Family practice
Volume 36, Issue 4, 2019, Pages 445-451

Impact of health care reform on enrolment of immigrants in primary care in Ontario, Canada (Article)

Batista R. , Pottie K.C. , Dahrouge S. , Manuel D.G. , Tanuseputro P. , Mark A.E. , Ng E.
  • a Institute for Clinical Evaluative Sciences, Ottawa, Canada, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
  • b Elizabeth Bruyere Research Institute, University of Ottawa, Ottawa, Canada
  • c Institute for Clinical Evaluative Sciences, Ottawa, Canada, Elizabeth Bruyere Research Institute, University of Ottawa, Ottawa, Canada
  • d Institute for Clinical Evaluative Sciences, Ottawa, Canada, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
  • e Institute for Clinical Evaluative Sciences, Ottawa, Canada, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
  • f Institute for Clinical Evaluative Sciences, Ottawa, Canada
  • g Health Analysis Division, Statistics Canada, Ottawa, Canada

Abstract

OBJECTIVES: In 2003, Ontario introduced a patient enrolment system as part of health care reforms, aimed at enhancing primary health care services, but it is unclear whether immigrants have benefited from this health care reform. Therefore, we studied whether this reform changed the extent of immigrants' enrolment in primary care services in Ontario between 2003 and 2012. METHODS: This is a population-based retrospective cohort study, in which a closed cohort of 9231840 Ontario residents between 1985 and 2003 was created, using linked health administrative and immigration databases. Levels of enrolment for traditional and more comprehensive capitation-based practice between 2003 and 2012 were compared by immigrant status. Logistic regression modelling was used to assess the odds of enrolment on primary care practices. RESULTS: Overall enrolment in primary care practices increased gradually after 2004, until 2012, when two-thirds of the cohort (67%) were enrolled. The immigrants' enrolment level remained consistently lower than that of long-term residents over the study period. By 2012, enrolment of immigrants in capitation-based models was significantly lower (17.3% versus 25.4%). In particular, enrolment in Family Health Teams, considered the most comprehensive care model, was considerably lower in immigrants compared with long-term residents (5.6% versus 18.0%; OR = 0.40, 95% CI: 0.40 to 0.41). CONCLUSIONS: Immigrant enrolment rates in new comprehensive primary care models were consistently lower than among long-term residents. This has implication on equitable primary care access for immigrant populations. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].

Author Keywords

patient enrolment immigrants Primary health care Ontario Access to care health equity

Index Keywords

male case report female human immigrant cohort analysis adult retrospective study family health clinical article health equity health care policy resident Article Ontario immigration primary health care
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85070935022&doi=10.1093%2ffampra%2fcmy082&partnerID=40&md5=5fdc1a9f687c32c88ce0849e69cf8f10
DOI: 10.1093/fampra/cmy082
ISSN: 14602229
Original Language: English