Document Type

Article

Publication Date

2013

Publication Title

Health & Social Work

Volume

38

Issue

4

First Page

240

Last Page

248

DOI

doi: 10.1093/hsw/hlt022

Keywords

Canada, Cohort study, Colon cancer, health care reform, health insurance, historical cohort, poverty, single-payer system, United States

Abstract

Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged. They were more likely to have received indicated surgery and chemotherapy, and their wait times for care were significantly shorter. Consequently, the Canadian women were much more likely to experience longer survival times. Regression analyses indicated that health insurance nearly completely explained the Canadian advantages. Implications for contemporary and future reforms of U.S. health care are discussed.