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. 2019 Aug;110(4):395-403.
doi: 10.17269/s41997-019-00204-5. Epub 2019 Apr 15.

Income-based inequities in access to mental health services in Canada

Mary Bartram  1   2
Affiliations

Income-based inequities in access to mental health services in Canada

Mary Bartram. Can J Public Health. 2019 Aug.

Abstract
in English, French

Objectives: While mental health services provided by general practitioners and psychiatrists can be billed to public health insurance programs in Canada, services provided by psychologists, social workers and other non-physician providers cannot. This study assesses the extent to which access to mental health services varies by income after first taking into account the higher concentration of mental health needs at lower income levels.

Method: Data from the Canadian Community Health Survey 2013-2014 are used to calculate need-standardized concentration indices for access to mental health services.

Results: More pro-rich utilization of mental health services provided by non-physicians and more equitable utilization of physician services is found for psychologists and general practitioners, but not for social workers, nurses and psychiatrists. Unmet need for healthcare for mental health problems is found to be more pro-poor than unmet need for physical health problems.

Conclusion: By standardizing for inequitable distribution of mental health need, this study provides strong evidence that income-based inequity in access to mental health services is an issue under Canada's two-tier system, particularly with regard to general practitioners and psychologists. For other types of providers, the results suggest that inequities in service utilization vary not just by Medicare coverage but also by service settings and target populations. Despite these variations, greater inequities in unmet need for mental health care than for physical health care suggest that inequity is the dominant reality for Canadians. The results provide a baseline that could be used to assess the equity impacts of policy reforms.

Objectifs: Au Canada, les omnipraticiens et les psychiatres peuvent facturer leurs services de santé mentale aux programmes publics d’assurance-santé, mais les psychologues, les travailleurs sociaux et les fournisseurs autres que les médecins ne le peuvent pas. Nous avons cherché à évaluer si l’accès aux services de santé mentale varie selon le revenu, en tenant compte au préalable de la plus forte concentration de besoins en santé mentale aux niveaux de revenu inférieurs.

Méthode: À l’aide des données de l’Enquête sur la santé dans les collectivités canadiennes de 2013–2014, nous avons calculé des indices de concentration standardisés selon les besoins pour l’accès aux services de santé mentale.

Résultats: Nous avons constaté que l’utilisation des services de santé mentale fournis par les non-médecins est déséquilibrée en faveur des populations plus aisées; l’utilisation des services médicaux offerts par les psychologues et les omnipraticiens est plus équitable, mais ce n’est pas le cas pour les services des travailleurs sociaux, des infirmières et des psychiatres. Le besoin insatisfait de soins de santé pour les troubles de santé mentale est plus présent dans les populations démunies que le besoin insatisfait de soins de santé pour les troubles de santé physique.

Conclusion: En standardisant la distribution inéquitable des besoins en santé mentale, cette étude donne de fortes indications que les inégalités d’accès aux services de santé mentale fondées sur le revenu constituent un problème dans le système à deux vitesses du Canada, surtout en ce qui concerne les omnipraticiens et les psychologues. Pour les autres types de fournisseurs, les résultats indiquent que les inégalités dans l’utilisation des services ne varient pas seulement selon le régime public d’assurance-maladie, mais aussi selon le milieu de services et la population cible. Malgré ces écarts, les inégalités plus prononcées dans le besoin insatisfait de soins de santé mentale que de soins de santé physique donnent à penser que les inégalités sont la réalité dominante pour nos concitoyens et nos concitoyennes. Nos résultats constituent une base de référence qui peut servir à évaluer les répercussions des réformes de politiques sur l’équité.

Keywords: Access; Canada; Concentration index; Equity; Income; Mental health.

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Conflict of interest statement

The author declares no conflict of interest.

Figures

Fig. 1
Fig. 1
Illustrative example of concentration curves and concentration indices (CI)
Fig. 2
Fig. 2
Need-standardized concentration curves for utilization, CCHS 2013–2014
Fig. 3
Fig. 3
Need-standardized concentration curves for unmet need for healthcare, CCHS 2013–2014
See this image and copyright information in PMC

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