Objective. To conduct cross-country comparisons of Canada and the United States (US), and assess the impact of nativity status and other related factors on access to primary and preventive care.
Methods. Data came from the Joint Canada-US Survey of Health, the Canadian Community Health Survey, and the National Health Interview Survey. Logistic regression models were employed to assess the impact of various independent variables of interest on access to care, accounting for need, demographic factors, socioeconomic status (SES), and insurance coverage.
Results. In both countries, foreign-born populations had worse access to care than their native-born counterparts for some indicators, with the effect being more pronounced in the US than in Canada; the effect of foreign birth was attenuated in multivariable analyses. In direct cross-country comparisons, immigrants in Canada generally had better access to care than immigrants in the US. Most of these differences were explained by differences in SES and insurance coverage across the two countries. However, immigrants in the US were much more likely to have a recent Pap test than immigrants in Canada. Nativity-by-race joint effects were found in both countries for certain racial/ethnic groups, and a dose-response effect of education on access to care was found among the native-born but not the foreign-born. In both countries, immigrants with shorter length of stay and limited language proficiency generally had worse access to care compared with those with longer length of stay and language proficiency. In the US, being a noncitizen was also independently associated with worse access to care.
Conclusions. Inequalities in access to care based on nativity status, overall and in conjunction with race/ethnicity and SES, were found in both Canada and the US. In addition, shorter length of stay, limited language proficiency, and lack of citizenship served as barriers to care among immigrants. Access to care was generally better in Canada than the US for all immigrant groups, however disparities persisted in Canada. These findings suggest that universal health insurance coverage may not be sufficient for ensuring access to primary and preventive care for the population of foreign-born adults.
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 72/10, Dissertation Abstracts International|
|Subjects:||Public health, Ethnic studies, Health care management|
|Keywords:||Foreign-born adults, Health care, Health services, Immigrants, Primary care|
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