Visits to Family Physicians or Specialists by Elderly Persons in Canada and the United States: An Exploratory Comparative Study

Abstract

The objective of this exploratory study was to compare elderly persons' likelihood of visiting a family doctor/general practitioner or a medical specialist and the association of that likelihood with socioeconomic factors and health-related quality of life (a measure of perceived need) in Canada and the United States. The data were obtained from the 2002–2003 Joint Canada/United States Survey of Health. The main dependent measure was whether respondents saw a medical specialist or a general practitioner during their last health care visit. U.S. patients in the highest household income group were more likely to have seen a specialist during their last health care visit, after adjusting for potential confounding factors. Further, visits to a specialist in Canada were determined by need rather than by household income. In Canada, likelihood of specialist visits by elderly persons is systematically related to the burden of illness (need) and not systematically related to income. In the United States, the opposite is the case. These results suggest that there may be important lessons from Canada on the organization of health care services.

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References

Centers for Disease Control and Prevention and Merck Company Foundation. The State of Aging and Health in America 2007. Merck Company Foundation, Whitehouse Station, NJ, 2007.

Canadian Institutes of Health Research. CIHR Institute of Aging Strategic Plan 2006. www.cihr-irsc.gc.ca/e/34013.html (accessed August 10, 2007).

Iglehart

J. K.

Revisiting the Canadian health care system. N. Engl. J. Med. 342: 2007–2019, 2000.

Health Statistics Division. Access to Health Care Services in Canada. Catalogue 82-575-XIE. Statistics Canada, Ottawa, 2005.

Starfield

Shi

Macinko

Contribution of primary care to health systems and health. Milbank Q. 83:457–502, 2005.

Rothman

A. A.

Wagner

E. H.

Chronic illness management: What is the role of primary care?

Ann. Intern. Med. 138:256–261, 2003.

Harrold

L. R.

Field

T. S.

Gurwitz

J. H.

Knowledge, patterns of care, and outcomes of care for generalists and specialists. J. Gen. Intern. Med. 14:499–511, 1999.

Schoen

Taking the pulse of health care systems: Experiences of patients with health problems in six countries. Health Aff. (Millwood) W5:509–525, 2005.

Huynh

P. T.

The U.S. health care divide: Disparities in primary care experiences by income findings from the Commonwealth Fund 2004 International Health Policy Survey. April 2006. www.cmwf.org/usr_doc/Huynh_UShltcaredivide_900.pdf (accessed August 10, 2007).

10.

Health Canada. Canada's Health Care System at a Glance. www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2002/2002_care-soinsbk5_e.html (accessed January 14, 2008).

11.

Evans

Roos

N. P.

What is right about the Canadian health care system?

Milbank Q. 77:393–399, 1999.

12.

Statistics Canada, National Center for Health Statistics. Joint Canada/United States Survey of Health public use microdata file user guide. 2004. www.cdc.gov/nchs/about/major/nhis/jcush_mainpage.htm (accessed August 10, 2007).

13.

Feeny

D. H.

Multi-attribute and single-attribute utility functions for the Health Utilities Index Mark 3 System. Med. Care 40:113–128, 2002.

14.

Horsman

The Health Utilities Index (HUI): Concepts, measurement properties and applications. Health Qual. Life Outcomes 1:1–13, 2003.

15.

McDowell

Measuring Health: A Guide to Rating Scales and Questionnaires. Oxford University Press, New York, 2006.

16.

Feeny

Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: Group and individual-level comparisons. Soc. Sci. Med. 58:799–809, 2004.

17.

Grootendorst

Feeny

D. H.

Furlong

Health Utilities Index Mark 3: Evidence of construct validity for stroke and arthritis in a population health survey. Med. Care 38:290–299, 2000.

18.

Wilkins

Predictors of death in seniors. Health Rep. 16:57–67, 2006.

19.

Fisk

J. D.

Brown

M. G.

Sketris

I. S.

A comparison of health utility measures for the evaluation of multiple sclerosis treatments. J. Neurol. Neurosurg. Psychiatry 76:58–63, 2005.

20.

Jones

C. A.

Feeny

D. H.

Eng

Test-retest reliability of health utilities index scores: Evidence from hip fracture. Int. J. Technol. Assess. Health Care 21:393–398, 2005.

21.

Marra

C. A.

Are indirect utility measures reliable and responsive in rheumatoid arthritis patients?

Qual. Life Res. 14:1333–1344, 2005.

22.

SUDAAN, Version 9.0.1. Research Triangle Institute, Research Triangle Park, NC.

23.

Finkelstein

M. M.

Do factors other than need determine utilization of physicians' services in Ontario?

CMAJ 165(5):565–570, 2001.

24.

van Doorslaer

Masseria

Koolman

The OECD Health Equity Research Group: Inequalities in access to medical care by income in developed countries. CMAJ 174(2):177–183, 2006.

25.

van Doorslaer

Koolman

Puffer

Equity in the use of physician visits in OECD countries: Has equal treatment for equal need been achieved? In Measuring Up: Improving Health Systems Performance in OECD Countries, ed. OECD, pp. 225–248. OECD, Paris, 2002.

26.

U.S. Census Bureau, Current Population Reports, P23-209, 65+ in the United States: 2005. U.S. Government Printing Office, Washington, DC, 2005.

27.

Statistics Canada. CANSIM Database, Using E-STAT (distributor). http://estat.statcan.ca (accessed January 30, 2008).

28.

Arcury

T. A.

The effects of geography and spatial behavior on health care utilization among the residents of a rural region. Health Serv. Res. 40(1):135–155, 2005.

29.

Eichner

Vladeck

B. C.

Medicare as a catalyst for reducing health disparities. Health Aff. (Millwood) 24:365–375, 2005.

30.

Huguet

Kaplan

M. S.

Feeny

Socioeconomic status and health-related quality of life among elderly people: Results from the Joint Canada/United States Survey of Health. Soc. Sci. Med. 66:803–810, 2008.