High income is strongly associated with the ability of seniors to access a healthcare specialist in the United States – but not in Canada, where poor health is a much stronger predicter, according to a new study.
The study, published in the January issue of the International Journal of Health Services found that elderly Americans in the top 40 percent of income distribution are nearly twice as likely as those in the bottom 20 percent to visit a specialist. In Canada, the study found no statistically significant association between income and specialist visits.
“This study points out an inequity between the U.S. and Canadian healthcare systems,” says David Feeny, PhD, co-author of the study and a professor emeritus at the University of Alberta in Canada. “Both systems have government financed health insurance for the elderly, but in the U.S. the likelihood of visiting a specialist appears to be related to income, while in Canada it appears to be related to need or burden of illness.”
“This finding is especially important in the context of national healthcare reform,” said Mark Kaplan, lead author and professor of community health at Portland State University in Portland, Ore. “Even though they have Medicare coverage, some of the sickest Americans may not be able to afford the extra out-of-pocket expenses associated with seeing a specialist.”
The study, using data collected in 2002-03 by Statistics Canada and the U.S. National Center for Health Statistics survey, focused on 755 elderly Canadians and 1,151 elderly Americans who were asked if they had seen a doctor in the past 12 months and if their most recent visit was with a family doctor (general practitioner) or a medical specialist.
The survey collected demographic, socioeconomic, and health status information. The authors used statistical modeling to determine which factors were strongly associated with doctor visits.
Findings of the study include:
- In the United States, respondents with household incomes of $50,000 or more (top 40 percent of income distribution) were nearly twice as likely as those with household incomes of less than $30,000 (bottom 20 percent of income distribution) to have seen a specialist.
- In Canada, poor health – as measured by the Health Utilities Index – was strongly associated with having seen a specialist.
- Nearly the same percentage of elderly people in the United States (81.6 percent) and Canada (78.8 percent) had seen a physician in the past year.
- A greater percentage of U.S. respondents (25.6 percent) had seen a specialist, compared to Canadians (16.4 percent). The authors said this might be explained by the gatekeeper system in Canada, where a referral from a general practitioner or family doctor is required to see a specialist.
- In Canada there are almost the same number of specialists and general practitioners, while more than two-thirds of U.S. doctors are specialists.