Skip to main content

Table 5 Health service delivery across socio-economic groups and between practice models

From: Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

 

Salaried

Fee-for-service

New capitation

Established capitation

Duration of visit

Overall mean (minutes)

24

15

15

15

Estimated effect – Beta (95% CI)a

Low income b

3.1 (-0.7, 7.0)

1.1 (-1.3, 3.4)

0.5 (-1.8, 2.8)

-0.3 (-2.6, 2.0)

Low education c

-1.3 (-7.1, 4.5)

-0.8 (-3.1, 1.5)

0.1 (-2.0, 2.3)

-0.1 (-2.1, 1.9)

Low income and education

0.2 (-4.9, 5.3)

0.7 (-2.7, 4.2)

1.0 (-2.1, 4.1)

0.1 (-3.4, 3.6)

Number of visits per year

Overall mean (# visits)

8.3

7.2

5.3

4.8

Estimated effect – Beta (95% CI)a

Low income

7.0 ( 4.8, 9.2 )

3.5 ( 1.6, 5.3 )

1.4 ( 0.2, 2.6 )

1.6 ( 0.5, 2.6 )

Low education

3.6 ( 0.3, 6.9 )

4.2 ( 2.3, 6.0 )

1.1 ( 0.0, 2.3 )

1.2 ( 0.3, 2.2 )

Low income and education

5.4 ( 2.4, 8.4 )

3.7 ( 1.0, 6.3 )

0.9 (-0.7, 2.5)

1.7 ( 0.1, 3.3 )

Estimated yearly visits for the typical patient d

No risk factor

7.0

7.3

5.8

4.9

Low income

14.0

10.7

7.2

6.5

Low education

10.6

11.4

7.0

6.2

Low income and education

12.4

10.9

6.7

6.6

Primary care assessment tool – Overall e

Mean overall score

86%

86%

86%

88%

Estimated effect – Beta (95% CI)a

Low income

-0.6 (-2.2, 1.1)

0.0 (-2.0, 2.0)

-0.8 (-2.8, 1.2)

1.0 (-1.0, 2.9)

Low education

0.5 (-1.9, 2.9)

1.8 (-0.2, 3.8)

-0.5 (-2.3, 1.4)

0.6 (-1.1, 2.3)

Low income and education

1.5(-0.6, 3.7)

3.9 ( 1.0, 6.7 )

3.0 ( 0.4, 5.7 )

2.1 (-0.8, 4.9)

Primary care assessment tool - Individual scales f

Effect of low income and low education– Beta (95% CI)a

First Contact Accessibility

-2.3 (-6.1, 1.6)

8.7 ( 3.7, 13.8 )

1.7 (-3.0, 6.5)

3.1 (-1.3, 7.4)

First Contact Utilization

-1.2 (-3.1, 0.6)

-1.1 (-3.2, 1.0)

0.3 (-2.0, 2.6)

0.6 (-1.7, 2.9)

Cultural competency

2.2 (-1.3, 5.8)

2.4 (-2.6, 7.4)

3.4 (-1.5, 8.2)

1.3 (-4.6, 7.1)

Family Centered Care

2.5 (-0.3, 5.2)

2.9 (-1.1, 6.9)

4.4 ( 0.8, 7.9 )

2.3 (-2.0, 6.5)

Relational Continuity

5.1 ( 1.8, 8.5 )

5.1 ( 1.3, 9.0 )

5.3 ( 1.5, 9.2 )

2.0 (-1.9, 5.9)

Humanism

-0.5 (-3.3, 2.3)

1.8 (-1.9, 5.5)

4.9 ( 1.1, 8.7 )

1.8 (-2.6, 6.2)

Trust

-0.1 (-2.8, 2.7)

1.7 (-2.0, 5.5)

2.3 (-1.3, 5.9)

-0.2 (-4.1, 3.8)

Health promotion - Discussed at least one subject g

Low income

1.3 (0.6, 1.8)

1.1 (0.7, 1.8)

1.3 (0. 8, 2.1)

1.2 (0.6, 1.8)

Low education

0.7 (0.4, 1.2)

0.9 (0.6, 1.5)

1.1 (0.7, 1.7)

0.9 (0.6, 0.4)

Low income and education

1.7 ( 1.0, 2.8 )

0.8 (0.4, 1.7)

1.2 (0.6, 2.2)

0.9 (0.4, 2.0)

Discussed healthy foods g

    

Low income

1.3 (0.9, 1.9)

0.8 (0.4, 1.5)

1.0 (0.5, 1.8)

0.8 (0.4, 1.6)

Low education

0.7 (0.4, 1.4)

0.7 (0.4, 1.4)

0.8 (0.5, 1.5)

1.1 (0.6, 1.9)

Low income and education

1.4 (0.8, 2.3)

1.0 (0.4, 2.5)

