Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.
OBJECTIVE
We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.


METHODS
We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.


RESULTS
In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.


CONCLUSIONS
United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.
Lasser
Karen E
KE
Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass, USA. klasser@challiance.org
Himmelstein
David U
DU
Woolhandler
Steffie
S
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D004641:Emigration and Immigration; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D007182:Income; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000208:ethnology; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D019472:Universal Health Insurance