all provinces and territories.
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Reviews and summarizes the policy choices made across provinces, with a focus on characteristics of policies that might shape equity in access to care.
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Brings together information from Objectives 1 and 2 to identify the characteristics of policy changes that are most promising for improving equity in access to primary care.
Strong primary care is very important for health systems that are able to deliver good outcomes, value for money, and positive experiences for patients and clinicians. This project provides information about the characteristics of innovations in primary care delivery most likely to support equity in addition to these goals.
Findings
This analysis identifies disparities in access to primary care by income, educational attainment, dwelling ownership, recent immigration, racialization, and sex/gender. These disparities are persistent over time or increasing, in the case of income and racialization. ​Findings suggest that approaches to primary care transformation that do not explicitly consider equity may continue to entrench inequities.
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The absence of measurable goals, meaningful community consultation, and clear connections between a policy response to acknowledged inequities may help explain persistent inequities in primary care across Canada.
Health leaders are encouraged to design primary care transformation efforts with equity as a priority area of focus, considering the following key implications of this research:
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Include equity as an integral objective in primary care reform.
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Support models of team-based care with equity mandates and accountability to communities, such as community health centres.
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Ensure patterns of funding and resource allocation are tailored to needs and responsive as needs change.
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Ensure equity mandates are reflected in accountability and performance frameworks.
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Careful monitoring of the equity impacts of ongoing policy reforms is needed.
Team Members
Nominated Principal Investigator
Ruth Lavergne
Co-Principal Investigators
Erin Christian
Co-Investigators & Collaborators
Alan Katz, David Rudoler, Emily Marshall, George Kephart, Lindsay Hedden, Mohammad Hajizadeh, Myles Leslie, Sara Allin
Research Staff
Aidan Bodner, Sarah Spencer, Tai Hollingbery
Contact
Outputs
Papers
Research Articles
Lavergne MR, Bodner A, Allin S, Christian E, Hajizadeh M, Hedden L, Katz A, Kephart G, Leslie M, Rudoler D, Spencer S. (2023). Disparities in access to primary care are growing wider in Canada. Healthcare Management Forum, 36(5): 272–279.
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Spencer S, Hollingbery T, Bodner A, Hedden L, Rudoler D, Christian E, Lavergne MR. (2024). Evaluating engagement with equity in Canadian provincial and territorial primary care policies: Results of a jurisdictional scan. Health Policy, 140: 104994.