Canadians tend to lead longer, healthier lives than Americans on average, say researchers who point to lack of universal health care in the U.S. as one reason.The study in Thursday's online issue in BioMed Central's journal Population Health Metrics was based on data from the 2002-03 Joint Canada/United States Survey of Health, which offered comparable data on the health of the population in both countries.
'I think that Canadians can look at these results and get some affirmation that the investments that they have made in reducing inequality and in having a health-care system with universality have paid off.' — David Feeny
David Feeny, a dual Canadian/U.S. citizen and investigator at the Center for Health Research at Kaiser Permanente Northwest in Portland, Ore., and his U.S. colleagues calculated health-adjusted life expectancy, which takes into account not only mortality risk but also the health-related quality of life, such as being free of disability.
The study's authors found a 19-year-old in Canada could expect to enjoy 2.7 more years of perfect health than a 19-year-old in the U.S. In this case, someone in perfect health would have a top score of 1.00 on the Health Utilities Index Mark 3.
The index lowers an individual's score depending on their level of disability in eight areas: vision, hearing, speech, ambulation dexterity or ability to move, emotion, cognition, pain and discomfort. The lowest score is 0.00 for death.
About two-thirds of the gap was because mortality rates in Canada are lower and the remaining one-third was thanks to lower rates of morbidity or disease in Canada —differences Feeny called "quite substantial" with policy implications on both sides of the border.
"I think that Canadians can look at these results and get some affirmation that the investments that they have made in reducing inequality and in having a health-care system with universality have paid off," said Feeny, who worked for more than 30 years in Canada at McMaster University in Hamilton, Ont., and the University of Alberta in Edmonton.
"I think it underscores the need for additional vigilance on emerging issues such as child poverty in Canada that will eventually affect population health," he added.
The survey itself did not say why Canadians are healthier, but the study's authors pointed to two major potential explanations:
- Differences in access to care between the "prenatal to grave" health service offered by provinces and territories compared with the non-universal American access that is typically through employee coverage or Medicaid or Medicare for those with low incomes and seniors.
- The higher degree of social inequity that is more pronounced in the U.S., particularly among seniors.
What the U.S. team found is consistent with what most other studies have also concluded about the cost effectiveness and better outcomes in Canada, said Raisa Deber, a professor in the department of health policy, management and evaluation at the University of Toronto.
Barriers to access care
"I would suspect that a chunk of it is the ability to pick up chronic conditions while they are still treatable," Deber said.
For Canada, the results run contrary to the debate of starting user fees, both Deber and Feeny said.
"I think given that we're back to the debate about should we start having user fees, I would say this is evidence no we shouldn't because we don't have those sorts of gaps," Deber said.
Likewise, Feeny questioned the usefulness of user fees "for anything but raising revenue."
Its not possible to ascribe the differences in health care to the difficulty some Americans may face in trying to receive health insurance coverage because of a pre-existing health condition, but that is an example of a barrier to accessing care, Feeny said.
On Wednesday, three health insurers in the U.S. pledged to limit the circumstances under which they cancel coverage when a customer falls sick. UnitedHealth Group Inc., Humana Inc. and Blue Shield of California all said they will drop or rescind coverage only in cases where a patient has committed fraud or intentional misrepresentation.
For the U.S., the findings offer support for the health-care reform legislation that is coming online, Feeny said.
The study did not include people who are institutionalized, and the researchers consider their findings an underestimate given the poorer telephone response rate in the U.S. survey, 50.2 per cent, versus 65.5 per cent in Canada. People in poorer health may have been less likely to respond.
With files from The Associated Presswww.cbc.ca
