Americans are less healthy and have more problems despite spending nearly twice as much per capita as Canadians do for health care
Boston (14 July 2006) - A study by Harvard Medical School researchers concludes that U.S. residents are less healthy than Canadians, experience more problems getting health care and have more unmet health needs despite spending nearly twice as much per capita on health care.
The study, reported in the July, 2006 issue of the American Journal of Public Health, analyzes the results of a joint Canada-U.S. study carried out by the national statistical agencies for each country, Statistics Canada and the U.S. Census Bureau.
The authors report that U.S. residents were less healthy than Canadians, and had higher rates of nearly every serious chronic disease examined, including diabetes, arthritis, and chronic lung disease.
U.S. residents also had more high blood pressure (18% of U.S. residents versus only 14% for Canadians). American rates of obesity and sedentary lifestyle were also higher; with 21% of U.S. respondents reporting obesity versus 15% of Canadians. However, U.S. residents were slightly less likely to smoke.
Clear advantage
Canadians had better access to most types of medical care (with the single exception of pap smears).
Canadians were 7% more likely to have a regular doctor and 19% less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9% of U.S. respondents couldn't afford medicine vs. 5.1% in Canada).
The availability of doctors to respondents was also assessed. After taking into account income, age, sex, race and immigrant status, Canadians were 33% more likely to have a regular doctor and 27% less likely to have an unmet health need. For each of these measures, the average Canadian did about as well as insured U.S. residents.
Race and income disparities, although present in both countries, were larger in the U.S.
Notably, both white and non-white Canadians had fewer unmet health needs than white U.S. residents. After taking into account income, age, sex, race and immigrant status, poor U.S. residents (making less than $20,000 per year) were 2.6 times less likely to have a regular doctor than the affluent ( those making $70,000 or more). In Canada, the poor were only 1.7 times less likely.
Cost biggest U.S. barrier
In the U.S., cost was the largest barrier to care. More than seven times as many U.S. residents reported going without needed care due to cost as Canadians (7.0% of U.S. respondents vs. 0.8% of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4% reported having an unmet health need due to cost.
Dr. Karen Lasser, the lead author of the report and a primary care doctor at Cambridge Health Alliance and Instructor of Medicine at Harvard, commented:
"Most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures. But we found that waiting times affect few patients, only 3.5% of Canadians vs. 0.7% of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada. Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down," she said.
"These findings raise serious questions about what we're getting for the $2.1 trillion we're spending on health care this year," added Dr. David Himmelstein, Associate Professor of Medicine at Harvard and study co-author. "We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live 2 to 3 years longer."
Universal national coverage the key
Dr. Steffie Woolhandler, also an Associate Professor of Medicine at Harvard and co-author of the study, concluded:
"Universal coverage under a national health insurance system is key to improving health. It's striking that both whites and non-whites do better in Canada. A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. How much longer must we wait?"
Statistics Canada surveyed 3,506 Canadians for the data used in the study by the Harvard experts. The U.S. Census Bureau surveyed 5,183 Americans. NUPGE
More information:
• Access to Care, Health Status and Health
• Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey - pdf
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