Access to physician treatment for a mental disorder: a regional analysis

Background: This study examined (1) disparities in the proportion of person s who accessed a physician for treatment of a diagnosed mental disorder acr oss 17 health regions in Alberta, Canada, and (2) the extent to which regio nal disparities in physician access could be explained by differences in re gional demographies, population needs, or physician supply. Methods: The st udy illustrates the use of ecological comparisons for regional health syste m performance evaluations. Regional characteristics were aggregated from fo ur sources of data: the health insurance registry file (population denomina tors and regional demographies), physician claims data (treatment access), census data (social indicators of population need), and the medical directo ry of the College of Physicians of Surgeons (physician supply). Results: Re gional variability in needs-adjusted measures of access to physician-based treatment services were comparatively small (varying by a factor of 1.6). M odels containing adjustments for demography, need, and physician supply exp lained 41% of regional variation in access. Of the total variation explaine d, physician supply explained a smaller proportion (39%) in comparison to s ocial demography and needs (61%). Few large regional imbalances were noted when needs-adjusted and supply-adjusted estimates were compared. Only two a reas appeared to be underserviced in comparison to their local needs, refle cting approximately 6% of the provincial population. Conclusions: While all three study factors proved important, findings support the broad conclusio n that social demography and social risk (a proxy for need) will remain the key determinants predicting access to physician services for treatment of mental disorders in publicly funded health systems.