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Equity in health care: a Study of health services in a northern regional district of British Columbia

University of British Columbia

The provision of health care and preventive services that has evolved in Canada was based on the concept of equality. Within any one province all but a few selected groups pay equal prepaid insurance premiums or tax and are given the same benefit; payment of the provider for services rendered. The concept of Distributive Justice suggests that those with special needs should receive special services but selective provision of care or services may give rise to feelings of Relative Deprivation in non-recipients. For a health service to be equitable and perceived as "fair" there must be maximal distributive justice and minimal relative deprivation. During a research project in the Kitimat-Stikine Regional District during the summer of 19 75, it was found that northern British Columbians viewed their health services as unfair. They believed they subsidized the care and services used by southern British Columbia residents. This study investigates the factors in the health service system which affect the utilization and provision of health services and compares the utilization of hospital services of the Kitimat-Stikine Regional District with three other regional districts; Cowichan Valley, North Okanagan and East Kootenay and with British Columbia as a whole province. The comparative regional districts were chosen on the basis of demography, lifestyle, industrial, ethnic and geographic similarities and differences. Statistical tools used were Frequency Distribution, Simple and Multiple Regression. Determinants of access to care are discussed; the perception of illness, convenience costs, financial costs, availability of manpower, programmes and facilities, social and geographic isolation. An examination is made of the distribution of power in the health system and the use that is made of it by political decision makers, government administrators and planners, professional organizations, educators and pressure groups. The health services in the Kitimat-Stikine Regional District are described with emphasis given to missing programmes. The regional district has a high facilities-population ratio and a low manpower-population ratio. The expectations of the residents of northern British Columbia for provision of health care are presented, noting a concentration of expectation on access to acute health care. The planner's expectations, arising from elements in the health system are delineated. Manpower, facility and hospital utilization data were obtained for the four regional districts and the province. The hospital utilization data, separations by disease of residents from hospitals within and without their domiciliary regional district are subjected to statistical testing to determine whether access to care is reduced in the remote regional districts. The data are adjusted for the age and sex composition of the populations of each region-.and the province. There is no indication from the examination of hospital utilization data that the barriers to access to care that exist are effective in reducing the access gained. In each of the four regional districts, the numbers of separations are higher than expected based on the age and sex composition of the populations. A breakdown of the data on the 186 diseases into disease grouping indicates that hospital utilization is significantly high in some regions for particular groups of diseases. The results indicate a need to examine lifestyle and environmental factors in the four regional districts that may be influencing hospital use for these diseases. There are implications for policy formulation and for health planning activities. There is a need for regional districts to broaden their area of concern to include health services other than hospitals, to control environmental health hazards of industries, agencies and homes within their boundaries and to educate the residents about their personal responsibility for their health status, the special needs of some groups of people, the services required to meet those needs and why some services cannot be offered locally but require referral outside the regional district. The health system which has developed, based on the concept of equality does not provide northerners with a perception of equity or fairness. There is a need to obtain innovative services to meet special needs and to ensure the people excluded from the extra benefit are aware of the special needs of those for whom it is provided. Services which provide a high degree of distributive justice and minimize relative deprivation would result in an equitable and unequal service that could be perceived as fair by all.

Text

2010-02-25

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http://hdl.handle.net/2429/20896

Health Care and Epidemiology

University of British Columbia

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