Equity in Health Care Utilization Among First Nations Populations Living Off-reserve in Canada

Abstract

Background: Reducing inequities (unfair inequalities) in health and health care is a primary goal of health policy in Canada. Inequity in utilization of care is a significant issue. Inequity may be present in the utilization of many types of health care services including but not limited to: primary care, specialist care, mental health care and dental care. Although the investigation of inequity in health care utilization is common in the general population and several subpopulations in Canada, little research has been done to assess inequities in health care utilization within Indigenous populations in this country. There are several reasons to investigate inequity in health care utilization among this population, including differences in health status, health care coverage and cultural/historical context. Objective: To examine income-related inequity in four types of health care utilization within two off-reserve Indigenous populations in Canada viz. status and non-status First Nations, namely: primary care (general practitioner/nurse care), specialist care, dental care and mental health care utilization. Methods: The study was conducted as a secondary analysis using a cross-sectional survey. We used the 2012 Aboriginal Peoples Survey (APS), which is a nationally representative survey of the off-reserve Indigenous populations in Canada administered through statistics Canada. The survey collects information on income, health care utilization, need and various other non-need variables required for the analysis. The target population for this research was adults (>18 years) who self-identified as a member of any First Nations group in Canada. Inequity was assessed using multiple methods: the Horizontal Inequity index (HI) was calculated for primary and specialist care to compare the degree of horizontal inequity between both status and non-status First Nations groups. The Concentration index (C) and logistic regression was employed for testing inequity in both mental and dental health care utilization for these populations. Results: This research indicated significant inequities in health care utilization within First Nations peoples living off-reserve in Canada. Specifically, there is pro-rich inequity in primary care utilization for the total First Nations populations, HI: 0.2085 (95% CI: 0.1521, 0.2649) and for those in each status group individually (more pro-rich in the status population). Additionally, inequity in dental care utilization is present based on the concentration index of actual use for those who need care. We find pro-rich inequity in the total population, C: 0.0812 (95% CI: 0.0182, 0.1442) and in the non-status population, C: 0.1783 (95% CI: 0.0771, 0.2794). Results also show no evidence of inequity in specialist care utilization or mental health care utilization, although statistically insignificant point estimates for inequity are moderately pro-rich. Conclusion: This research has filled a gap in the literature around inequity in health care utilization for off-reserve First Nations populations in Canada by measuring inequity within both status and non-status groups individually. These results have provided insight into income-related inequities in health care utilization for First Nations populations in Canada and may provide valuable evidence for policy makers in this area.