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Some family physicians’ offices discriminate against people with low socio-economic status, study finds

Toronto, February 25, 2013

By Leslie Shepherd

Family physicians’ offices appear to discriminate against people of low socio-economic status, even when there is no economic incentive to do so under Canada’s system of publicly-funded universal health insurance, new research has shown.

At the same time, these offices appear to give preference to people with chronic health conditions, according to the research led by Dr. Stephen Hwang of St. Michael’s Hospital.

In his study, published today in the Canadian Medical Association Journal, researchers telephoned the offices of family physicians and general practitioners in Toronto playing the role of an individual seeking a primary care physician. They followed a script that indicated they had high socioeconomic status (a bank employee transferred to the city) or low socioeconomic status (welfare recipient) and the presence or absence of chronic health conditions (diabetes and low back pain).

Sample audio recordings

The proportion of calls resulting in an offer of an appointment was significantly higher for people with high socioeconomic status (22.6 per cent) than people with low socioeconomic status (14.3 per cent). If you include people who were offered a screening visit or a spot on a waiting list, the difference is 37 per cent for people with high status with 24 per cent for those with low status.

An individual with chronic health issues was significantly more likely to get an appointments than someone without – 23.5 per cent compared to 12.8 per cent.

“Even in a system where doctors receive the same payment for every patient, regardless of the patient’s income or occupation, we see evidence of discrimination against people of low socioeconomic status,” said Dr. Hwang, a general internal medicine physician at the hospital and a researcher in its Centre for Research on Inner City Health. “This impairs access to primary care, and we don’t think this is acceptable.”

Dr. Hwang noted that the Ontario College of Physicians and Surgeons has a policy prohibiting “cherry picking” or screening of patients. Family physicians who are accepting new patients are expected to take patients on a first-come, first-served basis.

“Screening visits, or ‘patient auditions,’ are unacceptable,” Dr. Hwang said, yet that is what nine per cent of the doctors surveyed offered. “Obviously that presents even more opportunities to discriminate.”

Dr. Hwang said that stricter enforcement of the college’s rules would help prevent discrimination in access to primary health care.

Dr. Hwang stressed he was not trying to single out family physicians or suggest they discriminate more than other physicians or professions. He also noted that most of the telephone calls made by the researchers were answered by secretaries or administrative assistants, and their actions do not necessarily reflect the views of the physicians for whom they work.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Media contacts

For more information or to interview Dr. Hwang, please contact:

Leslie Shepherd
Manager, Media Strategy
St. Michael's Hospital
416-864-6094 or 647-300-1753
shepherdl@smh.ca