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Comparative analysis of health system performance in Montreal and New York: the importance of context for interpreting indicators

Published online by Cambridge University Press:  19 June 2018

Michael K. Gusmano ,
Erin Strumpf ,
Julie Fiset-Laniel ,
Daniel Weisz  and
Victor G. Rodwin
Michael K. Gusmano*
Affiliation:
Associate Professor of Health Policy, School of Public Health, Rutgers University, New Brunswick, NJ, USA
Erin Strumpf
Affiliation:
Associate Professor, Department of Economics, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
Julie Fiset-Laniel
Affiliation:
Agente de planification, de programmation et de recherché, Centre intégré universitaire de santé et de services sociaux, du Centre-Sud-de-l’Île-de-Montréal, Direction régionale de santé publique, Montreal, Québec, Canada
Daniel Weisz
Affiliation:
Research Associate, Columbia University, New York, NY, USA
Victor G. Rodwin
Affiliation:
Professor of Health Policy and Management, Robert F. Wagner School of Public Service, New York University, New York, NY, USA
*
*Correspondence to: Michael K. Gusmano, Associate Professor of Health Policy, School of Public Health, Rutgers University, 112 Paterson Street, Room 424, New Brunswick, NJ 08901, USA. Email: mkg93@sph.rutgers.edu
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Abstract

Although eliminating financial barriers to care is a necessary condition for improving access to health services, it is not sufficient. Given the contrasting health systems with regard to financing and organization of health insurance in the United States and Canada, there is a long history of comparing these countries. We extend the empirical studies on the Canadian and US health systems by comparing access to ambulatory care as measured by hospitalization rates for ambulatory care sensitive conditions (ACSC) in Montreal and New York City. We find that, in New York, ACSC rates were more than twice as high (12.6 per 1000 population) as in Montreal (4.8 per 1000 population). After controlling for age, sex, and number of diagnoses, significant differences in ACSC rates are present in both cities, but are more pronounced in New York. Our findings are consistent with the hypothesis that universal, first-dollar health insurance coverage has contributed to lower ACSC rates in Montreal than New York. However, Montreal’s surprisingly low ACSC rate calls for further research.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Issue 1 , January 2019 , pp. 101 - 118
Copyright
© Cambridge University Press 2018 

