Research ArticleDisability in two health care systems: Access, quality, satisfaction, and physician contacts among working-age Canadians and Americans with disabilities†
Section snippets
Questions for Research
Given the issues just described, a series of analyses are conducted to compare the health care experiences of working-age uninsured and insured Americans with Canadian working-age individuals (all of whom are insured). Quantitative data from the Joint Canada/United States Survey of Health (JCUSH) are analyzed, and two questions for research guide the inquiry:
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On the basis of disability severity level and health insurance status, are there differences in self-reported measures of access,
Survey data
The JCUSH, which was conducted jointly by the U.S. National Center for Health Statistics (NCHS) and Statistics Canada, provides nationally representative, cross-sectional data on Canadian and American household residents aged 18 years or older. Administered between November 2002 and June 2003, the survey excludes members of the armed forces and institutionalized persons in both nations, and persons without a landline telephone in the household. Households were drawn through random digit dialing
Disability, overall health, insurance coverage, and demographics in the United States and Canada
In Table 1, four views of the working-age population are provided by country and by disability level. Distributions on two important variables, overall health and U.S. insurance status, are also provided. In the United States, there are an estimated 21.2 million working-age persons with nonsevere disabilities (about 12% of the 173.4 million working-age persons overall) and another 16.6 million persons with severe disabilities (about 10% of the total). In Canada, there are an estimated 2.3
Discussion and Study Limitations
Working-age people with disabilities in Canada and the United States have much in common. The percentage reporting disability is quite similar, even after standardizing for age. In both nations, overall health is significantly worse among people with disabilities than among people without them, particularly for those with severe disabilities. In Canada and the United States alike, the need for services from physicians expands greatly with the increasing severity of disability. Yet, while all
Acknowledgments
We gratefully acknowledge the project assistance we received from Jane Gentleman, Peter Meyer, Elizabeth Rasch and Catherine Simile. We particularly wish to thank Jane Gentleman, Debra Blackwell, Michael Martinez and Jennifer Madans for their extensive notes and substantive suggestions on earlier drafts of this paper. In addition, the critiques we received from the peer reviewers at the Disability and Health Journal were invaluable to us.
References (49)
- et al.
Health of community-dwelling adults with mobility limitations in the United States: prevalent health conditions, Part I
Arch Phys Med Rehabil
(2008) - et al.
The disablement process
Soc Sci Med
(1994) - et al.
Characteristics of patients seen and services provided in primary care visits in obstetrics/gynecology: data from NAMCS and NHAMCS
Am J Obstet Gynecol
(2004) - et al.
US health care spending in an international context: why is US spending so high and can we afford it?
Health Aff
(2004) - et al.
Access to care, health status and health disparities in the United States and Canada: results of a cross-national population-based survey
Am J Public Health
(2006) - et al.
Comparing health and health care use in Canada and the United States
Health Aff
(2006) - et al.
How does the quality of care compare in five countries?
Health Aff
(2004) - Schoen C, Osborn R, Huynh PT, et al. Primary care and health system performance: adults’ experiences in five countries....
- et al.
Common concerns amid diverse systems: health care experiences in five countries
Health Aff
(2003) - et al.
The organization and financing of health services for persons with disabilities
Milbank Q
(2002)
Disability in America: Toward a National Agenda for Prevention
Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions
Phys Ther
Healthy People 2010: Disability and Secondary Conditions, Vision for the Decade. Proceedings and recommendations of a symposium
More Than Ramps: A Guide to Improving Healthcare Quality and Access for People With Disabilities
Americans With Disabilities: Current Population Reports Number P70-73
Americans With Disabilities, 2002: Current Population Reports Number P70-107
An Overview of the U.S. Health Care System Chart Book
Some conceptual issues in disability and rehabilitation
Classification of Impairments and Handicaps
Enabling America: Assessing the Role of Rehabilitation Science and Engineering
An Introduction to the ICF
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Financial disclosure: Funds for these analyses were generously provided by contract with the National Center for Health Statistics, Centers for Disease Control and Prevention (NCHS/CDC). The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the NCHS/CDC. This paper was also required to clear internal review at NCHS/CDC. These relationships, and this review process, did not restrict either author from developing the research questions, conducting the analyses, or presenting the results in an unbiased fashion, and in the authors’ opinions, lessened the possibility of bias in this manuscript. Both authors are unaware of any further financial or other relationships affecting this work.