The effect of socioeconomic status on access to primary care: an audit study

I take issue with the unsupported claim that there is an "absence of economic incentives" to "discriminate against people of low socioeconomic status".

While reimbursement by OHIP is unaffected by patients' socioeconomic status, it is affected to a very high degree by the question of whether the putative patient actually shows up for the appointment.

While the concept may cause some hand-wringing among those who use the term "socioeconomic" with a straight face there is usually a reason why people of low socioeconomic status (defined in the paper as a "recipient of social assistance") are of low socioeconomic status: it's because as a group they may be described as disorganized, easily distracted, unreliable and less likely than middle-class bank employees to keep doctor's appointments after having made them. There are exceptions, to be sure. There are always exceptions.

A doctor who has scheduled time for an appointment not kept has suffered economic harm; thus, contrary to the paper's bald statement, there is economic incentive to make appointments with prospective patients most likely to keep them.

I am stunned that such an obvious rebuttal was not caught before publication. The authors may wish to apply for grants to study propensity to keep appointments by socioeconomic group.

Conflict of Interest:

None declared