Provincial inequities of income-related home care: receipt of formal and informal care

Abstract

Background: Although physician and hospital services are universally accessible without user charges through the stipulations of the Canada Health Act (CHA), formal home care is not included in the CHA and may be subject to user charges, which vary across provinces. The user charges may result in differential substitutability with informal care across provinces according to an individual’s income. Objectives: The objective of this research is to understand if income is related to the probability of receipt of caregiving, formal or informal, in the community (excluding institutional care). It will also be investigated if and in what measure income-related horizontal inequity exists for the receipt of formal and informal care and if this relationship varies across provinces. Methods: This secondary analysis first specified a logic regression model for predicting the use of informal care and home care. After standardizing for need, a concentration index was computed to measure horizontal inequity, which was then decomposed to understand the contributing factors to the unequal distribution in the receipt of formal home care and informal care. Results: After controlling for need, pro-poor income-related horizontal inequity exists for the receipt of formal home care and informal care. Conclusions: Income-tested provincial user charges for home care may contribute to a greater utilization of home care among the poor, but it should be further investigated if there is an unequal distribution of informal caregiver burden that results from the substitution with informal care due to these user charges.