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Health Status, Health Care and Inequality: Canada vs. the U.S


  • June E. O'Neill
  • Dave M. O'Neill


Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs. We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

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  • June E. O'Neill & Dave M. O'Neill, 2007. "Health Status, Health Care and Inequality: Canada vs. the U.S," NBER Working Papers 13429, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:13429
    Note: HC HE

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    References listed on IDEAS

    1. Theodore Joyce, 1994. "Self-Selection, Prenatal Care, and Birthweight among Blacks, Whites, and Hispanics in New York City," Journal of Human Resources, University of Wisconsin Press, vol. 29(3), pages 762-794.
    2. Michaud Pierre-Carl & van Soest Arthur H.O. & Andreyeva Tatiana, 2007. "Cross-Country Variation in Obesity Patterns among Older Americans and Europeans," Forum for Health Economics & Policy, De Gruyter, vol. 10(2), pages 1-32, December.
    3. Kaestner, Robert & Joyce, Theodore & Wehbeh, Hassan, 1996. "The Effect of Maternal Drug Use on Birth Weight: Measurement Error in Binary Variables," Economic Inquiry, Western Economic Association International, vol. 34(4), pages 617-629, October.
    4. Janet Currie & Jonathan Gruber, 1994. "Saving Babies: The Efficacy and Cost of Recent Expansions of Medicaid Eligibility for Pregnant Women," NBER Working Papers 4644, National Bureau of Economic Research, Inc.
    5. Joyce, Theodore & Grossman, Michael, 1990. "The dynamic relationship between low birthweight and induced abortion in New York City : An aggregate time-series analysis," Journal of Health Economics, Elsevier, vol. 9(3), pages 273-288, November.
    6. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    7. Hope Corman & Theodore J. Joyce & Michael Grossman, 1987. "Birth Outcome Production Function in the United States," Journal of Human Resources, University of Wisconsin Press, vol. 22(3), pages 339-360.
    8. Corman, Hope & Grossman, Michael, 1985. "Determinants of neonatal mortality rates in the U.S. : A reduced form model," Journal of Health Economics, Elsevier, vol. 4(3), pages 213-236, September.
    9. repec:aph:ajpbhl:2002:92:8:1323-1330_3 is not listed on IDEAS
    10. Hope Corman & Theodore J. Joyce & Michael Grossman, 1985. "Birth Outcome Production Functions in the U.S," NBER Working Papers 1729, National Bureau of Economic Research, Inc.
    11. Theodore Joyce & Andrew D. Racine & Sandra McCalla & Hassan Wehbeh, 1994. "The Impact of Prenatal Exposure to Cocaine on Newborn Costs and Length of Stay," NBER Working Papers 4673, National Bureau of Economic Research, Inc.
    12. Sandra L. Decker & Dahlia K. Remler, 2004. "How Much Might Universal Health Insurance Reduce Socioeconomic Disparities in Health? A Comparison of the US and Canada," NBER Working Papers 10715, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Duclos, Jean-Yves & Échevin, Damien, 2011. "Health and income: A robust comparison of Canada and the US," Journal of Health Economics, Elsevier, vol. 30(2), pages 293-302, March.

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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