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Karen E. Lasser, MD, MPH, David U. Himmelstein, MD and Steffie Woolhandler, MD, MPH

Karen E. Lasser, David U. Himmelstein, and Steffie Woolhandler are with the Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass.

Correspondence: Requests for reprints should be sent to Karen E. Lasser, MD, MPH, Department of Medicine, The Cambridge Hospital, 1493 Cambridge St, Cambridge, MA 02139 (e-mail: klasser{at}challiance.org).

Objectives. We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.

Methods. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.

Results. In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.

Conclusions. United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.

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