A quarter of Canadians over 45 struggled to access health care in 2020: survey

A quarter of Canadians over 45 experienced challenges accessing health-care services during the first year of the COVID-19 pandemic, according to survey results published in the Canadian Medical Association Journal (CMAJ) this month.

However, the degree to which people were affected depended on factors like race, immigration status, sex, age and education and income levels.

As COVID-19 spread in 2020, health-care providers coped with the strain of patients sick with the virus by cancelling elective surgeries and in-person appointments and turning more to virtual care. Nationally, emergency department visits and inpatient admission levels dropped by 24 per cent and 10 per cent, respectively, according to the Canadian Institute for Health Information. Home and primary care services were also affected.

In order to understand how these disruptions affected older Canadians and their health-care needs in 2020, researchers from McMaster University, McGill University, Dalhousie University and the Public Health Agency of Canada surveyed 23, 972 people between April 15 and Dec. 29, 2020, about their experiences accessing health care.

What they found was that the level of difficulty respondents faced accessing health care varied widely based on a range of social determinants.

"Substantial unmet health-care needs were reported by Canadian adults during the first year of the pandemic," the authors wrote in the CMAJ paper on Feb. 14 that outlined the results of the survey. "The results of this study have important implications for health equity."

From September to December 2020, 25 per cent of survey respondents experienced challenges accessing health-care services, eight per cent did not go to a hospital or see a doctor when they needed to and four per cent faced barriers to testing for COVID-19 infection.

Immigrants and people with chronic conditions were more likely to report challenges accessing health care, as well as not visiting a hospital or seeing a doctor when they needed to. Women and racialized people were also more likely to report not visiting the hospital or seeing a doctor when needed, compared to men and white respondents.

"The literature has established that immigrants face unique difficulties accessing health care," the authors wrote, adding that Canadians who are not white are less likely to have a regular physician.

People with chronic conditions had higher odds of reporting challenges accessing services and not going to a hospital or doctor when needed, while people who experienced difficulty meeting their health-care needs prior to the pandemic were more likely to have experienced all three outcomes in 2020.

The study found respondents had an easier or harder time accessing care depending on which province they lived in.

Respondents from Ontario were most likely to report challenges accessing health care and barriers to COVID-19 testing, while Quebec residents were most likely to not visit a hospital or doctor, and least likely to struggle with the other two outcomes.

Nationally, the most common reasons for not visiting a hospital or doctor were fear of COVID-19 exposure and health-care providers redirecting services to prioritize vulnerable groups.

Redirection was more of an issue for adults aged 50 to 54 years old than for those aged 85 to 96 years old. In fact, older age was associated with reporting fewer challenges in all three areas of access to health care.

People with higher education levels were more likely to report facing challenges accessing health care, though the authors said this could be because they had better access to health care pre-pandemic than those with lower education levels, so their perception of disruption during the pandemic could have been greater.

Similarly, people with higher levels of income were more likely to report challenges accessing health care and barriers to COVID-19 testing, but less likely to report not visiting a hospital or seeing a doctor.

"People with higher levels of income tend to be less likely to forgo care, as has been noted even during the pandemic," the authors wrote. "Meaning they may have greater expectations for accessibility of services."

The authors acknowledged admitted there were some limitations to their data. They issued their surveys to people already participating in the Canadian Longitudinal Study on Aging, a national long-term study of adults between 45 and 85 at the time of recruitment. However, it excludes residents of the three territories and First Nations reserves, Canadian Armed Forces members and people living in institutions. The researchers also did not follow up with survey respondents about their experiences accessing health care throughout the pandemic, distributing their final round of surveys in December 2020.

Nevertheless, the authors said the study shows Canadians enjoy unequal access to health care based on factors like sex, race and immigration status, with or without the complicating factor of a pandemic.

"Self-perceived unmet needs are a reflection of access to, and performance of, a health-care system," they wrote.

"There is evidence that people with pre-existing vulnerabilities experience difficulties when trying to access health care services. Efforts must continue to ensure accessible care for Canadians."