International Health Care Systems

U.S. vs. Canada: Health outcomes and heart disease

This blog has posted frequently on comparisons between the U.S. and Canadian healthcare systems (see here, here, here and here).  Although there are many points of contention, it is clear that the Canadian system is less expensive than the American.  According to the OECD, in 2006 Canada spent $3,678 per person on health care and the U.S. spent $6,714.  From this additional expense, do Americans receive better health outcomes?

A paper by Pozen and Cutler (2010) examines this question for individuals with heart disease.  Using data from the Joint Canada-U.S. Survey of Health between 2002 and 2003, the authors compare health outcomes between Americans and Canadians who are aged aged 45 and older and who have heart disease.  “Past analyses using these data have found that wealthier Americans and Canadians report similar overall health status, while poorer Americans report worse health status than poorer Canadians.”

The results of the study are as follows:

Being Canadian was positively associated with fair or poor health, but negatively associated with disability and functional impairment. None of these coefficients, however, was statistically significant from zero at the 5 percent level (though the coefficient on disability was significant at the 10 percent level). Results that were significant in some cases were income, education, and risk factors such as hypertension and smoking status.

One problem with this simple analysis is that Canadians may simply be more or less optimistic about their health state than Americans.  If could be the case that Canadians report poor health even though–based on objective measures—they may have the same quality health.  A difference in difference estimate would be useful where one could compare the health self-reports of clinically healthy Canadians and clinically healthy Americans and see if the health self-report difference is higher or lower for cohorts in each country with heart disease.

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