An evaluation of gender equity in different models of primary care practices in Ontario
Simone Dahrouge1,§, William Hogg1,2,3, Meltem Tuna1, Grant Russell1,2,3, Rose Anne Devlin3, Peter Tugwell3,4, Elisabeth Kristjansoon4
1 C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
2 University of Ottawa, Department of Family Medicine, Ottawa, Ontario, Canada
3 University of Ottawa, Department of Epidemiology and Community Medicine, Ottawa, Ontario, Canada
4 University of Ottawa, Institute of Population Health, Ottawa, Ontario, Canada
BMC Public Health March 2010, 10:151 doi:10.1186/1471-2458-10-151
Available online at: http://www.biomedcentral.com/1471-2458/10/151
PDF [28p.] at: http://www.biomedcentral.com/content/pdf/1471-2458-10-151.pdf
The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries.
The authors of this study performed this evaluation in Ontario where primary care models resulting from reforms co-exist.
Background
The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist.
Methods
This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based.
We compared the quality of care delivered to women and men in practices of each model.
We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n=5,361) and chart abstractions (n=4,108).
Results
Health service delivery measures were comparable in women and men, with differences < 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending Fee for service FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92).
There was no difference in the other three prevention indicators.Fee for service FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC).
Conclusions
The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in Fee for service FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued….”
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