Variation in health and health care use by socioeconomic status in Winnipeg, Canada: does the system work well? Yes and no

Abstract

Health varies with socioeconomic status; those with higher incomes or who are better educated can expect to have better health. The success of the Canadian universal health care system in delivering care according to need was assessed. Consistent gradients in all-cause and cause-specific mortality according to neighborhood income characteristics are evident among Winnipeg residents. Poorer, less healthy groups receive more acute hospital care and have more contacts with general practitioners. Surgical rates and contacts with specialist physicians however, show less variation by socioeconomic status. One reason may be that members of higher socioeconomic groups have the skills required to negotiate for surgery when they develop conditions, like joint pain, that are less critical. The move toward organized priority lists in Canada may remedy this situation. As access to health care is more equalized, improvement in the health of lower and middle socioeconomic groups will occur through changes in social policy like improvement of educational opportunities.