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

Mary H. Bartram

56 citations0/0 files storedCanadian Journal of Public Health

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Mental Health Treatment and Access Health disparities and outcomes Public Health and Social Inequalities

Abstract

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.

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References

1995Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?2007Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation 2014Making Mental Health Count 2015Better access to mental health care and the failure of the Medicare principle of universality 2013Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey-Mental Health.2005Service Use for Mental Health Reasons: Cross-Provincial Differences in Rates, Determinants, and Equity of Access 2007Income-related inequality in mental health in Britain: the concentration index approach 2007Equity in health and health care in a decentralised context: evidence from Canada

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