Is access to care worse in US than in Canada?

The major advocates for a single-payer health insurance system in the United States released the results of the Joint Canada/US Survey of Health offering support for their belief the US should model is health care system after Canada’s. This large random telephone survey of non-institutionalized adults provide population-based data about access to care, health status, and health disparities in the US and Canada. The data reveal that Americans tend to more often be obese (21% vs. 15%) and sedentary (14% vs. 7%). Diabetes, hypertension, arthritis, and COPD are also slightly more prevalent in American society.

Unadjusted analyses demonstrated that Americans are less likely to have a regular medical doctor (79.6% vs. 84.9%; p<0.0001) but are more likely than Canadians to have gotten a recent PAP smear (88.9 vs. 79.0%; p<0.0001) or mammogram (88.8% vs. 81.3%; p=0.003). Americans tend to describe more unmet health needs secondary to cost (7% vs. 0.8%; p<0.0001), but fewer do to waiting times (0.7% vs. 3.5%; p=<0.0001), compared to their Canadian counterparts. In data not shown, Americans with insurance fared better than Canadians while Americans without insurance fared worse on many of the study’s measures of access to care.

Commentary:

While it appears that Americans have worse health status as noted by higher rates of certain chronic diseases, certain process measures – i.e. cervical and breast cancer screening – are better followed in the US than in Canada. And while at first glance Americans have significantly more unmet health needs due to financial reasons, the authors do not show us the data comparing insured Americans versus Canadians. Is this because insured Americans have better access to care than Canadians? Poor response rates (69% in Canada and 50% in the US) limit the validity of this study. Finally, we should be cautious about data presented by authors who are ideologically invested in one particular strategy (single-payer health insurance) for health reform in the United States.

AJPH 96; 7: 1300-1307.

by

Cedric K. Dark, MD, MPH