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Rural Health-Care Gap Probed

Rural residents make less use of the country’s health-care system and government policy-makers don’t really understand why, says a study done for the Canadian Institutes of Health Research.

“An important message for health-care policy-makers is that despite universal health insurance coverage, inequities in access to care still exist between rural and urban residents,” the study notes. These inequities are often overlooked because governments evaluate health-care access on a very large scale, which doesn’t account for the impact of the place of residence.

“Understanding the relationship between rural-urban and other determinants will help policy-makers to target interventions appropriately to specific demographic, provincial, community, or rural categories,” adds the study by Lyn Sibley of the University of Toronto department of health policy and Jonathan Weiner of Johns Hopkins University.

“The best place to be is in or near a small city because it’s more likely to have family doctors and an up-to-date hospital,” Sibley said in an interview. “For rural communities, the more rural it gets, the less likely you are to find specialists.”

For many rural residents, health care is postponed until a trip to a hospital emergency room is needed.

The Telehealth system in Ontario where residents call a 1-800 number for medical information “is likely a lot more important to rural residents who are trying to diagnose a medical problem in the absence of a family doctor or nearby hospital.”

The study found rural residents outside of Quebec didn’t have near the access to specialist physician services that urban dwellers do nor the same supply of family doctors common in smaller cities. Their study also suggests health-care officials need to better understand the effect of physician supply, as well as factors such as how far people have to travel to receive care, rural income levels, and the proportion of the population that is Aboriginal.

Income plays a key role even with the universal health-care programs, the study found. “Those in the lowest quartile for household income were less likely to have had a flu shot, (to) have seen a specialist, or to have a regular medical doctor,” the study states.

The effect is more pronounced for those without full-time jobs.

“An unusual pattern is seen among people who were employed for only part of the year. These people were less likely to have a flu shot, more likely to report unmet need, more likely to see a family or specialist physician and less likely to have a regular medical doctor.”

Despite the shortcomings, rural residents are less likely to report having unmet healthcare needs, the study says. Officials might view that as an indication that their healthcare needs are looked after, but the study says this is unlikely given their lower usage of specialist physicians and poorer health status.

“This result suggests different expectations of the healthcare system, leading to rural residents having a different threshold at which they report their needs being unmet, its adds. Rural residents are more likely to postpone seeking care until economically or socially convenient.”

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