Improving Equity in Access to Primary Care: Is Team-Based Primary Care the Answer?

Access to primary health care is at the forefront of health care policy in our nation. Even with universal insurance coverage for primary health care with no cost at the point of service, the literature suggests that access to primary health care may be inequitable, especially among marginalized populations, defined by, factors such as income, education, and race. It is expected that the team-based practice approach, where family doctors work in collaboration with other health care workers such as nurses, may improve equity in access to primary health care. Whether this expectation is realized, however, is not certain as more advantaged populations, for example, those with higher income and education, are often better able to adapt to innovative care. To ensure that primary health care reform is improving equity in access, evaluation is necessary. In the past, evaluating primary health care has been challenging due to data limitations. For example, the current literature examining access to primary health care in Canada is limited to basic questions such as Do you have a regular family doctor? and How many times did you visit your family doctor in the past year? A new survey, the Canadian Survey of Experiences with Primary Health Care offers uniquely detailed information on access to primary health care. Using this survey I plan to examine the impact of primary health care reform undertaken in Canada on inequity in access to primary care. More specifically, I will examine systematic variations in access to primary health care between those receiving team-based primary care and those receiving care from a single family doctor. I will determine if and to what degree certain factors, such as income, education, and employment status become barriers to access to primary health care after taking into account need for health care measured by age, sex, and health status.