an evaluation of access to health care services along the rural-urban continuum in canada获得卫生保健服务的评价城乡连续在加拿大.pdfVIP

Sibley and Weiner BMC Health Services Research 2011, 11:20 /1472-6963/11/20 RESEARCH ARTICLE Open Access An evaluation of access to health care services along the rural-urban continuum in Canada Lyn M Sibley1,2*, Jonathan P Weiner3 Abstract Background: Studies comparing the access to health care of rural and urban populations have been contradictory and inconclusive. These studies are complicated by the influence of other factor which have been shown to be related to access and utilization. This study assesses the equity of access to health care services across the rural- urban continuum in Canada before and after taking other determinants of access into account. Methods: This is a cross-sectional study of the population of the 10 provinces of Canada using data from the Canadian Community Health Survey (CCHS 2.1). Five different measures of access and utilization are compared across the continuum of rural-urban. Known determinants of utilization are taken into account according to Andersen’s Health Behaviour Model (HBM); location of residence at the levels of province, health region, and community is also controlled for. Results: This study found that residents of small cities not adjacent to major centres, had the highest reported utilisation rates of influenza vaccines and family physician services, were most likely to have a regular medical doctor, and were most likely to report unmet need. Among the rural categories there was a gradient with the most rural being least likely to have had a flu shot, use specialist physicians services, or have a regular medical doctor. Residents of the most urban centres were more likely to report using specialist physician services. Many of these differences are diminished or eliminated once other factors are accounted for. After adjusting for other factors those living in