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)

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

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

Recent Posts

December 18 • 4:00 AM

Should Movies Be Rated RD for Reckless Driving?

A new study finds a link between watching films featuring reckless driving and engaging in similar behavior years later.


December 17 • 4:00 PM

How to Run a Drug Dealing Network in Prison

People tend not to hear about the prison drug dealing operations that succeed. Substance.com asks a veteran of the game to explain his system.


December 17 • 2:00 PM

Gender Segregation of Toys Is on the Rise

Charting the use of “toys for boys” and “toys for girls” in American English.


December 17 • 12:41 PM

Why the College Football Playoff Is Terrible But Better Than Before

The sample size is still embarrassingly small, but at least there’s less room for the availability cascade.


December 17 • 11:06 AM

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.


December 17 • 10:37 AM

A Public Lynching in Sproul Plaza

When photographs of lynching victims showed up on a hallowed site of democracy in action, a provocation was issued—but to whom, by whom, and why?


December 17 • 8:00 AM

What Was the Job?

This was the year the job broke, the year we accepted a re-interpretation of its fundamental bargain and bought in to the push to get us to all work for ourselves rather than each other.


December 17 • 6:00 AM

White Kids Will Be Kids

Even the “good” kids—bound for college, upwardly mobile—sometimes break the law. The difference? They don’t have much to fear. A professor of race and social movements reflects on her teenage years and faces some uncomfortable realities.



December 16 • 4:00 PM

How Fear of Occupy Wall Street Undermined the Red Cross’ Sandy Relief Effort

Red Cross responders say there was a ban on working with the widely praised Occupy Sandy relief group because it was seen as politically unpalatable.


December 16 • 3:30 PM

Murder! Mayhem! And That’s Just the Cartoons!

New research suggests deaths are common features of animated features aimed at children.


December 16 • 1:43 PM

In Tragedy, Empathy Still Dependent on Proximity

In spite of an increasingly connected world, in the face of adversity, a personal touch is most effective.


December 16 • 12:00 PM

The ‘New York Times’ Is Hooked on Drug du Jour Journalism

For the paper of record, addiction is always about this drug or that drug rather than the real causes.


December 16 • 10:00 AM

What Is the Point of Academic Books?

Ultimately, they’re meant to disseminate knowledge. But their narrow appeal makes them expensive to produce and harder to sell.


December 16 • 8:00 AM

Unjust and Unwell: The Racial Issues That Could Be Affecting Your Health Care

Physicians and medical students have the same problems with implicit bias as the rest of us.


December 16 • 6:00 AM

If You Get Confused Just Listen to the Music Play

Healing the brain with the Grateful Dead.


December 16 • 4:00 AM

Another Casualty of the Great Recession: Trust

Research from Britain finds people who were laid off from their jobs expressed lower levels of generalized trust.


December 15 • 4:00 PM

When Charter Schools Are Non-Profit in Name Only

Some charters pass along nearly all their money to for-profit companies hired to manage the schools. It’s an arrangement that’s raising eyebrows.


December 15 • 2:00 PM

No More Space Race

A far cry from the fierce Cold War Space Race between the U.S. and the Soviet Union, exploration in the 21st century is likely to be a much more globally collaborative project.


December 15 • 12:32 PM

The Hidden Psychology of the Home Ref

That old myth of home field bias isn’t a myth at all; it’s a statistical fact.


December 15 • 12:00 PM

Gluttony and Global Warming: We’re Eating Ourselves to a Warmer Planet

Forget your car. Our obsession with beef and dairy has a far more devastating effect on the climate.


December 15 • 10:00 AM

The 2016 Presidential Race Has Already Started

And this is the most exciting part.


December 15 • 8:00 AM

The Second Life of Old iPods

Why is it that old iPods are suddenly cool—and pricey again?


December 15 • 6:00 AM

The Lifelong Consequences of Rape

The long-term psychological and physical effects of the experience are devastating. And they’re likely exacerbated by the shame our culture insists on perpetuating.


December 15 • 4:00 AM

Mating Mindset Interferes With Attempts to Stop Smoking

Taiwanese researchers find photos of attractive women put men in an immediate-gratification state of mind.


Follow us


Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.

The Hidden Psychology of the Home Ref

That old myth of home field bias isn’t a myth at all; it’s a statistical fact.

A Word of Caution to the Holiday Deal-Makers

Repeat customers—with higher return rates and real bargain-hunting prowess—can have negative effects on a company’s net earnings.

Crowdfunding Works for Science

Scientists just need to put forth some effort.

There’s More Than One Way to Be Good at Math

Mathematical ability isn’t one single skill set; there are indeed many ways to be “good at math,” research shows.

The Big One

One in two United States senators and two in five House members who left office between 1998 and 2004 became lobbyists. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.