Investigators at the University of Michigan Medical School, Ann Arbor, Mich., compared two health surveys released in the early 1990s to assess differences in use of preventive services (such as breast and cervical cancer screening), hospital admissions, and outpatient visits between residents of Ontario, Canada and those of the Midwestern and Northeastern United States.

The investigators tested the hypothesis that many of the differences in health care use in Canada and the United States were due to socioeconomic factors and other population characteristics rather than differences between the two health care systems.

Key Findings

In several publications, the investigators reported their key findings:

• Women with higher incomes in both the United States and Canada were more likely to receive breast and cervical cancer screening despite Canada's universal health insurance coverage of its citizens.
• Higher physician-visit rates among healthy Canadians reflect greater access to primary health care, which is the result of minimal out-of-pocket costs for patients combined with a much larger network of general practitioners than in the United States.
• The researchers concluded that in the United States, the presence of illness triggers a level of physician care that exceeds that in Ontario — at least among the nonpoor. Higher visit rates in the United States among the sick nonpoor might reflect a more aggressive practice style among US physicians, greater demand for service among American patients, or both.

The investigators had their work published in several peer-reviewed journals including the Journal of the American Medical Association and the American Journal of Public Health.

Funding

The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $49,998 between September 1993 and September 1994.