A groundbreaking observational study conducted in Ontario, Canada, reveals a profound and concerning barrier in accessing primary healthcare: the geographical distance between patients and their family physicians. Published in the Canadian Medical Association Journal (CMAJ), this research specifically investigates how residing more than 30 kilometers from a family doctor negatively impacts patients’ healthcare utilization patterns and quality of care outcomes. Housing nearly ten million patients’ data as of March 31, 2023, this large-scale analysis challenges the notion that proximity to healthcare providers is merely a convenience, underscoring it as an essential determinant of equitable health service access.
Over the past decade, Canada has witnessed a steady decline in primary care availability, a trend that has been exacerbated by the COVID-19 pandemic. This decline has sharpened the focus on structural challenges in healthcare systems, including the physical reachability of health services. Notably, patients often continue to seek care from their established family physicians even after relocating farther away, enduring longer travel distances rather than switching providers. This underlines the significance of continuity in patient-doctor relationships but simultaneously exposes how distance acts as a deterrent to optimal health engagement.
Dr. Archna Gupta, a family physician and scientist affiliated with St. Michael’s Hospital and Upstream Lab in Toronto, spearheaded the study. Gupta emphasizes that geographical distance constitutes a fundamental parameter influencing healthcare utilization. The study quantifies distance as a critical factor that may enhance or hinder medical service uptake, reinforcing the perspective that physical accessibility needs to be integrated into health policy frameworks as a measurable determinant of care quality and delivery.
Findings from this extensive cross-sectional analysis demonstrate that approximately 13% of Ontarians live more than 30 kilometers away from their family physician. This subgroup exhibited distinctly different healthcare behaviors and outcomes, characterized by an increased likelihood of visiting emergency departments (ED) for nonurgent needs. Such usage patterns indicate potential shortcomings in effective primary care engagement, as nonurgent ED visits often reflect gaps in accessible routine medical services. Additionally, this population had fewer appointments with family physicians during the preceding two years, suggesting barriers in obtaining preventative and ongoing care.
Demographically, patients residing farther away from their primary care doctors tended to be younger males under 65, dwellers in low-income neighborhoods, and newcomers to Ontario. These factors point to an intersection of social determinants that compound health inequities. Lower income status and immigrant populations already face systemic challenges in healthcare navigation, and added geographical hurdles exacerbate disparities, affecting overall public health outcomes.
Particularly concerning was the revelation that patients living over 150 kilometers from their primary care providers had the highest odds of nonurgent emergency department visits. This finding illuminates a gradient effect, where greater distance correlates with deteriorating access and increased reliance on acute care settings. Moreover, the frequency of physician visits inversely correlated with distance, reinforcing a causal link between separation from care sources and decreased primary healthcare utilization, which could predispose patients to more severe and costly health episodes.
Preventive healthcare outcomes were notably compromised among those at greater distances, as evidenced by lower rates of participation in routine cancer screenings, including colorectal, breast, and cervical cancer checks. Preventive screening is a cornerstone of reducing morbidity and mortality from cancer, and its underutilization suggests that physical barriers translate directly into delayed diagnosis and worsened prognoses. These findings highlight the ripple effects distance creates throughout the healthcare continuum, from preventive to curative care levels.
The study challenges policymakers to reconceptualize healthcare planning by embedding geographic distance as a non-negligible metric within health equity and access frameworks. Prioritizing the distribution and availability of primary care services such that no patient must routinely travel more than 30 kilometers could fundamentally reshape utilization patterns, alleviate emergency department pressures, and improve population health metrics. The authors argue for reforms aimed at systematic deployment of family physicians in underserved, geographically isolated areas to improve equitable healthcare access.
Additionally, the research elucidates the complex behavioral economics underlying healthcare engagement. Patients’ willingness to travel long distances to maintain existing physician relationships hints at a strong preference and trust in continuity of care, juxtaposed against the practical inconveniences of distance. This duality suggests future models of care might integrate telemedicine and decentralized healthcare hubs to bridge distances without sacrificing relational continuity or care quality.
This investigation contributes essential empirical evidence to the discourse on healthcare disparities and accessibility, demonstrating how spatial parameters influence utilization and health outcomes. It underscores the multidimensional nature of health equity, compelling integrated approaches that simultaneously address socioeconomic, demographic, and geographic barriers. The comprehensive data set from Ontario illuminates patterns likely reflective of other regions with similar urban-rural divides and healthcare workforce distributions.
Furthermore, the study’s methodology is robust, leveraging observational data from an extensive patient cohort, allowing researchers to capture real-world patient behaviors and healthcare usage across diverse populations. This enhances generalizability and the applicability of findings beyond Ontario, potentially informing international health systems grappling with equitable primary care distribution.
As healthcare systems globally confront growing demands and resource constraints, findings from this study emphasize that strategic placement and access optimization of primary care providers are not merely logistical concerns but foundational to population health and cost-effective care. Reduction in avoidable emergency department visits through enhanced primary care proximity could free critical resources and reduce systemic health inequities.
In summary, this critical research delineates an urgent need to address geographical barriers in primary care accessibility. It shows that distance is more than a physical measurement—it is a social determinant that materially impacts patient health outcomes and service utilization. By prioritizing healthcare delivery reforms grounded in spatial equity, policymakers can foster resilient health systems where care becomes truly accessible, equitable, and patient-centered for all Ontarians and beyond.
Subject of Research: People
Article Title: Distance to primary care and its association with health care use and quality of care in Ontario: a cross-sectional study
News Publication Date: 3-Nov-2025
Web References:
– https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250265
– http://dx.doi.org/10.1503/cmaj.250265
References: Canadian Medical Association Journal, DOI: 10.1503/cmaj.250265
Keywords: Family medicine, Health care, Health disparity, Health equity, Health care delivery, Emergency medicine, Health care costs, Preventive medicine
