Scream this from the rooftops, a continuing series

by on September 22, 2007 at 7:35 am in Medicine | Permalink

Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

Here is the paper (can anyone find a non-gated version?), which offers many other interesting points of comparison between the two systems.  Here are previous installments in the series.

Jeff September 22, 2007 at 10:13 am

another couple key sentences:

“The U.S. health care system is often critiqued by noting that health expenditures in the U.S. are the highest among the OECD countries—twice as high on a per capita basis as Canada’s”

and

“Briefly, our findings are: No significant differences are evident in the four health status indicators available in the JCUSH data.”

So the Canadian system produces the same results at half the cost and the implicit criticism is that it is not producing better results for half the price, as some claim?

Ironman September 22, 2007 at 10:58 am

The steeper Canadian health expenditure vs income with respect to the U.S. should be expected given Canada’s position with respect to the U.S. on the S-shaped curve that describes the relationship between these two factors – see this graph (from this post).

Tyler Cowen September 22, 2007 at 11:06 am

The point is this: you can present a health care plan for greater government involvement and argue: “This will save the United States on the cost side.” This claim can then be argued on its merits. But if you argue: “A single payer system will give us fairer health outcomes” — and yes that is a major, major claim made in these debates — this result is a big ouch. A big, big ouch. The temptation is to conclude “the Canadian system is still good enough for me” without in the meantime engaging in the necessary revision of beliefs about fairness. The reality is that for most advocates of single-payer systems equity is a major motivation, maybe the major motivation (along with supposedly better outcomes in the absolute sense), and ex post people try to find ways to make it affordable, make up on savings elsewhere (e.g., preventive care), raise taxes, and so on.

Mike Huben September 22, 2007 at 11:49 am

Tyler, can you cite some actual measurement of motivations, or is that just your personal opinion?

My personal motivation is not equity in the sense of fairness or in the sense of equality. It’s fear: fear of personally not having access to needed health care for myself. That fear is one thing that drives me to continuous employment, and of course it locks many others with pre-existing conditions into their current employment.

thehova September 22, 2007 at 12:16 pm

Tyler:”But if you argue: “A single payer system will give us fairer health outcomes” — and yes that is a major, major claim made in these debates — this result is a big ouch. A big, big ouch.”

Where Michael Moore starts to make sense to me (and he almost never does) is his argument that uninsured people put off visiting a doctor when indicators of serious illness (a lump, for example) appear.

Now will they fall into economic ruin by visiting a doctor to check out a suspicious lump. No. and there are safety nets in place (medicaid, high deductible insurance plans) to protect one if the lump turns out to be cancer.

But that doesn’t really matter, because uninsured people put off visiting doctors. And I’m not sure if Tyler’s quote above takes this into consideration.

juancarlos September 22, 2007 at 2:13 pm
Jeff September 22, 2007 at 2:28 pm

Tyler, among all the blather in my previous posts I have a genuine question:

If infant mortality and life expectancy can be dismissed by the authors as methods for judging a health care system because they are affected by many factors other than the system, why is it logically acceptable to then use self-reported, 4-categories-available, “poor/good/very good/or excellent” “health status” as a basis for judging the system, when someone’s “health status” has to be subject to other factors as well?

So “health status” is a legitimate variable to compare across socioeconomic strata to judge health care, while life expectancy and infant mortality are dismissed (and in the latter case directly linked to the # of blacks in the US)?

The authors seem to cherry-pick play with their data until they get the result they like.

Is there really no harder data on which to base socioeconomic health care results than regression analysis of a 4-box survey?
Is this study typical of economic research?
It seems very lazy and specious to me.

Tom West September 23, 2007 at 11:59 am

“A single payer system will give us fairer health outcomes”

I suspect that many people (being one of them) are really thinking

A single payer system will give us fairer access to health services

To be honest, I think process is far more important in most people’s mind’s than outcome, which is very hard to meaningfully measure in any case.

kvn September 24, 2007 at 2:26 am

“Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.”
~ Isn’t it possible that this just reflects the fact that wealthier people in either country tend to take better care of themselves? It probably has more to do with lifestyle habits. Wealthier people tend to exercise and eat better than the less wealthy. Why this is more true in Canada might be due to any number of factors that don’t relate to their national health care system.

Ricardo September 24, 2007 at 6:25 pm

You cannot compare self-reported health (SRH) across two different countries. Even in the US, it has been shown that Hispanics show much lower SRH values than other ethnicities despite having better (or at least as good) health outcomes when measured by more objective variables.

Funny, when they used HUI (a more comparable measure of health) they found “In the HUI regression results the gradient is weaker in Canada than in the US and not statistically significant”, but of course they chose not to mention this result in their abstract…

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