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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2017 Jan 1;108(1):e7–e13. doi: 10.17269/CJPH.108.5715

An examination of perceived health care availability and unmet health care need in the City of Toronto, Ontario, Canada

Jongnam Hwang 12,✉, Sara J T Guilcher 22,32,42, Kathryn E McIsaac 42,52, Flora I Matheson 32, Rick Glazier 32,42,62,72, Patricia O’Campo 42,62
PMCID: PMC6972417  PMID: 28425893

Abstract

OBJECTIVES: Although timely access to health care is a top priority, a burgeoning body of research highlights the important role of neighbourhood environments on unmet health care needs. This study aimed to examine an association between perceptions of neighbourhood availability of health care services and experience of unmet health care needs by gender in an urban city setting.

METHODS: A total of 2338 participants from the Neighbourhood Effects on Health and Well-being (NEHW) study, between 25 and 64 years of age and dwelling in the City of Toronto, Ontario, Canada, were included in the analyses. Four different logistic regression models stratified by gender were used to examine the relationship between neighbourhood health care availability and unmet health care need as well as the impact of neighbourhood perception of health care availability on the three different types of unmet needs.

RESULTS: Perceived health care availability was associated with higher likelihood of experiencing unmet health care needs in both women and men (women = OR: 1.58, 95% CI: 1.09–2.28; men = OR: 1.92, 95% CI: 1.23–2.99). In addition, perceived health care availability was associated with barrier-and wait times-related unmet health care need among women (OR: 1.83, 95% CI: 1.13–2.97; OR: 1.93, 95% CI: 1.10–3.40 respectively), and personal choice- and wait times-related unmet need among men (OR: 1.99, 95% CI: 1.10–3.58).

CONCLUSION: Individuals’ perception of health care availability plays a crucial role in the experience of unmet health care needs, suggesting the importance of community-based policy development for improving physical conditions and the social aspect of health care services.

Key Words: Unmet health care need, neighbourhood environment, access to care, Toronto, Canada

Footnotes

Acknowledgements: This research was funded by Canadian Institutes of Health Research (CIHR) Grant MOP-84439 and the Social Sciences and Humanities Research Council Grant 410-2007-1499. At the time of the study, Drs. Hwang, Guilcher and Mclsaac were funded by a CIHR Strategic Training Initiative in Health Research [ACHIEVE] post-doctoral fellowship (Grant #96566) and the Centre for Urban Health Solutions (formerly the Centre for Research on Inner City Health). Dr. Glazier is supported as a Clinician Scientist in the Department of Family and Community Medicine at St. Michael’s Hospital and at the University of Toronto.

Conflict of Interest: None to declare.

