It then uses comparable household data from 2010 in the two countries to measure and compare the probability of high household medical expenses, where high is defined relative to income. This article begins with a brief conceptual discussion of optimal cost-sharing practices, followed by a short portrayal of health care financing in Canada and the United States. 4, 5 As health reform in the United States strives to provide Americans with the level of financial security more typical elsewhere, and thus improve the overall performance of its health care system, Canada serves as a benchmark to measure how far from the norm America is, and for speculating how much closer it will be to this norm after the Patient Protection and Affordable Care Act (ACA) is fully implemented. 6 – 11Ĭanada is also typical of other wealthy countries in terms of the financial burden that OOP spending places on households.
Moreover, OOP expenditures in each account for a similar share of total health expenditures and have been trending upward. Canada makes a relevant reference point for the United States because of its physical proximity as well as the degree of similarity between the two countries. We divide each county’s population into 10 distinct groups based on age and income and make cross-national comparisons for citizens with identical age and income profiles. This article uses international-comparable household data from the Luxembourg Income Study (LIS) for both the United States and Canada to present a unique comparison between these two countries of the financial burden that OOP requirements create in each. 3, 4 A recent Commonwealth Fund study comparing the health care systems in 11 countries placed the United States last in terms of both access and equity, rankings in large part due to the United States’ high OOP spending requirements.
Cross-national studies of the financial burden that cost-sharing measures place on citizens in different countries are rare, but those few that do exist find that Americans face the highest burden. A common way to assess the impact of OOP measures is to examine the financial burden they create. Theoretically, these requirements help constrain the demand for health care, and therefore its cost however, cost-sharing practices also tend to be regressive, 1, 2 can result in cost-related reductions in medical care, and can contribute to worse health outcomes. Extensive research investigates the impact of medical cost-sharing requirements, often referred to as out-of-pocket (OOP) medical spending.
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