Rich Canadians may do better than poor getting doctors' appointments: study

The Canadian Press
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People of higher socioeconomic status seeking a primary-care doctor are more likely to receive an appointment than those of lower status, even though there’s no financial benefit under Canada’s universal health-care system, a study suggests.

TORONTO — People of higher socioeconomic status seeking a primary-care doctor are more likely to receive an appointment than those of lower status, even though there’s no financial benefit under Canada’s universal health-care system, a study suggests.

The study found that individuals who called a physician’s office asking to be seen as a new patient were more than 50 per cent more likely to get an appointment if they presented themselves as being of high socioeconomic status.

“Our study provides very strong evidence of discrimination, but it does not identify specific offices that are discriminating,” said principal researcher Dr. Stephen Hwang, a specialist in inner-city health at St. Michael’s Hospital in Toronto.

“It simply shows that you are more likely to get an appointment if you are of high socioeconomic status,” he said. “We think this indicates pretty clearly that there is preferential access to primary care.”

To conduct the study, published Monday in the Canadian Medical Association Journal, researchers phoned 375 family physician and general practitioner offices in Toronto, posing as a bank employee or a welfare recipient, either with chronic health conditions or seeking only routine care.

“So every physician’s office got a call from one person and there were four possible scenarios that they could be randomly assigned to,” said Hwang, noting that the doctors’ offices were chosen at random and most responses were from receptionists or other administrative staff.

The proportion of calls resulting in an appointment offer was higher for those posing as bank employees — 23 per cent — than for those presenting themselves as welfare recipients — 14 per cent.

When including those who were offered a screening visit or a spot on a waiting list, the difference was 37 per cent for so-called better-off callers and 24 per cent for those of more limited means.

“Typically, the caller who was turned down would be told: ’I’m sorry, but Dr. X is not accepting patients currently’ or ’The practice is not open to new patients,”’ Hwang said.

“That’s what they would be told, but what we observed is that you’re more likely to be told that if you’re of low socioeconomic status than if you’re of high socioeconomic status.

“We don’t know if this is a subconscious bias on the part of the receptionist or if they’re carrying out instructions that are given to them or if it’s conscious bias. We don’t know.”

Unexpectedly, researchers who said they had chronic health conditions — in this case, diabetes and low back pain — were more likely to receive appointment offers than those seeking routine care, such as a check-up (24 per cent versus 13 per cent).

“We were very surprised by that,” said Hwang, who had hypothesized that patients without complex health problems would be more likely to be accepted as patients.

“We thought because patients with chronic health conditions take more time and more effort that physicians might be preferentially seeking to enrol healthy patients in their practices.

“But we were pleased to see the opposite, that physician offices were appropriately giving priority to people with health problems over those who did not have immediate health problems.”

The study found no evidence that the length of time a doctor had been practising nor the socioeconomic status of the neighbourhood where offices were located had any bearing on whether a patient was accepted.

Hwang said the College of Physicians and Surgeons of Ontario, for one, recommends against doctors cherry-picking patients based on their health status, socioeconomic profile or other factors.

“They say ’it is not appropriate for physicians to screen potential patients because it can compromise public trust in the profession, especially at a time when access to care is a concern.”’

The college has a clear policy that new patients should be taken on a first-come, first-served basis, but the policy does not appear to be enforced, he said.

“I think the first thing is we need to recognize is ... (that we’re) all prone to treating people differently and discriminating,” Hwang said.

“Socially, within the realm of health care, we feel that that’s inappropriate.”

Organizations: College of Physicians, Hospital in Toronto, Canadian Medical Association Journal

Geographic location: TORONTO, Canada, Michael Ontario

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Recent comments

  • RG
    February 25, 2013 - 16:31

    I hate to discriminate myself, however I've found that when dealing with people who aren't so well off, they're personalities tend to be a little harder to deal with when they're either trying to get something or have been turned down. I wonder if the study took that into account or if they told people to act the same way regardless of their scenario. (I'm not painting all people who are on welfare with this picture, but from my experience, the majority I've spoken to have more of a tendency to act like this) I used to work at a call centre and I could be asked the same question by one person who was paying their bill on time and they would be very understanding while the person who's behind on their payments would take offense, even if didn't affect them at all or was something that affected all clients. (ie, something insignificant like bills being sent Mondays instead of Tuesdays) If a was a receptionist I'd be much more likely to take on a patient that's easy to talk to and understanding than somebody who looks to just be causing trouble (Which is how these folks sounded when I took their calls)

    • Bill Kays
      Bill Kays
      February 27, 2013 - 16:39

      RG - You sound very young to me and it sounds to me like you love to discriminate. I can tell by how you speak about people that you peg yourself quite a bit higher on the totem pole than others. Obviously you mistake their frustration at the system personally. Well you go on protecting your precious system and I will continue to do all I can to inform people of the reality of the world today.

  • Bill Kays
    February 25, 2013 - 15:59

    Gee whiz, do you think? There has always been 2 tiers of health care in Canada and there is nothing that will change that as long as the general population puts up with it. We do not have a health care system. We have a "managed disease system" that has been set up with profit as the main objective instead of saving lives or preventing disease.The power brokers that be own (or control) the whole of the medical system, the hospital, insurance companies, drug companies, etc., etc., with the following result. The result is higher medical costs due to the profiteering by all parties involved, right dow to doctors getting kickbacks for prescribing certain medications. POOR PEOPLE HAVE NO HEALTH CARE at all. The whole strategy needs to be redone and a new system put in its place based on helping people, not making profits. Centralized health care (and government) seems to be closer at achieving governments goal of spending less through delivering less services.

  • Two class state well established in PEI
    February 25, 2013 - 15:30

    While 27% of Islanders collect EI every year, they are all treated as garbage Federally, Provincially and by banks, insurance companies. The lower class have their children discriminated against while the elite demand their entitlements. All government, health care, lawyers and accountants are in the upper class and commonly accept the lower class are "losers" that deserve nothing. Brooke MacMillan handed out over 100 million dollars but not one cent went to losers, fellas like Kevin Murphy, Tim Banks and Nancy Key deserve more than losers. funny eh?