Inequalities in access to primary care services and health insurance in Black adults in Canada.

Abstract

Background: Previous research has shown that Black adults in Canada experience higher cause-specific mortality and differential rates of diagnosis and hospitalization compared with White adults. These disparities may reflect underlying differences in access to health care. This study assesses whether inequalities in access to primary and pharmaceutical health care exist between Black and White adults in Canada.

Data and methods: This study used pooled data from the annual Canadian Community Health Survey from 2015 to 2019. Access to care was measured through indicators of primary care access and insurance for prescription medicine. Inequalities were assessed through crude and adjusted differences between Black and White adults, and counterfactual decomposition methods were applied to identify the contributions of specific factors to observed inequalities.

Results: Primary care access and insurance for prescription medicine were significantly lower for Black adults aged 25 years and older, compared with White adults in the same age group, from 2015 to 2019. About three-quarters of the differences in having a regular health care provider and insurance for prescription medicine were explained by population differences in the levels of measured covariates, including demographic, immigrant, and socioeconomic factors. By contrast, less than one-third of the difference in going to a doctor's office for care of a minor problem was explained by model covariates.

Interpretation: Much of the measured inequality between Black and White adults in having a regular health care provider and insurance for prescription medicine was attributable to differences in demographic factors, immigrant status, and socioeconomic variables. However, these factors explained less of the inequality in visiting a doctor's office for care of a minor problem. Notably, socioeconomic factors - including educational attainment, occupational skill level, and household income - represent modifiable determinants that may be amenable in reducing the observed disparity.