Physician use in Ontario and the United States: The impact of socioeconomic status and health status

Objectives. This study compared physician use in Ontario and the midwestern and northeastern United States for persons of different socioeconomic status and health status. The distribution of health problems associated with the most recent physician visit also was compared. Methods. The design of the study was cross sectional; data derived from the 1990 Ontario Health Survey and the 1990 US National Health Interview Survey were used in analyses. Results. Overall, persons in Ontario averaged 19% more visits than US residents, but differences varied markedly across income and health status. At each level of health status, low-income Canadians had 25% to 33% more visits than their US counterparts. However, among higher income persons, those in excellent or very good health had 22% more visits than Americans, while those in good, fair, or poor health had 10% fewer visits than Americans. Higher visit rates in Ontario were not associated with a greater prevalence of low-priority visits. Conclusions. Under the Canadian single-payer system, medical care in Ontario has been redistributed to low-income persons and the elderly, Compared with the United States, there has been a lower intensity of medical care for the sick higher income population.