Lasser Karen E, Himmelstein David U, Woolhandler Steffie
Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass, USA.
Am J Public Health. 2006 Jul;96(7):1300-7. doi: 10.2105/AJPH.2004.059402. Epub 2006 May 30.
We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.
We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.
In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.
United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.
我们比较了美国和加拿大的健康状况、医疗服务可及性及医疗服务利用情况，并比较了种族、收入和移民身份方面的差异。
我们分析了加拿大/美国健康联合调查中3505名加拿大成年人和5183名美国成年人的基于人群的数据。在控制性别、年龄、收入、种族和移民身份的情况下，我们使用逻辑回归分析国家作为医疗服务可及性、医疗质量和医疗满意度的预测因素，以及这些指标差异的预测因素。
在多变量分析中，美国受访者（与加拿大人相比）拥有固定医生的可能性较小，未满足的健康需求可能性更大，放弃所需药物的可能性也更大。两国都存在基于种族、收入和移民身份的差异，但在美国更为极端。
美国居民比加拿大人更难获得医疗服务。全民医保似乎能减少医疗服务可及性方面的大多数差异。
