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Canadian Journal of Public Health

, Volume 106, Issue 2, pp e66–e71 | Cite as

Development of a measure of health care affordability applicable in a publicly funded universal health care system

  • Jeannie L. HaggertyEmail author
  • Jean-Frédéric Levesque
Quantitative Research

Abstract

Objective

Direct measures of health care affordability from the user perspective are needed to monitor equitable access to publicly funded health care in Canada. The objective of our study was to develop a survey-based measure of health care affordability applicable to the Canadian context.

Methods

We developed items after focus group exploration of access and cost barriers in the health care trajectory. We administered an initial instrument by telephone to a randomly-selected sample of 750 respondents in metropolitan, rural, and remote settings in Quebec. After analysis we developed a new, self-administered version eliciting the frequency of problem access due to five affordability dimensions. This version was mailed to a subset of participants. We conducted exploratory and confirmatory factor analysis. We used ordinal logistic regression modelling to examine how individual items and the subscale score predicted indicators of difficult access. We looked for effect modification by income categories.

Results

The five items load on a single construct with good internal consistency (α = 0.77). The overall score, 0 to 5, reflects the sum of problems with health care affordability due to direct and indirect costs. The item and subscale scores are sensitive to income status, with affordability problems more prevalent among low-income than high-income respondents. Each unit increase in the subscale score predicts increased likelihood of unmet needs (OR = 1.54), emergency room use (OR = 1.41), and delay-related health problem aggravation (OR = 1.80).

Discussion

This subscale reliably and validly measures cost barriers to medically necessary services in Canada, and can potentially be applied in other settings with publicly funded health systems. It can be used to monitor and compare health care equity.

Key Words

Primary health care accessibility of health services Canada health care disparities outcome and process assessment (health care) 

Résumé

Objectif

: La mesure directe de l’accessibilité économique des soins de santé du point de vue de l’utilisateur est nécessaire pour surveiller l’équité d’accès aux soins de santé financé publiquement. Notre objectif est de développer une mesure d’accessibilité financière des soins de santé applicable au contexte canadien.

Méthodes

Les items potentiels ont été développés à partir de résultats de groupes de discussion explorant les obstacles et facilitateurs de l’accès durant le processus de consommation des soins. La version initiale de l’instrument a été administrée par téléphone à un échantillon de 750 répondants sélectionné au hasard dans des régions métropolitaines, rurales et éloignées du Québec. Après analyse, une nouvelle version auto-administrée a été envoyée à un sous-ensemble de participants. L’échelle mesure la fréquence de problèmes d’accès selon cinq dimensions d’accessibilité économique. Nous avons effectué des analyses factorielles exploratoires et confirmatoires. Des modèles de régression logistique ordinale ont été utilisés pour examiner la capacité prédictive de chaque item et du score de la sous-échelle en terme de difficultés d’accès. Nous avons testé pour la modification de l’effet par catégorie de revenu.

Résultats

Les cinq items de la sous-échelle se regroupent sur un seul facteur qui démontre une bonne cohérence interne (α = 0,77). Le score global, de 0 à 5, reflète la somme des problèmes d’accessibilité économique des soins de santé en raison des couts directs et indirects. Le score est sensible au statut économique des répondants, les problèmes d’accessibilité économique étant plus répandus chez les répondants ayant un faible revenu. Un accroissement du score de la sous-échelle prédit une propension accrue à déclarer des besoins non comblés (RC = 1,54), l’utilisation de soins d’urgence (RC = 1,41), et une aggravation de problèmes de santé due à des délais d’accès (RC = 1,80).

Discussion

Cette sous-échelle mesure de manière fiable et valide des obstacles économiques aux services médicalement nécessaires dans le système de santé canadien. Elle pourrait potentiellement être appliquée dans d’autres pays ayant des soins de santé financés par l’État. Il peut être utilisé pour surveiller et comparer l’équité des soins de santé.

Mots Clés

soins de santé primaires accessibilité aux services de santé; Canada disparités en soins de santé évaluation des processus et résultats (soins de santé) 

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Copyright information

© The Canadian Public Health Association 2015

Authors and Affiliations

  • Jeannie L. Haggerty
    • 1
    • 2
    Email author
  • Jean-Frédéric Levesque
    • 3
  1. 1.Department of Family MedicineMcGill UniversityMontrealCanada
  2. 2.Hayes Pavilion–Suite 3734St. Mary’s Hospital Research CentreMontrealCanada
  3. 3.Centre for Primary Health Care and EquityUniversity of New South WalesSydneyCanada

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