Income-Related Inequities in Primary and Specialist Care Among First Nations Peoples Living Off-Reserve in Canada.

Background: Improving equity in healthcare is a primary goal of health policy in Canada. Although the investigation of equity in healthcare utilization is common in the general population, little research has been conducted to assess equity in healthcare utilization within First Nations peoples living in Canada.

Objective: To examine income-related inequities in primary care (family doctor/general practitioner and nurse practitioner care) and specialist care within status and non-status First Nations adults living off-reserve.

Methods: Using the 2017 Aboriginal Peoples Survey (APS), a nationally representative survey of Indigenous peoples living off-reserve in Canada, we analyzed income-related inequities in healthcare among Indigenous adults (>18 years) who self-identified as a member of any First Nations group in Canada. Logistic regression analysis was performed to identify factors associated with the utilization of primary and specialist care. The Horizontal Inequity index (HI), which measures unequal healthcare use by income for equal need, was used to quantify and decompose income-related inequities for primary and specialist care for status and non-status, and total First Nations groups.

Results: The regression results revealed higher primary and specialist care use among females, high socioeconomic status (high income and more educated) and status First Nations peoples in Canada. The positive values of the HI suggested a higher concentration of primary care and specialist care utilization among higher income First Nations peoples after adjusting for healthcare need. These pro-rich inequities persisted for the total First Nations populations, and for those in each status group individually. The decomposition results suggested observed inequities in both primary and specialist care among First Nations peoples can be predominantly attributed to the unequal distribution of education and income.

Conclusion: Although primary and specialist services in Canada are free at the point of the provision, we found pro-rich inequities in healthcare use among First Nations adults living off-reserve in Canada. These results warrant policies and initiatives to address barriers to healthcare use within and outside health system among low-income First Nations peoples living off-reserve.