High income is strongly associated with elderly people seeing a specialist in the United States, but not in Canada, where poor health is a much stronger predictor of who is able to visit a specialist. Those are the findings of a new study published in the January 2010 issue of the International Journal of Health Services. The study found that elderly Americans in the top 40% of the income distribution were nearly twice as likely to visit a specialist as those in the bottom 20%. The study found that in Canada, there was no statistically significant association between income and specialist visits.
“This study points out an inequity between the US and Canadian healthcare sytems,” says David Feeny, PhD, co-author of the study and Professor Emeritus, University of Alberta. “Both systems have government financed health insurance for the elderly, but in the United States the likelihood of visiting a specialist appears to be related to income, while in Canada it appears to be related to need or burden of illness.”
“This finding is especially important in the context of national healthcare reform,” says lead author Mark Kaplan, DrPH, professor of community health at Portland State University in Oregon. “Even though they have Medicare coverage, some of the sickest Americans may not be able to afford the extra out-of-pocket expenses associated with seeing a specialist.”
The study used data collected in a 2002/2003 survey conducted by Statistics Canada and the US National Center for Health Statistics. Nearly the same percentage of elderly people in the United States (81.6%) and Canada (78.8%) had seen any type of physician in the past year. However, the greater percentage of respondents who had seen a specialist were US citizens at 25.6% as compared to the 16.4% of Canadians. The authors suggest that this might be explained by the gatekeeper system in Canada, where a referral from a general practitioner or family doctor is required to see a specialist. In Canada, there are also nearly an equal number of specialists and general practitioners; in the United States, more than two thirds of doctors are specialists. Study limitations include a lower response rate in the United States than Canada, and that the study relied on self-reported data could have been influenced by socially desirable responses.
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