title: A comparison of health care in Canada and the United States: the case of Pap smears.
abstract: BACKGROUND
  Compliance with preventive care recommendations differs between countries. Directly comparable data are often not available. The recent release of the Joint Canada/United States Survey of Health makes available data for both Canadians and Americans.
  
  
  OBJECTIVE
  The health care systems in the United States and Canada differ quite dramatically. Canadians are covered by a universal health care system while residents of the United States, if they are insured, obtain their insurance from various private or public sources. This paper examines how the use of the Papanicolaou test (Pap smear) by women differs in the United States and Canada.
  
  
  METHODS
  American women are more likely than Canadians to receive a pap smear. A Blinder/Oaxaca type decomposition is used to determine influence of observed population characteristics and unobserved differences between the 2 countries on this gap.
  
  
  RESULTS
  The decomposition shows that the gap in Pap smears between Canada and the United States is not influenced by observed demographic differences. Most of the difference is attributable to unobserved heterogeneity or how women are treated in the 2 systems.
  
  
  CONCLUSIONS
  Although Canada has universal health coverage, the use of Pap smears is lower than that of all US women and equal to that of uninsured US women. Most of the differences in use of Pap smears is the result of differences in unobserved heterogeneity or the way that the systems treat women which may be a function of differences between the 2 health care systems in marketing, delivering, and reimbursing care.
authors.affiliation: Department of Economics, College of Business, University of Louisville, Kentucky 40292, USA. sfgohm01@louisville.edu
authors.forename: Stephan F
authors.initials: SF
authors.lastname: Gohmann
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D019472:Universal Health Insurance / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health; D014932:Women's Health Services / Q000706:statistics & numerical data; D055815:Young Adult