Menus Subscribe Search

Follow us

Callers to Canadian clinics had a significantly smaller chance of getting an appointment if they posed as a homeless person or welfare recipient. (PHOTO: BRIAN EICHHORN/SHUTTERSTOCK)

Health Care Bias Even in Canada

• March 25, 2013 • 4:00 AM

Callers to Canadian clinics had a significantly smaller chance of getting an appointment if they posed as a homeless person or welfare recipient. (PHOTO: BRIAN EICHHORN/SHUTTERSTOCK)

Canada may have universal health care, but to get an appointment, it still helps to be upper crust.

Single-payer healthcare solves a lot of problems—dizzying insurance premiums, preexisting condition jeopardy—just not all of them.

Prejudice, like diabetes, is a condition for which no drug yet exists, and as a new bit of research in the Canadian Medical Association Journal demonstrates, even physicians working in a universal care system aren’t immune to its effects.

Stephen Hwang, an internist at the University of Toronto, wanted to know just how endemic socioeconomic discrimination was in local clinics. “I provide care for a number of people who are homeless and marginalized in society,” he says, “and they not infrequently mention to me that they feel that, in the past, they’ve been treated differently by certain health care providers. They feel that it was simply because they were poor or homeless.”

Hwang, along with colleagues Michelle Olah and Gregory Gaisano, decided to explore that complaint by calling the offices of 375 primary care physicians in Toronto, posing as a first-time patient. Half the time, the “patient” explained that he was an executive at a major bank, just transferred to town, looking for a new family doctor; in other cases, the “patient” was a welfare recipient whose caseworker had instructed him to start receiving annual check-ups.

The authors discovered that a rich patient’s odds of getting an appointment were nearly one in four, while a poor patient’s were one in seven. While “physician reimbursement is unaffected by patients’ socioeconomic status” in a universal system, they write, affluent Canadians “received preferential access to primary care” over their lower-class countrymen.

“What we found was about what we suspected was going on,” says Hwang, who went to medical school at Johns Hopkins and studied public health at Harvard before moving to Toronto. “Having practiced in both the U.S. and Canada, I think that while the Canadian system of universal health insurance provides much more equitable access for people of all income levels and social background, what it doesn’t eliminate is a universal predisposition to treat people differently because of their status in society.”

At the same time, the researchers found that a “patient” complaining of chronic conditions—back pain or diabetes—was far more likely to receive an appointment than one simply looking for an their annual wellness check. And that’s a good thing, says Hwang. Doctors, many of them already heavily oversubscribed, seem to be prioritizing the sickest Canadians. (Although it’s also possible that they stood to bill more services to a patient with a chronic illness.)

Hwang is quick to note that the study is hardly a condemnation of single-payer care. “I think that people are by and large better off in the Canadian health care system than in the United States, both in terms of equity and outcomes overall,” he says. Still, the findings are a useful reminder that physicians are only human; like all of us, they suffer from ugly, if unconscious, prejudices and predilections. And for that malady, there’s no easy cure.

Kevin Charles Redmon
Kevin Charles Redmon is a journalist and critic. He lives in Washington, D.C.

More From Kevin Charles Redmon

Tags: ,

If you would like to comment on this post, or anything else on Pacific Standard, visit our Facebook or Google+ page, or send us a message on Twitter. You can also follow our regular updates and other stories on both LinkedIn and Tumblr.

A weekly roundup of the best of Pacific Standard and, delivered straight to your inbox.

Follow us

Subscribe Now

Quick Studies

What Makes You Neurotic?

A new study gets to the root of our anxieties.

Fecal Donor Banks Are Possible and Could Save Lives

Defrosted fecal matter can be gross to talk about, but the benefits are too remarkable to tiptoe around.

How Junk Food Companies Manipulate Your Tongue

We mistakenly think that harder foods contain fewer calories, and those mistakes can affect our belt sizes.

What Steve Jobs’ Death Teaches Us About Public Health

Studies have shown that when public figures die from disease, the public takes notice. New research suggests this could be the key to reaching those who are most at risk.

Speed-Reading Apps Will Not Revolutionize Anything, Except Your Understanding

The one-word-at-a-time presentation eliminates the eye movements that help you comprehend what you're reading.

The Big One

One state—Pennsylvania—logs 52 percent of all sales, shipments, and receipts for the chocolate manufacturing industry. March/April 2014