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Vancouver, BC, Canada: University of British Columbia (doctoral dissertation).
University of British Columbia, Vancouver, BC, Canada
The objectives of this thesis are to identify equity objectives in the stated intentions of the health care system in British Columbia, and then to assess the extent to which the system appears to be meeting those objectives.
The primary equity principle that emerges through an historical review of legislation and policy documents is the intent to deliver hospital and physician services based on need rather than ability to pay. A principle of equity that is equally important but gets much less attention is a separation between contributions to financing and the use of physician and hospital services. More contentious is how that financing should be shared across income groups.
An analysis of health status, health care services use and health care financing in British Columbia in 1992 and 2002 shows that, as expected, health status increases with increasing income. Health care services are largely provided according to need, though the use of surgical day care services became more likely among higher income groups over that decade. In contrast, admission to an acute inpatient facility is more likely for lower-income individuals; lower income groups also use more inpatient acute services, on average, once admitted.
Financing for the physician and hospital sectors in B.C. comes from general tax revenues. There were many changes in taxes during this decade; nevertheless, contributions to health care financing were distributed across income groups in about the same way in 1992 and 2002. The analyses here show the tax system is only mildly progressive, meaning that higher income groups contribute only a slightly higher proportion of income to taxes. This finding is at odds with the perception of the general public, which appears to believe that physician and hospital services are (and should be) financed through progressive taxation, more like what is seen with income taxes.
Further changes in the physician and hospital sectors and in the health care system overall have the potential to erode equity currently in the system. If there is a commitment to principles of equity, better measures and more monitoring of achievements will be important as these changes continue.
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