Equality in medical care under national health insurance in Montreal

N Engl J Med. 1980 Jul 3;303(1):10-5. doi: 10.1056/NEJM198007033030103.


In November 1974, four years after national health insurance in Canada had eliminated all out-of-pocket payment for physicians' services, we surveyed 1559 households in a socially heterogeneous area of Montreal to assess social-class differences in the use of physicians' services. When reported health status as well as age and sex were taken into account, the rates of physician visits during the two-week period preceding the survey were essentially the same in the low, middle, and high economic classes, thus confirming that disparity of access had been reduced. However, relative to other groups, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter observations may indicate that the poor, as compared with other groups consulted the doctor for more advanced conditions. Official statistics showed no increase in the workload of the average physician, although the number of physician visits per person per year had risen steadily. There was no evidence of abuse of "free" medical care by the poor.

MeSH terms

  • Data Collection
  • Health Services Accessibility / economics*
  • Health Services Misuse / trends
  • Hospitals / statistics & numerical data
  • Humans
  • Income
  • Insurance, Health / economics
  • Insurance, Physician Services / economics*
  • National Health Programs*
  • Personal Health Services / statistics & numerical data*
  • Quebec
  • Social Class*
  • Social Justice
  • Socioeconomic Factors