Socioeconomic Status and Utilization of Health Care Services in Canada and the United States

Findings from a Binational Health Survey

This article compares the effect of socioeconomic status on consumption of health care services in Canada and the United States. Canada offers universal health care, while the United States has a more complex mix of private and public insurance, and previous research has indicated that socioeconomic status is more likely to effect health care use in the United States than in Canada. However, most previous research on the topic has relied on limited comparative studies.

The authors analyzed data from the Joint Canada/United States Survey of Health, 2002-2003. They studied doctor visits and hospitalizations using multivariate models to assess the influence of socioeconomic status after adjusting for health needs and predisposing characteristics.

Key Findings:

  • Socioeconomic status, measured by education, income and having a regular doctor, did not influence rates of hospitalization in either Canada or the United States.
  • In both countries, socioeconomic status was associated with frequency of doctor visits. In Canada, individuals with lower education levels were less likely to have seen a doctor in the previous year. In the United States, individuals with lower income or less education were less likely to visit a doctor than individuals with higher socioeconomic status.
  • In the United States, uninsured individuals were hospitalized at the same rate as insured individuals, but spent fewer nights in the hospital on average.
  • Overall, health care utilization patterns were similar in both Canada and the United States. In each country, approximately one in 10 individuals had been hospitalized in the previous year and four in five individuals had visited a doctor.

This research indicates that while the United States and Canada have health insurance systems with very different structures, the two countries have similar health care utilization patterns. In both countries, socioeconomic status affects frequency of doctor visits but not hospitalizations. This research sheds light on some of the interactions between socioeconomic status and health care consumption.