Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Epidemiology and Biostatistics


Ali, Shehzad

2nd Supervisor

Thornton, Jane



Despite the promise of universal care, many Canadians report having unmet healthcare needs. We conducted two studies: (1) a systematic review of studies on social determinants of health (SDH) and unmet need; and (2) a secondary analysis using the Canadian Longitudinal Study on Aging (CLSA) to investigate the association of SDH and (2a) self-reported unmet need and (2b) having a family physician. The review (n=40) found a positive association between unmet need and lower income, mental health and chronic conditions, and negative association with older age, better perceived health and having a family physician. The CLSA analysis found the odds of having a family physician were >1 for older age, female sex, higher household income and having chronic conditions. The odds of having unmet need were >1 for younger age, female sex, non-white, low household income, poor health status, chronic conditions and not having a family physician. Policymakers need to consider these determinants to address system-wide barriers to healthcare access.

Summary for Lay Audience

Canada is one of the few countries with universal healthcare coverage. However, many Canadians experience difficulties accessing the services they need. Having a regular family physician allows people to be referred to specialists, receive timely checkups and have an unbroken chain of care. People without a family doctor, on the other hand, tend to attend walk-in clinics or go to emergency departments to receive medical care, placing strain on the healthcare system. In addition, they may not be provided the same level of care as those with a family doctor. Unmet health needs result when people needing medical care receive insufficient or no care. Prior research shows that factors, such as age, sex, income, and health status can be used to determine who is likely to have a family doctor and who is likely to have unmet health needs. While these research questions have been investigated by several Canadian studies, their findings have not been previously combined. Additionally, very few studies have focused on the aging population.

The main goal of this thesis was to examine the factors associated with having a family doctor and unmet health needs using two studies: (1) a study reviewing previously published Canadian studies, and (2) a study assessing the factors that factors associated with having a family doctor and unmet health needs in middle-aged and older Canadians. The systematic review study combined findings from 40 previously published Canadian studies and found that people with low income, mental health problems and chronic health conditions have higher unmet health needs while people who are older, in better health and have a family doctor have fewer unmet needs. The second study found that people who were older, female, had higher income and chronic health conditions were likely to have a family doctor. People who were younger, female, non-white, in poorer health, had lower income and did not have a family doctor were likely to have unmet health needs. Provincial and territorial governments and policymakers need to work together to improve Canadian’s access to a family doctor and reduce unmet needs.

Available for download on Friday, September 01, 2023