Challenges and opportunities for primary care and health equity in the age of technology

From Healthy Debate

There is no doubt primary care plays a vital role in reducing health inequities. Health systems with strong primary care have been shown in multiple studies to lower both the absolute numbers and the gap between people with low and high incomes when it comes to neonatal mortality, babies with low birth weight and deaths from cancer, stroke, heart and lung disease, while increasing life expectancy at the population level.

Even though health care in Canada is publicly funded, individuals with low incomes too often face barriers when it comes to accessing health-care services, which can adversely impact their overall health. For instance, the life expectancy in Montreal’s poorest neighbourhoods is 10 years shorter than in the richest ones, due to an interplay of unfavourable health determinants, including access barriers to primary-care services that are influenced by cultural, economic and educational factors. For example, recent data from Ontario found that people living in the poorest neighborhoods were the least likely to have a regular family doctor. The COVID-19 pandemic illustrated how low income – and other social determinants of health – coalesced with poor access to services; together these were associated with communities having higher numbers of COVID-19 cases, hospitalizations and deaths.

At the same time, the COVID-19 pandemic has significantly accelerated the adoption of virtual care in Canada, leading to major investments by the federal government and the emergence of multiple privately operated virtual-only services, some of which are not part of the publicly funded system.

But income plays a significant role in virtual care adoption and interest.

According to the OurCare survey, 69 per cent of individuals with an income of $150,000 or more say that they are not at all or not very willing to use virtual services that charge fees for services they could obtain for free through regular doctor or nurse practitioner visits. In comparison, 88 per cent of those with an income less than $20,000 say the same. If improperly regulated, the development of new private-pay virtual care services could potentially exacerbate existing disparities in access to care.

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