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Canadians Healthier Than Americans, Survey Says

They have better access to health care while spending much less on it

TUESDAY, May 30, 2006 (HealthDay News) -- Canadians are healthier than Americans, have better access to health care and have fewer unmet health needs, a new study of both countries reveals.

The findings come in spite of the fact that the United States spends almost twice as much per capita on health care as Canada, the researchers noted.

"This shows that you can spend much less than we [Americans] do, and deliver much more and better care then we do," said study co-author Dr. David U. Himmelstein, an associate professor of medicine at Harvard Medical School in Cambridge, Mass.

The new study appears to reinforce the findings of a Rand Corporation report issued earlier this month that showed a similar health care gap between the U.S. system and that of Great Britain, which, like Canada, has a universal health care system -- subsidized by tax dollars.

In the current study, Himmelstein and his colleagues reviewed responses from more than 3,500 Canadians and almost 5,200 Americans over the age of 18 who participated in the Joint Canada/U.S. Survey of Health -- a one-time phone survey conducted between 2002 and 2003.

In addition to documenting race, class and immigrant status, the survey sought to assess each individual's current health status, access to health care, use of health care, history of illness, and ongoing behaviors -- such as smoking -- considered to be health risks.

Reporting in the July issue of the American Journal of Public Health, the researchers found that although Canadians smoke more than Americans, Americans are more likely to be inactive and obese, and have higher rates of diabetes, high blood pressure, arthritis and lung disease.

Specifically, Americans are one-third less likely to have a regular doctor, two times less likely to take needed medications, and one-fourth more likely to have unmet health care needs than Canadians.

While Americans were more likely to identify cost as the impediment to care, Canadians were more likely to cite waiting times as their main obstacle to good care. However, just 3.5 percent of Canadians were impacted by treatment delays, the survey found.

Despite generally better health and access to care, however, Canadians do not appear to be any happier with their health care system than Americans.

In fact, Americans said they were more satisfied than Canadians with the quality of care they received at either a hospital or a community-based facility. Canadians were happier with their physicians, however.

As well, American health care did excel in some areas compared to the Canadian system. For example, American women were more likely to have had a Pap smear and a mammogram than their Canadian counterparts.

Nevertheless, the American health system appears weakest in relation to the Canadian approach when it comes to caring for the uninsured.

Americans lacking insurance were found to have a much worse health care experience than both insured Americans, and (universally insured) Canadians. The survey found that nearly one in every three (30.4 percent) uninsured Americans had gone without some kind of needed care because of cost.

Overall, 7 percent of all U.S. residents cited cost as a barrier preventing them from getting needed care. That number was just 0.8 percent for Canadians.

The influence of wealth on access was also less acute in Canada, where poorer patients have better access to health care than low-income Americans.

In terms of race and health, non-whites in both countries were less satisfied with their health care than whites. However, racial differences in accessing care appear to be less drastic in Canada.

Based on the results, the researchers conclude that universal health care coverage should be implemented in the United States. But they also called for the health care community to improve services to the poor, and particularly the immigrant populations. They also urged reforms to prevent waiting-period issues that have impeded Canada's system.

Although this research indicts the American health care system, Himmelstein said he wanted to accent the positive.

"Actually it's a very hopeful message," he said. "We (Americans) have the best doctors, best hospitals, and best nurses in the world. But the way we finance healthcare just doesn't let us do the job. Given what we are now spending on our healthcare system, we can do better -- if we just had national health insurance and were allowed to do it right."

Jon Gabel, vice president of the Washington, D.C.-based non-partisan research organization Center for Studying Health System Change, said the absence of universal health coverage in the United States means patients don't get full access to care or better bang for their health-care buck.

However, Gabel noted that any between-country comparison depends in large part on whether the focus is on each system's "haves" or "have-nots".

"For example, once you're in the U.S. health-care system, patient satisfaction is higher than in Canada," he noted.

Greg Scandlen, the founder of the non-profit Consumers for Health Care Choices based in Hagerstown, Md., disputed the findings.

"In terms of overall satisfaction with the health care system, Americans score better," noted Scandlen. "So, the headline coming out of this ought to be that 'Americans are more satisfied with their healthcare system than Canadians are.'"

Scandlen also criticized the way the study was conducted, noting that there was too much focus on routine health issues, to the relative exclusion of crisis situations that can demand more costly and dramatic interventions.

"Canada clearly emphasizes primary care pretty strongly, and I give them credit for that," he said. But he added, "This survey doesn't look at the more serious stuff, like surgery and cardiac care -- serious, expensive things that apply to a minority of the population."

More information

For more on the U.S. healthcare system, head to the Kaiser Family Foundation.

SOURCES: David U. Himmelstein, M.D., associate professor, medicine, Harvard Medical School, Cambridge, Mass; Jon Gabel, vice president, Center for Studying Health System Change, Washington, D.C.; Greg Scandlen, founder, Consumers for Health Care Choices, Hagerstown, Md; July 2006 American Journal of Public Health.
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