References

  • 1.Hutchison B. Disparities in healthcare access and use: Yackety-yack, yackety-yack. Healthc Policy. 2007;3(2):10–13. [PMC free article] [PubMed] [Google Scholar]
  • 2.Sibley LM, Glazier RH. Reasons for self-reported unmet healthcare needs in Canada: A population-based provincial comparison. Healthcare Policy. 2009;5(1):87–101. [PMC free article] [PubMed] [Google Scholar]
  • 3.Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ. 2013;16(1):21–33. doi: 10.1007/s10198-013-0546-4. [DOI] [PubMed] [Google Scholar]
  • 4.Veugelers PJ, Yip AM. Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health? J Epidemiol Community Health. 2003;57(6):424–28. doi: 10.1136/jech.57.6.424. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Curtis LJ, MacMinn WJ. Health care utilization in Canada: Twenty-five years of evidence. Can Public Policy. 2008;34(1):65–87. [Google Scholar]
  • 6.Birch S, Abelson J. Is reasonable access what we want? Implications of, and challenges to, current Canadian policy on equity in health care. Int J Health Serv. 1993;23(4):629–53. doi: 10.2190/K18V-T33F-1VC4-14RM. [DOI] [PubMed] [Google Scholar]
  • 7.Maddison A, Asada Y, Urquhart R. Inequity in access to cancer care: A review of the Canadian literature. Cancer Causes Control. 2011;22(3):359–66. doi: 10.1007/s10552-010-9722-3. [DOI] [PubMed] [Google Scholar]
  • 8.Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians’ services: Results from the Canadian National Population Health Survey. Soc Sci Med. 2000;51(1):123–33. doi: 10.1016/s0277-9536(99)00424-4. [DOI] [PubMed] [Google Scholar]
  • 9.Bissonnette L, Wilson K, Bell S, Shah TI. Neighbourhoods and potential access to health care: The role of spatial and aspatial factors. Health Place. 2012;18(4):841–53. doi: 10.1016/j.healthplace.2012.03.007. [DOI] [PubMed] [Google Scholar]
  • 10.Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91(11):1783–89. doi: 10.2105/ajph.91.11.1783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Poortinga W, Dunstan F, Fone D. Perceptions of the neighbourhood environment and self rated health: A multilevel analysis of the Caerphilly Health and Social Needs Study. BMC Public Health. 2007;7(1):285. doi: 10.1186/1471-2458-7-285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Ross NA, Tremblay SS, Graham K. Neighbourhood influences on health in Montreal, Canada. Soc Sci Med. 2004;59(7):1485–94. doi: 10.1016/j.socscimed.2004.01.016. [DOI] [PubMed] [Google Scholar]
  • 13.Ellen IG, Mijanovich T, Dillman K-N. Neighborhood effects on health: Exploring the links and assessing the evidence. J Urban Aff. 2001;23(3–4):391–408. [Google Scholar]
  • 14.Lévesque J-F. Unmet Health Care Needs: A Reflection of the Accessibility of Primary Care Services? Montreal, QC: Agence de la santé et des Services sociaux de Montréal, Direction de santé publique; 2008. [Google Scholar]
  • 15.Nelson CH, Park J. The nature and correlates of unmet health care needs in Ontario, Canada. Soc Sci Med. 2006;62(9):2291–300. doi: 10.1016/j.socscimed.2005.10.014. [DOI] [PubMed] [Google Scholar]
  • 16.Zygmunt A, Asada Y, Burge F. Int J Health Serv. 2015. Is team-based primary care associated with less access problems and self-reported unmet need in Canada? p. ii. [DOI] [PubMed] [Google Scholar]
  • 17.Asada Y, Kephart G. Understanding different methodological approaches to measuring inequity in health care. Int J Health Serv. 2011;41(2):195–207. doi: 10.2190/HS.41.2.a. [DOI] [PubMed] [Google Scholar]
  • 18.Allin S, Grignon M, Le Grand J. Subjective unmet need and utilization of health care services in Canada: What are the equity implications? Soc Sci Med. 2010;70(3):465–72. doi: 10.1016/j.socscimed.2009.10.027. [DOI] [PubMed] [Google Scholar]
  • 19.Weden MM, Carpiano RM, Robert SA. Subjective and objective neighborhood characteristics and adult health. Soc Sci Med. 2008;66(6):1256–70. doi: 10.1016/j.socscimed.2007.11.041. [DOI] [PubMed] [Google Scholar]
  • 20.Brondeel R, Weill A, Thomas F, Chaix B. Use of healthcare services in the residence and workplace neighbourhood: The effect of spatial accessibility to healthcare services. Health Place. 2014;30:127–33. doi: 10.1016/j.healthplace.2014.09.004. [DOI] [PubMed] [Google Scholar]
  • 21.Law M, Wilson K, Eyles J, Elliott S, Jerrett M, Moffat T, et al. Meeting health need, accessing health care: The role of neighbourhood. Health Place. 2005;11(4):367–77. doi: 10.1016/j.healthplace.2004.05.004. [DOI] [PubMed] [Google Scholar]
