Evaluating unmet need and access to a family physician in a universal health system: a national analysis using the Canadian Longitudinal Study of Aging

The Canadian health care system was founded on the principle of universal access to care. However, recent reports have ranked the country among the lowest performing high-income health systems in terms of access to care and health equity. This study investigates the determinants of access to care in older Canadian adults using a nationally representative survey. This cross-sectional study used data from the Canadian Longitudinal Study of Aging (N = 41,135) to examine the determinants of two indicators of healthcare access: self-report of having a family physician and unmet need of care. Multivariable logistic regression models were used to evaluate the association between these indicators and sociodemographic determinants. Approximately 1 in 30 of the survey participants (aged ≥ 45 years at baseline) did not have a family physician, and 8% reported having unmet need for healthcare. The odds of having a family physician were higher for individuals who were older (≥ 55 years), female, had higher income (≥$100,000), poorer perceived mental health, or had ≥1 chronic condition. The odds of reporting unmet need were higher for individuals who were younger (45-54 years), female, non-white, had lower income (<$50,000), poorer perceived health status and had ≥2 chronic conditions. Despite progress over recent years, access to healthcare remains a challenge for older Canadians, particularly those who are socially disadvantaged. Tailored policy interventions are needed to reduce unmet need in the aging Canadian population.