Canada's single-payer health-care system is often said to be more equitable than the American system with its greater reliance on private-sector provision and payment. Because all Canadians have equal access to health-care services irrespective of ability to pay, it is widely believed that health outcomes are distributed more evenly across socio-economic groups in Canada than in the United States. But is this in fact the case?
An analytical approach to this question would look at correlation between personal income and personal health status in the two countries. If the hypothesis that Canada’s system is more equitable is correct, one would expect to observe a closer relationship between income and health in the US compared to Canada.
The Joint Canada/US Survey of Health (JCUSH) conducted in 2002-2003 under the direction of Statistics Canada and the US National Center for Health Statistics gathered the data necessary to examine this issue. A working paper from the National Bureau of Economic Research compares heath status in the two countries based on these data. The paper is entitled “Health Status, Health Care, and Inequality: Canada vs. the U.S.” by June E. O’Neill and Dave M. O’Neill, both of Baruch College.
The analysis shows that the data do not support the hypothesis that Canada’s health care system is more equitable than that of the US. Not only is health status in Canada no more evenly distributed than in the US, the analysis indicates that Canada is actually slightly less equitable than the US.
Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is more prominent in Canada than it is in the U.S. The need to ration when care is delivered “free” ultimately leads to long waits or unavailable services and to unmet needs. In the U.S. costs are more often a source of unmet needs. But costs may be more easily overcome than the absence of services. When asked about satisfaction with health services and the ranking of the quality of services recently received, more U.S. residents than Canadians respond that they are fully satisfied and rank quality of care as excellent.
The paper’s abstract is posted here; the full paper can be purchased for US$5 via a link at the same page. (The above quote is from p. 17 of the full paper.)
Statistics Canada’s summary of findings from the JCUSH is posted here. The National Center for Health Statistics has a portal to the survey here. The official JCUSH analytical report can be downloaded here or here.
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