Rethinking Access: A Social Work Perspective on Equity In Universal Health Care for Hispanics In Canada

Background and Purpose

Ensuring equitable access to health care is central to social work and to the functioning of systems intended to serve the common good. In Canada, universal health coverage is designed to provide access to medical services independent of ability to pay. However, equitable access to care extends beyond formal coverage and includes an individual’s ability to establish and maintain connection to the health system, particularly for racialized peoples. Hispanics represent a rapidly growing population in Canada, yet remain underexamined in national health services research. Understanding whether access to a regular medical doctor is equitably distributed across populations—and how it varies across social positions—is critical for evaluating how effectively publicly funded systems promote equity and inclusion. This study examines whether Hispanics in Canada experience differences in access to a regular medical doctor compared with non-Hispanic Whites (NHW) and evaluates how these patterns vary across social positions.

Methods

This population-based cross-sectional study used pooled data from the 2015–2018 Canadian Community Health Survey. The analytic sample included 177,071 adults aged 18 years and older. The outcome was self-reported having a regular medical doctor (yes/no), a widely used indicator of attachment to primary care. Ethnicity was categorized as Hispanic, NHW (reference), and other racialized groups. Sequential logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic, socioeconomic, health behavior, and psychosocial factors.

Results

Hispanics had significantly lower odds of having a regular medical doctor compared with NHWs. In fully adjusted models, Latin Americans had 65% lower odds of having a regular doctor (OR = 0.35, 95% CI: 0.27–0.45), corresponding to nearly threefold higher odds of lacking a provider. Disparities varied across social positions, with more pronounced inequities observed among lower-income groups, Canadian-born Hispanics, and longer-term immigrants. These findings suggest that inequities in attachment to primary care persist despite universal health insurance coverage.

Conclusions and Implications

Findings indicate that universal health coverage is necessary but insufficient to ensure equitable inclusion in health systems intended to serve the public, especially for racialized populations. Differences in having a regular medical doctor highlight how structural and social factors—such as socioeconomic inequality, immigration-related conditions, and challenges in system navigation—shape access to care. For social work, these results underscore a critical role in advancing health equity by addressing the conditions that influence how individuals engage with public systems. As a field grounded in person-in-environment and structural perspectives, social work is uniquely positioned to identify and address barriers to care, support system navigation, and advocate for policies that improve access for marginalized populations. Expanding access is only the first step; social work must also ensure that access translates into meaningful engagement and equity.