摘要：Objectives. We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. Methods. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures. Results. In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States. Conclusions. United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care. Canada, with a system of universal health insurance, spends about half as much on health care per capita as does the United States, yet Canadians live 2 to 3 years longer. 1 Few population-based data are available on health habits and processes of care in the 2 countries that might explain this paradox. Blendon et al. 2 found that both US residents and Canadians were dissatisfied with their health care systems, that low-income US residents reported more problems obtaining care than their peers in 4 other English-speaking countries (Australia, Canada, New Zealand, and the United Kingdom), and that quality-of-care ratings were similar in the 5 countries. 3 Among other studies, some, 4 but not all, 5 have found better health care quality in Canada. Socioeconomic inequalities in health, commonly perceived as pervasive in the United States, seem less stark in Canada. 2 , 6 – 10 We analyzed population-based data from the recently released Joint Canada/US Survey of Health (JCUSH) to compare health status, access to care, and health care utilization in the 2 countries. We also sought to explore whether universal health insurance can mitigate disparities in health 11 , 12 —a question complicated by differences in race, poverty, and immigrant status in the 2 nations.
