- Gregory P. MarchildonEmail author,
Affiliated with
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Tarun R. Katapally,
- Caroline A. Beck,
- Sylvia Abonyi,
- JoAnn Episkenew,
- Punam Pahwa PhD and
- James A. Dosman
International Journal for Equity in HealthThe official journal of the International Society for Equity in Health201514:148
DOI: 10.1186/s12939-015-0279-3
© Marchildon et al. 2015
Received: 6 August 2015
Accepted: 8 December 2015
Published: 18 December 2015
Abstract
Background
In settler societies such as
Australia, Canada, New Zealand and the United States, health inequities
drive lower health status and poorer health outcomes in Indigenous
populations. This research unravels the dense complexity of how
historical policy decisions in Canada can influence inequities in health
care access in the 21st century through a case study on the
diagnosis and treatment of obstructive sleep apnea (OSA). In Canada,
historically rooted policy regimes determine current discrepancies in
health care policy, and in turn, shape current health insurance coverage
and physician decisions in terms of diagnosis and treatment of OSA, a
clinical condition that is associated with considerable morbidity in
Canada.
Methods
This qualitative study was
based in Saskatchewan, a Western Canadian province which has
proportionately one of the largest provincial populations of an
Indigenous subpopulation (status Indians) which is the focus of this
study. The study began with determining approaches to OSA care provision
based on Canadian Thoracic Society guidelines for referral, diagnosis
and treatment of sleep disordered breathing. Thereafter, health policy
determining health benefits coverage and program differences between
status Indians and other Canadians were ascertained. Finally,
respirologists who specialized in sleep medicine were interviewed. All
interviews were audio-recorded and the transcripts were thematically
analyzed using NVIVO.
Results
In terms of access and
provision of OSA care, different patient pathways emerged for status
Indians in comparison with other Canadians. Using Saskatchewan as a case
study, the preliminary evidence suggests that status Indians face
significant barriers in accessing diagnostic and treatment services for
OSA in a timely manner.
Conclusions
In order to confirm initial
findings, further investigations are required in other Canadian
jurisdictions. Moreover, as other clinical conditions could share
similar features of health care access and provision of health benefits
coverage, this policy analysis could be replicated in other provincial
and territorial health care systems across Canada, and other settler
nations where there are differential health coverage arrangements for
Indigenous peoples.