Access and Satisfaction with Health Care in Canada and the United States

Presenter: Stephan Gohmann, University of Louisville

Abstract

Rationale: Recent studies comparing health access in Canada and the United States have found that US residents are less likely to have access to a regular physician, more likely to have unmet health needs and more likely to forgo medications. However, those in the US are more likely to find the quality of health care to be better.

Objectives: Since the health care systems in the United States and Canada differ in the way residents are covered for health care, their access to care and perceptions of quality are likely to differ. This paper examines the differences between these two groups.

Methodology: Access and quality perceptions are determined by demographic variables as well as the type of treatment provided in the US and Canadian health care systems. Logistic regressions are estimated to predict the probability of access (satisfaction) for Canadian and American residents. We calculate descriptive statistics to examine differences in means between Canadians and Americans and use logit regressions to examine difference in the effects of these characteristics between the two groups. We perform a Blinder/Oaxaca type decomposition to determine the influence of each characteristic on the estimated probabilities. The methodology follows that of Fairlie(1999, 2005).

Results: The Canadians tend to be healthier than the Americans, more likely to smoke, be white, and lead a sedentary lifestyle. They are less likely to suffer from hypertension, arthritis, and less likely to have a college degree. Significant differences between Canadians and Americans occur in several of the access and quality variables. These include having a regular doctor (90% Canada, 83% US), needing medicines but not being able to afford them (7% Canada, 12% US), having a dental visit last year (53% Canada, 63% US), rating quality of service as excellent (36% Canada, 40% US), and being very satisfied with health care services (42% Canada, 53% US). For these variables, the percentage of the differences that can be explained by the observable characteristics is as high as 30 percent. The reminaing differences are attributable to unobserved characteristics or differences in the health care systems.

Conclusions: Although the Canadian health system results in greater access to care, the perceptions of the quality and satisfaction with the services is lower than that in the US. Observalble characterisitcs of individuals in these systems do not provide much information about why the differences occur. The results must be attributed to either non-observable individual characteristics or differences in the health care systems.