Access to health care for economically disadvantaged Canadians: a model

In Canada, cultural, physical and structural barriers to the poor's accessibility to health care persist. The economically disadvantaged are clearly identified as a national high-risk target group because of poorer health status and health behaviours than higher-income Canadians. A four-component model is proposed to describe the complex, multivariate nature of access to health care for the economically disadvantaged. The mutual effects of characteristics of access and poverty are outlined and strategies to facilitate improved access are delineated and exemplified. Education, comprehensive and personalized care, consumer participation, and environmental strategies, while not uniquely applicable to the needs of the poor, may collectively constitute a reasonable approach to removing barriers to access to care for this vulnerable group. Furthermore, these four strategies are consistent with premises of primary health care and health promotion. While the model encompasses many relevant variables, it is neither exclusive nor all-inclusive. Further research is required to assess the linkage between specific elements of these four components and to conduct monetary and human cost-benefit analyses of recommended approaches.