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Inequity of access

ics.55 This, of course, puts greater demands

vival rates for different types of illness, depending

on where patients live. The problem of unequal

on the U.S. health care system. Yet patients

to resources is

access is so well known in Britain that the press

diagnosed with either of these diseases have a

pervasive in

refers to the NHS as a "postcode lottery" in

better chance of survival.

Canada.

which a person's chances for timely, high-quality

treatment depend on the neighborhood or

Myth No. 5: Countries with

"postcode" in which he or she lives.58

National Health Insurance

Canadian officials also put a high premium

on equality of access to medical care. In 1999, for

Create Equal Access to

instance, Health Minister Allan Rock stated that

Health Care

"equal access regardless of financial means will

continue to be a cornerstone of our system."59

One of the most surprising features of

national health insurance systems is the enor-

How well have the Canadians done? A series of

mous amount of rhetoric devoted to the notion

studies from the University of British Columbia

of equality and the importance of achieving it--

in the 1990s consistently found widespread

especially in relation to the tiny amount of

inequality in the provision of care among British

progress that appears to have been made.

Columbia's 20 or so health regions. These stud-

Aneurin Bevan, father of the NHS, declared that

ies are unique because researchers identified

"everyone should be treated alike in the matter of

patients by the region in which they lived rather

medical care."56 But more than 30 years into the

than the region where they received care. This

allowed investigators to identify inequities in the

program (in the 1980s), an official task force (the

amount of care received by residents of each

Black Report) found little evidence that access to

region, including those patients forced to travel

health care was any more equal than when the

NHS was started.57 Almost 20 years later, a sec-

hundreds of miles (from one region to another)

for treatment.60

ond task force (the Acheson Report) found evi-

dence that access had become less equal in the

For example, the rural Peace River region

years between the two studies. Across a range of

of British Columbia spends much less per

indices, NHS performance figures have consis-

patient on specialists than Vancouver health

tently shown widening gaps between the best-

authorities. One might suppose the higher

performing and worst-performing hospitals and

level of GP services would offset the lower

health authorities, as well as vastly different sur-

level of specialist services in Peace River. As

Figure 9

Per Capita Spending on Physician Services in British Columbia

$410

Peace River

Vancouver

$199

$125

$106

Specialis ts

General Practitioners

Note: Figures are expressed in Canadian dollars and are age/sex standardized.

Source: Arminée Kazanjian et al., “Fee Practice Medical Expenditures Per Capita and Full-Time-Equivalent

Physicians in British Columbia, 1993–94,” University of British Columbia, 1995.

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