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References

Backus, L., Moron, M., Baccheti, P., Baker, L. C. and Bindman, A. B. (2002), ‘Effect of managed care on preventable hospitalization rates in California’, Medical Care, 40(4): 315–324.Google Scholar
Bailey, D., Arieger, N., Agénor, M., Graves, J., Linos, N. and Bassett, M. T. (2017), ‘Structural racism and health inequities in the USA: evidence and interventions’, The Lancet, 389(10077): 1453–1463.Google Scholar
Barua, B. and Ren, F. (2016), Waiting Your Turn: Wait Times for Health Care in Canada, 2016 Report. Montreal: Frazer Institute.Google Scholar
Billings, J., Anderson, G. M. and Newman, L. S. (1996), ‘Recent findings on preventable hospitalizations’, Health Affairs, 15(3): 239–249.Google Scholar
Bradley, E. H., Elkins, B. R., Herrin, J. and Elbel, B. (2011), ‘Health and social services expenditures: associations with health outcomes’, BMJ Quality & Safety, 20: 826–831.Google Scholar
Brandolini, A. and Smeeding, T. M. (2007), ‘Inequality Patterns in Western-Type Democracies: Cross-Country Differences and Time Changes’, CHILD Working Papers wp08_07, CHILD - Centre for Household, Income, Labour and Demographic Economics – Italy.Google Scholar
Brown, A. D., Goldacre, M. J., Hicks, N. and Rourke, J. T. (2001), ‘Hospitalization for ambulatory care-sensitive conditions: a method for comparative access and quality studies using routinely collected statistics’, Canadian Journal of Public Health, 92(2): 155.Google Scholar
Canadian Institute for Health Information (2017), How Canada Compares: Results From The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries. Accessible Report. Ottawa, ON: CIHI.Google Scholar
Canadian Museum of History (2007), ‘Making Medicare: The History of Health Care in Canada, 1914-2007’, http://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-6h02e.shtml [May 2018].Google Scholar
Casanova, C. and Starfield, B. (1995), ‘Hospitalizations of children and access to primary care: a cross-national comparison’, International Journal of Health Services, 25(2): 283–294.Google Scholar
David, R. J. and Collins, J. W. (1997), ‘Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites’, New England Journal of Medicine, 337: 1209–1214.Google Scholar
Davis, K., Stremikis, K., Squires, D. and Schoen, C. (2014), ‘Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2014 Update’, http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf [May 2018].Google Scholar
Dubé-Linteau, A., Pineault, R., Levesque, J. F., Lecours, C. and Tremblay, M. E. E. (2013), Québécoise sur l’expérience de soins 2010-2011. Le médecin de famille et l’endroit habituel de soins: regard sur l’expérience vécue par les Québécois, Volume 2, http://www.stat.gouv.qc.ca/statistiques/sante/services/generale/medecin-famille.pdf [21 July 2017].Google Scholar
Gusmano, M. K., Rodwin, V. G. and Weisz, D. (2006), ‘A new way to compare health systems: avoidable hospital conditions in Manhattan and Paris’, Health Affairs, 25: 510–520.Google Scholar
Gusmano, M. K., Rodwin, V. G. and Weisz, D. (2009), ‘Achieving horizontal equity: must we have a single payer health care system?’, Journal of Health Politics, Policy and Law, 34(4): 617–633.Google Scholar
Gusmano, M. K., Rodwin, V. G. and Weisz, D. (2010), Health Care in World Cities, Baltimore, MD: Johns Hopkins University Press.Google Scholar
Gusmano, M. K., Rodwin, V. G. and Weisz, D. (2017), ‘Persistent inequalities in health and access to health services: evidence from NYC’, World Medical & Health Policy, 9(2): 186–205.Google Scholar
Hadley, J., Steinberg, E. P. and Feder, J. (1991), ‘Comparison of uninsured and privately insured hospital patients: condition on admission, resource use, and outcome’, JAMA, 265(3): 374–379.Google Scholar
Hajizadeh, M. (2017), ‘Does socioeconomic status affect lengthy wait time in Canada? Evidence from Canadian Community Health Surveys’, European Journal of Health Economics, 19(3): 369–383.Google Scholar
Hwang, J., Guilcher, S. J. T., McIsaac, K. E., Matheson, F. I., Glazier, R. and O’Campo, P. (2017), ‘An examination of perceived health care availability and unmet health care need in the City of Toronto, Ontario, Canada’, Canadian Journal of Public Health, 108(1): E7–E13.Google Scholar
The Johns Hopkins ACG System (2011), Technical Reference Guide Version 10.0. December.Google Scholar
Klein, R. J. and Schoenborn, C. A. (2001), ‘Age adjustment using the 2000 projected U.S. population’, Healthy People 2010 Statistical Notes, 20: 1–12.Google Scholar
Krieger, N. (1990), ‘Racial and gender discrimination: risk factors for high blood pressure?’, Social Science & Medicine, 30(12): 1273–1281.Google Scholar
Kunitz, S. J. and Pesis‐Katz, I. R. (2005), ‘Mortality of white Americans, African Americans, and Canadians: the causes and consequences for health of welfare state institutions and policies’, Milbank Quarterly, 83(1): 5–39.Google Scholar
Lewis, S. (2015), ‘A system in name only – Access, variation and reform in Canada’s provinces’, New England Journal of Medicine, 372(6): 497–500.Google Scholar
Levesque, J. F., et al. (2013), ‘Patient-centred access to health care: conceptualising access at the interface of health systems and populations’, International Journal for Equity in Health, 11: 12–18.Google Scholar
Ministère de la Santé et des Services sociaux (2015), ‘Network reorganization’, http://www.msss.gouv.qc.ca/en/reseau/reorganisation/portrait [21 July 2017].Google Scholar
Pappas, G., Hadden, W. C., Kozak, L. J. and Fisher, G. F. (1997), ‘Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups’, American Journal of Public Health, 87: 811–816.Google Scholar
Paradies, Y. (2006), ‘A systematic review of empirical research on self-reported racism and health’, International Journal of Epidemiology, 35(4): 888–901.Google Scholar
Riverin, B. D., Li, P., Naimi, A. I. and Strumpf, E. (2017), ‘Effect of enrollment in team-based primary care reform models on timely follow-up care after hospital discharge’, CMAJ Open, 189(14): E585–E593.Google Scholar
Rodwin, V. G. and Gusmano, M. K. (2002), ‘World cities project: rationale and design for comparison of megacity health systems’, Journal of Urban Health, 9(4): 445–463.Google Scholar
Roos, N. P. and Mustard, C. (1997), ‘Variation in health and health care use by socioeconomic status in Winnipeg, Canada: does the system work well? Yes and no’, The Milbank Quarterly, 75(1): 89–111.Google Scholar
Sanchez, M., Vellanky, S., Herring, J., Liang, J. and Jia, H. (2008), ‘Variations in Canadian rates of hospitalization for ACSCS’, Healthcare Quarterly, 11(4): 20–22.Google Scholar
Sanderson, C. and Dixon, J. (2000), ‘Conditions for which onset or hospital admission is potentially preventable by timely and effective ambulatory care’, Journal of Health Services Research Policy, 5(4): 222–230.Google Scholar
Schneider, E. C. and Squires, D. (2017), ‘From last to first --- could the U.S. become the best in the world?’, New England Journal of Medicine, 377(10): 901–905.Google Scholar
Schoen, C., Osborn, R., Squires, D. and Doty, M. M. (2013), ‘Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries’, Health Affairs, 32(12): 2205–2215.Google Scholar
Shah, B. R., Gunraj, N. and Hux, J. E. (2003), ‘Markers of access to and quality of primary care for aboriginal people in Ontario, Canada’, American Journal of Public Health, 93(5): 798–802.Google Scholar
Sheehan, K. J., Filliter, C., Sobolev, B., Levy, A. R., Guy, P., Kuramoto, L., Kim, J. D., Dunbar, M., Morin, S. N., Sutherland, J. M., Jaglal, S., Harvey, E., Beaupre, L. and Chudyk, A. (2017), ‘Time to surgery after hip fracture across Canada by timing of admission’, Osteoporosis International, 29(3): 653–663.Google Scholar
Statistics Canada (2011), ‘National Household Survey’, https://emis.santemontreal.qc.ca/outils/atlas-sante-montreal/caracteristiques-de-la-population/caracteristiques-sociodemographiques-de-la-population-2011/[21 July 2017].Google Scholar
Weissman, J. S., Gatsonis, C. and Epstein, A. M. (1992), ‘Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland’, JAMA, 268: 2388–2394.Google Scholar
Wolff, E. N., Zacharias, A., Masterson, T., Eren, S., Sharpe, A. and Hazell, E. (2012), ‘A Comparison of Inequality and Living Standards in Canada and the United States Using an Expanded Measure of Economic Well-Being’, Levy Economics Institute of Bard College Working Paper, 703. Annandale-On-Hudson, NY.Google Scholar