The Geographies of Crisis: Exploring Accessibility to Health Care in Canada

By Wilson, Kathleen; Rosenberg, Mark W. | The Canadian Geographer, Fall 2002 | Go to article overview

The Geographies of Crisis: Exploring Accessibility to Health Care in Canada


Wilson, Kathleen, Rosenberg, Mark W., The Canadian Geographer


De plus en plus de Canadiens s'inquietent que leur systeme de soins de sante soit en etat de crise. On defend l'idee selon laquelle la reduction des paiements de transfert aux provinces par le gouvernement federal serait responsable de l'etat d'un systeme de sante caracterise par un sous-financement dans les domaines-cles et des decisions politiques de sante basees, non pas sur les besoins des membres de la societe canadienne, mais sur la fiscalite provinciale. Les gouvernements provinciaux ont reagi a la reduction du financement federal par une tactique de restructuration agressive (fermeture d'hopitaux et retrait de services medicaux des programmes d'assurance de sante provinciaux). Selon les medias, les groupes de consommateurs et meme les chercheurs en soins de sante, cette restructuration a eu pour effet un systeme en etat de `crise' (diminution de l'acces aux services, longues listes d'attente, hopitaux surcharges, augmentation des couts des medicaments etc). Un des themes recurrent est celui des decisions fiscales de toutes sortes qui entrainent une baisse de l'accessibilite financiere et geographique. Cette accessibilite est pourtant un des cinq principes de la Loi canadienne sur la sante definissant l'essence meme du systeme de sante au Canada. Utilisant les donnees tirees de l'Enquete nationale sur la sante de la population, 1998-99 et examinant l'acces aux services de sante et les obstacles rencontres dans les 10 provinces canadiennes, cet article evalue dans quelle mesure une crise d'accessibilite existe au sein du systeme de sante canadien. Les resultats demontrent qu'environ 6.0 pour cent des Canadiens ont rencontre des problemes d'accessibilite, avec des variantes allant de 4.5 pour cent a Terre-Neuve jusqu'a 8.3 pour cent au Manitoba. On observe aussi des variantes regionales dans les obstacles rencontres. L'accessbilite geographique en particulier semble un obstacle majeur dans les regions de l'Atlantique, alors que l'accessibilite financiere semble etre un obstacle majeur dans l'Ouest du Canada. Ces resultats sont presentes dans le contexte des debats actuels sur l'existence d'une `crise' dans le systeme de sante au Canada.

Mots-cles: Soins de sante, accessibilite, geographies de la crise

Introduction

Human geographers have long been concerned with issues of geographic accessibility. In health geography, access to health care services has consistently been identified as a key theme of research (Mayer 1982; Meade et al. 1988; Rosenberg 1998; Meade and Earickson 2000). Within Canada, accessibility takes on special meaning for geographers in general, health geographers in particular and most critically to all Canadians because of the fifth principle of the 1984 Canada Health Act (CHA).

The CHA is the only piece of Federal legislation that governs health care delivery in the provinces and territories. According to the CHA, all provinces and territories in Canada must abide by five principles in order to receive federal funds: universality; comprehensiveness; portability; public administration; and accessibility. The underlying sentiment of `accessibility' in the CHA is to ensure access to medically necessary health care services for all Canadians regardless of ability to pay. In fact, the act states that to meet the requirements of accessibility, provincial health insurance plans "must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons."

Some researchers have argued that the CHA is unclear in its discussion of what constitutes `reasonable access' to medically necessary services (e.g., Eyles et al. 1995). However, recently, Health Canada has distinguished between two types of reasonable access--economic and physical (Health Canada 2000). According to Health Canada, economic accessibility refers to the provision of health care services without financial charges, either direct or indirect. …

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