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UBC Theses and Dissertations

Access to primary health care : a case study of regional disparities in health manpower distribution in British Columbia Auyeung, Lankwai


Pre-paid medical and hospital insurance in Canada has enabled many people to obtain medical services that they could not previously afford, but equal access to health care is not yet ensured for all segments of the population. . It has been suggested that health care resources, particularly manpower, tend to concentrate in urban centres, while rural and remote areas have inadequate resources. In testing the relationship between rurality and accessibility to primary health care, this thesis aims at enriching the knowledge base for mitigation decisions. Seven groups of primary health care personnel were examined: general practitioners, pharmacists, dentists, general surgeons, pediatricians, obstetricians and psychiatrists Nine study regions were ranked by rurality and accessibility. Rurality was measured by (1) proportion of rural population residing in the study region, and (2) distance of the study region to the nearest metropolitan centre. Accessibility was measured by (1) travel distance to the nearest health care personnel, and (2) the ratio of health care personnel to the regional population. Rurality was then correlated with accessibility. Rurality was also correlated with waiting time for an appointment with a general practitioner, and statistical tests for significant difference were performed to determine if waiting time varies with community size. The relationship between practice locations of general practitioners and their personal attributes was tested (1) by correlating rurality with place and year of graduation, and (2) by testing for significant difference in place and mean year of graduation among different community size groups. Significant difference tests were also performed to test the effect of the federal policy restricting physician immigration on the proportion of foreign physicians in rural areas. The result of the accessibility test supports the hypothesis that accessibility diminishes with rurality. It also suggests that serious maldistributions occur in primary care sub-specialty personnel, namely pediatricians, obstetricians and psychiatrists, and that there are intra-regional disparities as well as inter-regional disparities. General practitioners are the least inequitably distributed. The findings reveal that population dispersion and small settlements are the primary obstacles to achieving equal access. Results of the waiting time tests were inconclusive. There is no evidence to support a linear relationship between waiting time and rurality. Long waiting times appear to associate with both the most rural and the least rural regions. Statistical tests of waiting time by community size indicate high variability, prohibiting meaningful comparison of the means. The tests of personal attributes of general practitioners indicate that age (year of graduation) decreases with rurality, and increases with community size, and that the proportion of non-B.C. graduates increases with rurality, but is not affected by community size. Federal immigration restrictions have diminished the proportion of foreign physicians in rural communities, but not in urban or metropolitan centres. The concluding discussion of policy implications covers: (1) Manpower Planning with special emphasis on the roles of the government, the Colleges and the University, and the potentials of various policy options, and (2) Regionalization and its application in health manpower planning.

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