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Cancer screening inequities in a time of primary care reform: a population-based longitudinal study in Ontario, Canada.
- Source :
- BMC Family Practice; 8/29/2018, Vol. 19 Issue 1, pN.PAG-N.PAG, 1p, 8 Charts, 2 Graphs
- Publication Year :
- 2018
-
Abstract
- Background: Primary care has been reformed in recent years in Ontario, Canada, with a move away from traditional fee-for-service to enhanced fee-for-service and capitation-based models. It is unclear how new models have affected disparities in cancer screening. We evaluated whether Ontario’s enhanced fee-for-service model was associated with a change in the gaps in cancer screening for people living with low income and people who are foreign-born. Methods: We conducted a population-based longitudinal analysis from 2002 to 2013 of Ontario family physicians who transitioned from traditional fee-for-service to enhanced fee-for-service. The binary outcomes of interest were adherence to cervical, breast and colorectal cancer screening recommendations. Outcomes were analyzed using mixed-effects logistic regression. Analyses produced annual odds ratios comparing the odds of being up-to-date for screening among patients in enhanced fee-for-service versus patients in traditional fee-for-service for each social stratum separately. We calculated the ratios of stratum-specific odds ratios to assess whether the transition from traditional to enhanced fee-for-service was associated with a change in screening gaps between immigrants and long-term residents, and between people in the lowest and highest neighbourhood income quintiles. Results: Throughout the study period, cancer screening was consistently lower among immigrants and among people in the lowest income quintile. Transition to enhanced fee-for-service was generally associated with increased screening uptake for all, however for most years, ratios of ratios were significantly less than 1 for all three cancer screening types, indicating that there was a widening of the screening gap between immigrants and long-term residents and between people living in the lowest vs. highest income quintile associated with transitions. Conclusion: The transition to enhanced fee-for-service in Ontario was generally associated with a widening of screening inequities for foreign-born and low-income patients. [ABSTRACT FROM AUTHOR]
- Subjects :
- BREAST tumor diagnosis
RECTUM tumors
COLON tumors
CERVIX uteri tumors
EARLY detection of cancer
HEALTH care reform
HEALTH services accessibility
HEALTH status indicators
IMMIGRANTS
LONGITUDINAL method
GENERAL practitioners
PRIMARY health care
LOGISTIC regression analysis
RESIDENTIAL patterns
SOCIOECONOMIC factors
FEE for service (Medical fees)
ODDS ratio
DIAGNOSIS
ECONOMICS
Subjects
Details
- Language :
- English
- ISSN :
- 14712296
- Volume :
- 19
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Family Practice
- Publication Type :
- Academic Journal
- Accession number :
- 131488041
- Full Text :
- https://doi.org/10.1186/s12875-018-0827-1