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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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