Racial Disparities in Access to Care Under Conditions of Universal Coverage

BackgroundRacial disparities in access to regular health care have been reported in the U.S., but little is known about the extent of disparities in societies with universal coverage.PurposeTo investigate the extent of racial disparities in access to care under conditions of universal coverage by observing the association between race and regular access to a doctor in Canada.MethodsRacial disparities in access to a regular doctor were calculated using the largest available source of nationally representative data in Canada-the Canadian Community Health Survey. Surveys from 2000−2010 were analyzed in 2014. Multinomial regression analyses predicted odds of having a regular doctor for each racial group compared to whites. Analyses were stratified by immigrant status-Canadian-born versus shorter-term immigrant versus longer-term immigrants-and controlled for sociodemographics and self-rated health.ResultsRacial disparities in Canada, a country with universal coverage, were far more muted than those previously reported in the U.S. Only among longer-term Latin American immigrants (OR=1.90, 95% CI=1.45, 2.08) and Canadian-born Aboriginals (OR=1.34, 95% CI=1.22, 1.47) were significant disparities noted. Among shorter-term immigrants, all Asians were more likely than whites, and among longer-term immigrants, South Asians were more like than whites, to have a regular doctor.ConclusionsUniversal coverage may have a major impact on reducing racial disparities in access to health care, although among some subgroups, other factors may also play a role above and beyond health insurance.