The doctor will not see you now: investigating the social determinants of specialist care using the Canadian Longitudinal Study on Aging (CLSA)

Front Public Health. 2024 Sep 27:12:1384604. doi: 10.3389/fpubh.2024.1384604. eCollection 2024.

Abstract

Background: The Canada Health Act mandates universal access to medical services for all Canadians. Despite this, there are significant disparities in access based on socioeconomic status, race and ethnicity, immigrant status, and indigeneity. However, there is limited evidence on the use of specialist services among older adults in Canada. The primary objective of this study is to identify the associations of social determinants of health with access to medical specialist services for Canadians aged 45 years and older. The second objective is to identify the reasons for not being able to access the needed specialist care.

Methods: A cross-sectional analysis of the Canadian Longitudinal Study on Aging survey was conducted. Based on the Andersen's model of health services use, a multivariable logistic regression model was used to evaluate the associations between 'not being able to access the needed specialist service(s) in the last 12 months' and individual-level sociodemographic determinants.

Results: Approximately 97% of those who required specialist care in the last year were able to visit a specialist. Of the participants who were not able to access the needed specialist services, about half (50.90%) were still waiting for a visit. The following factors were associated with greater difficulty in accessing specialist care: being younger (45-54 years), living in a rural area, having some post-secondary education, having a household income below $50,000 a year, not having a family physician, and having fair or poor perceived general health. Residents of British Columbia and Nova Scotia had a higher likelihood of reporting difficulty compared to those residing in Ontario.

Conclusion: While a majority of respondents were able to access specialist services when needed, those who had difficulty in accessing care were more likely to come from socially marginalized groups. Targeted policy interventions and improved health system coordination can reduce these barriers to care.

Keywords: CLSA; health care access; health care utilization; medical specialist; older adults.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Canada
  • Cross-Sectional Studies
  • Female
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Social Determinants of Health* / statistics & numerical data
  • Socioeconomic Factors
  • Specialization / statistics & numerical data

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was made possible using the data collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 94473 and the Canada Foundation for Innovation as well as the following provinces, Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia. This research has been conducted using the CLSA datasets Baseline Tracking version 3.7, Baseline Comprehensive version 6.0, Follow-up 1 Tracking version 2.3 and Follow-up 1 Comprehensive version 3.2, under Application Number 2104058. The CLSA is led by Drs. Parminder Raina, Christina Wolfson and Susan Kirkland.