Give Me Your Tired, Your Poor… But Tell Them to get Healthcare in Canada

Although no longer mandatory thanks to the Supreme Court decision in National Federation of Business v. Sebelius, the Affordable Care Act (ACA) was originally intended to reduce barriers to Medicaid for less privileged individuals by raising the federal Medicaid limit to those households up to 133 percent of the federal poverty line. To study the extent of some of these barriers, Yuriy Pylypchuk and Eric Sarpong recently completed a study utilizing two nationally representative surveys: the Medical Expenditure Panel Survey (MEPS) for the US and the Canadian Community Health Survey (CCHS) for Canada. The study compared healthcare utilization rates between the US and Canada for different income segments, education levels, and foreign-born versus native residents.

Among the general populations, the authors found that many measures of health were similar. However, Americans had higher rates of arthritis (five percentage points) and of high blood pressure (11 percentage points) than their Canadian counterparts. There were also noticeable differences in healthcare utilization between the general populations. For instance, individuals in the US were 18 percentage points less likely to have a regular medical doctor and 20 percentage points less likely to have visited a specialist within the last 12 months.

Despite the disparity in access to providers, the authors argue that the US actually utilizes preventative health care measures at a higher rate. As evidence, they show that individuals in the US are 17 percentage points and 12 percentage points more likely to have had a mammogram in their lifetime or a pap smear in the past 12 months, respectively. However, these results are not likely to be representative as they apply only to women.

The largest disparities arise when considering different segments of the US and Canadian populations. Among individuals with less than a high school degree, US residents were 33 percentage points less likely than similar Canadians to have a regular medical doctor, while Americans with some college or a college degree were only 14 percentage points less likely to have a regular medical doctor. There were similar results for having a regular medical doctor when considering income segments. Those who had negative earnings in the US were 31 percentage points less likely to have a regular medical doctor, and individuals making less than $20,000 were 24 percentage points less likely to have a medical doctor. For foreign-born residents, individuals in the US were 31-32 percentage points less likely to have a medical doctor than their Canadian equivalents.

In some cases, utilization rates among wealthy Americans were higher than the comparative category in Canada. For example, when considering dental visits, wealthy Americans (incomes greater than $59,0000) were six percentage points more likely to have visited a provider within the last 12 months, while the poorest segment was eight percentage points less likely to have visited a provider. Also, there were large disparities in the usage of preventative healthcare. Although the wealthiest Americans were 21 percentage points more likely to have had a mammogram, the poorest were only nine percentage points more likely.

The authors limited the study to individuals under 65, so we cannot see the effects of Medicare. Also, it does not appear that those individuals who are poorest in America benefitted much from Medicaid, but it would have been interesting to use an indicator for Medicaid enrollment status to discern any positive health effects from increased access to healthcare. Additionally, the study does not identify if the foreign-born immigrants it studies are legal or illegal immigrants, which, especially in America, would have had a large effect on individuals’ ability to receive healthcare. Still, a follow up study noting any changes from the expansion in Medicaid in some states will be an interesting comparison group to this study, and will enable discernment of any positive effects.

Feature Photo: cc/David Paul Ohmer