1.1 (0.5, 2.3)

0.5 (0.1, 1.7)

Discussed home safety g

    

Low income

1.3 (0.6, 2.7)

3.9 (1.4, 10.5)

6.7 ( 2.1, 21.2 )

1.0 (0.2, 4.4)

Low education

1.0 (0.3, 3.5)

4.9 ( 1.9, 12.7 )

2.8 (0.8, 10.2)

0.9 (0.3, 3.2)

Low income and education

2.4 ( 1.1, 5.5 )

2.2 (0.5, 10.7)

1.9 (0.2, 16.3)

2.0 (0.4, 9.8)

Discussed family conflict g

    

Low income

1.2 (0.8, 2)

2.7 ( 1.3, 5.4 )

1.7 (0.9, 3.3)

2.1 ( 1.1, 4.2 )

Low education

1.0 (0.5, 2.3)

1.6 (0.7, 3.5)

1.0 (0.4, 2.4)

0.6 (0.3, 1.5)

Low income and education

1.4 (0.7, 2.7)

1.7 (0.5, 5.2)

2.3 ( 1.0, 5.4 )

0.7 (0.2, 3)

Discussed exercise g

    

Low income

1.2 (0.8, 1.7)

0.9 (0.6, 1.6)

1.0 (0.6, 1.8)

0.7 (0.4, 1.3)

Low education

0.5 (0.3, 1.0)

0.7 (0.4, 1.2)

0.9 (0.6, 1.5)

0.7 (0.4, 1.3)

Low income and education

0.7 (0.4, 1.2)

1.2 (0.6, 2.3)

0.9 (0.4, 2.1)

1.0 (0.5, 2.1)

Discussed smoking g

    

Low income

0.8 (0.5, 1.3)

1.8 (1.0, 3.2)

1.0 (0.5, 2.0)

1.3 (0.7, 2.4)

Low education

1.2 (0.5, 2.5)

1.3 (0.7, 2.5)

1.6 (0.9, 2.9)

0.7 (0.3, 1.4)

Low income and education

1.7 (0.9, 3.0)

1.4 (0.6, 3.5)

2.1 (1.0, 4.6)

1.2 (0.5, 3.4)

Discussed alcohol g

    

Low income

0.8 (0.5, 1.4)

0.3 (0.1, 1.3)

0.4 (0.1, 1.1)

1.3 (0.6, 2.9)

Low education

0.4 (0.1, 1.1)

0.6 (0.2, 1.6)

0.9 (0.5, 1.9)

0.6 (0.2, 1.5)

Low income and education

0.7 (0.3, 1.5)

2.1 (0.7, 6.4)

0.8 (0.3, 2.4)

2.5 (0.9, 7.4)

Overall mean frequency of discussing at least one subject h

1.19

0.83

0.93

0.84

  1. Bolded numbers = Statistically significant (p < 0.05) difference across socio-economic groups.
  2. Italics = Statistically significant (p < 0.05) difference between practice models.
  3. aIndividuals living above the LICO and with at least a high school education make up the reference category. The model was adjusted for socio-demographic factors only (Demog in Table 4).
  4. bLow income is defined as falling below LICO (Table 3). The average income group makes up the reference category, and includes all patients with annual incomes above the LICO.
  5. cLow education is defined as not having completed high school. The average education group makes up the reference category, and includes all patients with secondary school diplomas.
  6. dDerived from regression betas. A typical patient is a woman, ages 30–65, living in a non-rural region, where travel distance to the nearest hospital is less than 10 kilometres.
  7. eSummary score for first contact accessibility and utilization, cultural competency, family centered care, and ongoing care/relational continuity.
  8. fThe effect sizes for individuals living below LICO and with low education only are shown. The effect sizes for individuals with low income only and or low education only did not exceed 3% in either direction (results now shown).
  9. gThe Odds Ratio of having discussed that subject across a socio-economic group.
  10. hOverall mean frequency of discussing any one of the subjects included in the analysis during any visit within the study’s parameters.
  11. Definitions: First contact accessibility is the ability to obtain patient-initiated needed care from the provider of choice within a time frame appropriate to the urgency of the problem; first contact utilization is the extent to which the provider/practice is first used for various types of problems; cultural competency is the extent to which providers integrate cultural considerations into communication, assessment, diagnosis and treatment planning; family-centered care is the extent to which providers consider the family (in all its expressions), understand its influence on a person’s health and engage it as a partner in ongoing health care; relational continuity is a therapeutic relationship between a patient or client and one or more identified providers that spans separate health care episodes and delivers care that is consistent with the patient’s or client’s biopsychosocial needs; humanism is an approach to medicine that emphasizes the relationship between caregiver and patient; trust is the degree to which patients or clients believe that their provider will care for patients’ or clients’ best interests (adapted from Haggerty et al.) [36].