  • 22.Kravet SJ, Shore AD, Miller R, Green GB, Kolodner K, Wright SM. Health care utilization and the proportion of primary care physicians. Am J Med. 2008;121(2):142–48. doi: 10.1016/j.amjmed.2007.10.021. [DOI] [PubMed] [Google Scholar]
  • 23.Litaker D, Love TE. Health care resource allocation and individuals’ health care needs: Examining the degree of fit. Health Policy. 2005;73(2):183–93. doi: 10.1016/j.healthpol.2004.11.010. [DOI] [PubMed] [Google Scholar]
  • 24.Yip AM, Kephart G, Veugelers PJ. Individual and neighbourhood determinants of health care utilization. Implications for health policy and resource allocation. Can J Public Health. 2002;93(4):303–7. doi: 10.1007/BF03405022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.O’Campo P, Wheaton B, Nisenbaum R, Glazier RH, Dunn JR, Chambers C. The Neighbourhood Effects on Health and Well-being (NEHW) study. Health Place. 2015;31:65–74. doi: 10.1016/j.healthplace.2014.11.001. [DOI] [PubMed] [Google Scholar]
  • 26.Andersen RM. Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav. 1995;36:1–10. [PubMed] [Google Scholar]
  • 27.Hox JJ, Moerbeek M, van de Schoot R. Multilevel Analysis: Techniques and Applications. New York, NY: Routledge; 2010. [Google Scholar]
  • 28.Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav. 2005;46(1):15–31. doi: 10.1177/002214650504600103. [DOI] [PubMed] [Google Scholar]
  • 29.Fisher ES, Wennberg JE, Stukel TA, Skinner JS, Sharp SM, Freeman JL, et al. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res. 2000;34(6):1351–62. [PMC free article] [PubMed] [Google Scholar]
  • 30.Fleury M-J, Grenier G, Bamvita J-M, Perreault M, Kestens Y, Caron J. Comprehensive determinants of health service utilisation for mental health reasons in a Canadian catchment area. Int J Equity Health. 2012;11(1):20. doi: 10.1186/1475-9276-11-20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Leaf PJ, Livingston MM, Tischler GL, Weissman MM, Holzer C I, Myers JK. Contact with health professionals for the treatment of psychiatric and emotional problems. Med Care. 1985;23:1322–37. doi: 10.1097/00005650-198512000-00002. [DOI] [PubMed] [Google Scholar]
  • 32.Lebel A, Pampalon R, Villeneuve P. A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region. Int J Health Geogr. 2007;6(1):27. doi: 10.1186/1476-072X-6-27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Bernard P, Charafeddine R, Frohlich KL, Daniel M, Kestens Y, Potvin L. Health inequalities and place: A theoretical conception of neighbourhood. Soc Sci Med. 2007;65(9):1839–52. doi: 10.1016/j.socscimed.2007.05.037. [DOI] [PubMed] [Google Scholar]
  • 34.Wen M, Hawkley LC, Cacioppo JT. Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois. Soc Sci Med. 2006;63(10):2575–90. doi: 10.1016/j.socscimed.2006.06.025. [DOI] [PubMed] [Google Scholar]
  • 35.Sampson RJ, Raudenbush SW. Seeing disorder: Neighborhood stigma and the social construction of broken windows. Soc Psychol Q. 2004;67(4):319–42. [Google Scholar]
  • 36.Burke J, O’Campo P, Salmon C, Walker R. Pathways connecting neighborhood influences and mental well-being: Socioeconomic position and gender differences. Soc Sci Med. 2009;68(7):1294–304. doi: 10.1016/j.socscimed.2009.01.015. [DOI] [PubMed] [Google Scholar]
  • 37.Nowatzki N, Grant KR. Sex is not enough: The need for gender-based analysis in health research. Health Care Women Int. 2011;32(4):263–77. doi: 10.1080/07399332.2010.519838. [DOI] [PubMed] [Google Scholar]
  • 38.Health Policy. 2009.
  • 39.Cavalieri M. Geographical variation of unmet medical needs in Italy: A multivariate logistic regression analysis. Int J Health Geogr. 2013;12:27. doi: 10.1186/1476-072X-12-27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Gany F, de Thiel Bocanegra H. Overcoming barriers to improving the health of immigrant women. J Am Med Womens Assoc (1972) 1996;51(4):155–60. [PubMed] [Google Scholar]
  • 41.Salganicoff A. Medicaid and managed care: Implications for low-income women. J Am Med Womens Assoc (1972) 1997;52(2):78–80. [PubMed] [Google Scholar]
  • 42.Diamant AL, Hays RD, Morales LS, Ford W, Calmes D, Asch S, et al. Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. Am J Public Health. 2004;94(5):783–89. doi: 10.2105/ajph.94.5.783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Kaplan DH, Douzet F. Research in ethnic segregation III: Segregation outcomes. Urban Geogr. 2011;32(4):589–605. [Google Scholar]

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