"It turns out that once we condition on infant birthweight–a significant predictor of infant health–the U.S. has equivalent infant mortality rates. In fact U.S. infant mortality is lower for low-birthweight babies than Canadian infant mortality for low birthweight babies. Overall infant mortality, however, is higher in the U.S. because the incidence of babies with low birthweight is higher than in Canada."
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"Overall Mortality Differences
Why do Canadians live longer. One reason is due to the excess number of accidents and homicides in the U.S. compared to Canada. In fact 50%-85% of the mortality gap between American and Canadian adults in their twenties can be explained by the increased American accident/homicide rates. For people over 50, 30-50% of the difference in age-specific mortality rates can be attributed to the excess number of heart disease patients in the U.S. These heart disease findings are more likely driven by American lifestyle choices rather than the efficacy of the U.S. medical system.
Access to Care
Well, the medical efficiency of the two systems may not be so different but access to care must vary greatly, right? Canada has an egalitarian, socialist system while the U.S. relies (somewhat) on free-market capitalism to allocate medical services.
Below we see that Canada general has a lower disease incidence rate, but treatment rates are generally higher in the U.S. "
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Preventive Services
Probably the most surprising discovery of the paper was that Americans partake in more preventive care than Canadians.
* Mammograms: 88.6% of American females 40-69 had ever had a mammogram compared to 72.3% of Canadians.
* PAP smear: 86.3% of American females 20-69 had a PAP smear in the last 3 years compared to 75.1% of Canadians.
* Prostate screening: 54.2% of American men 40-69 had ever had a PSA test compared to 16.4% of Canadians.
As an economist, I attributed this finding to moral hazard: Canadians know that if they would get a disease that their government will pay for their care. Thus, they may be less motivated to ask for preventive services. One of my medical school colleagues noted, however, that physician recommendations also play a large part in the amount of care given. Further, most patients strongly wish to avoid disease, not simply due to cost considerations, but because of the physical and mental impact the disease would have on their life.
Conclusion
American are less healthy than Canadians. What this paper finds, however, is that this is mainly due to the fact that the U.S. has a higher incidence of disease. It turns out that Americans may have slightly higher access to treatment than Canadians. The paper is not the most smoothly written piece I have read, but the data is revealing. The small-ish sample size of the JCUSH mean that the results should not be taken as definative. Since the data set uses the same survey for both countries, however, the authors present convincing evidence that this cross-country comparison is of a high quality.
healthcare-economist.com |
