The best of care and the worst of care

For retirees in the United States, access to health care is determined by income rather than need, according to a study by Portland State University’s community health professor Mark Kaplan.

The study, published in the January issue of the International Journal of Health Services, compared the factors leading to retiree visits to specialist physicians in the United States and Canada. In the U.S., those with better socioeconomic backgrounds were far more likely to have visited a specialist than those with lower incomes. In Canada, however, poor health was the leading determinant for visits.

“If you are of lower socioeconomic status [in the U.S.], obviously it works against you. But in Canada, health care is really above and beyond income levels. Need determines whether you have access to specialists,” Kaplan said.

“We have the best of care and the worst of care—the best of care if you have the money,” he said.

According to Kaplan, the overabundance of specialist physicians in the U.S. has contributed to this trend. He explained that Canada places more emphasis on primary care doctors, which are significantly less expensive. In addition, primary care providers differ little from specialists in their ability to manage chronic illnesses, such as heart disease. Although Canadians pay almost half of what Americans spend on health care, they experience longer life expectancy, fewer infant mortalities and increased satisfaction with their quality of life than Americans, Kaplan said.

He also points out the relation between geography and health care costs. In regions such as South Florida, where many people go to retire, there exists an abundance of specialists.

“When you compare the health profiles of people where there are more specialists, what comes out of that analysis is that the health of South Floridians isn’t any better than the health of people in areas where the concentration of specialists is lower,” Kaplan added.

When asked about the changes needed in the U.S., Kaplan said, “Minimally invasive surgery is not going to work in the U.S. What we need is major invasive surgery—major transformations.”

The U.S. is highly individualistic, Kaplan said, and as a culture is less willing to make sacrifices in order to reach health care reforms.

“In order to achieve what other countries have achieved, we need to come to terms with the fact that we’re all going to feel the pinch,” he said.

Among the changes made to the system, Kaplan would like to see equal access to care and an increased number of primary care physicians. Also, he argues that health care needs to be more portable.

“[So] if you lose your job, you’re not going to lose your health coverage,” he said.
The study was co-authored by Kaplan’s former graduate research assistant Nathalie Huguet, who received a doctorate from PSU’s School of Urban Studies and Planning. Huguet is a native of France, a country that has a universal health care system. Huguet said that she has been able to approach the American health care system with an outsider’s perspective.

“I think that [it] is important for the public to have a different perspective, especially when approaching the issues that are raised by health care,” Huguet said.

Kaplan also insists that the U.S. needs to adopt a new way of viewing health care in order to ensure that the system becomes more efficient and equitable.

“For economic reasons and for philosophical reasons, I just think it’s the ethical thing to do,” he said.