United States-Canadian Study of Doctor Visits

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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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