Background: This study compares health service deficits (HSDs) experienced by US adults with chronic illness with their Canadian counterparts. This study was undertaken in order ascertain if there were differences between the two populations given the differences in health care systems. Further, this comparison allows for a partial assessment of the impact the US Affordable Care Act might have on the prevalence of HSDs for US adults with at least one chronic illness (asthma, diabetes, arthritis, COPD). Methods: Bivariate and multivariate techniques were used to analyze US and Canadian health surveillance data in order to compare the prevalence of HSDs and ascertain the characteristics of adults with chronic illness who have HSDs. Results: Multivariate logistic regression analysis using having HSDs as the dependent variable and mutually adjusting for each of the study covariates, yielded that for the study populations non-Caucasians or visible minorities, those under 65 years of age, those with annual household incomes of <$50,000, and those defining their health as fair to poor all had greater odds of having at least one HSD. In difference to the Canadian population, the US population also had greater odds of being male and not being a university graduate. Conclusions: Using Canada as a proxy we were able to compare the prevalence of HSDs between a population with and without universal health care insurance. Our analyses revealed a lower prevalence of HSDs among adult Canadians with at least one chronic illness, suggesting that the 2010 US Affordable Care Act may over time result in a reduction of HSDs in the comparable US population.
Cassandra L. Furr, M. Nawal Lutfiyya, Taylor J. Hill, Matthew P. Rioux, Kristina A. Dittrich, John T. Grygelko, Catherine J. Kucharyski, Krista L. Rouse
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