Social determinants of access to timely elective surgery in Ontario, Canada: a cross-sectional population level study

Abstract

T imely access to surgical care is a global problem. In Canada, poor access is often experienced with long wait times for surgical care. 1 Increased surgical wait times negatively affect patient satisfaction, increase health care costs and are associated with poorer health outcomes. 1,2 Given that wait times may vary according to patient and community characteristics, 3 it is crucial to understand the distribution of wait times across socioeconomic segments. These data shed light on the equity dimension of timely access to surgical care. The Commission on Social Deter­ minants of Health report emphasized the impact of the cir­ cumstances in which people are "born, grow, live and work" on health. 4 The causal pathway between social determinants and health is complex; however, social disadvantage is strongly associated with reduced access to care and poorer health outcomes. 5,6 In health care systems in which out­of­ pocket or private health insurance is the norm, direct eco­ nomic barriers to accessing care are clear. We hypothesized that the negative consequence of social disadvantage related to surgical wait times would be mitigated in publicly funded universal health care systems such as those in Canadian provinces and territories. There is a gap in understanding the association between social determinants and access to timely surgical care in Canada. Given the ethical, legal and policy importance of equitable access to surgical care, we sought to investigate the association between social disadvantage and wait times for elective surgical procedures in Ontario. Background: Equitable access to surgical care has clinical and policy implications. We assess the association between social dis­ advantage and wait times for elective surgical procedures in Ontario.