Comparable Health Data Between Canada and the U.S.

1. Comparable Health Data Between Canada and the U.S. • Many organizations such as the United Nations, World Health Organization and the Organization of Economic Cooperation and Development have noted the importance of internationally comparable statistics on health and functioning • Such statistics are necessary to asses and compare the performance of national health systems and the health of the populations they serve

2. Comparable Health Data Between Canada and the U.S. • There has been considerable interest in comparing health and health determinants in Canada and the US due to the fact that each country shares many similarities but has different health systems • Previous research comparing similar survey data from the two countries has provided some useful insights and highlighted differences in certain health measures between Canadians and Americans.

3. Comparable Health Data Between Canada and the U.S. • However, such comparisons are difficult to make and may not be completely accurate True differences vs. Measurement differences

4. Comparable Health Data Between Canada and the U.S. • One of the key objectives of the joint survey is to produce a set of highly comparable health data on Canadian and U.S. populations that will enable researchers to better understand how the differing health care systems affect health care, health status and functional status

5. Analytical Purposes of Survey • Methodological • To compare the performance of 4 different measures of disability/restriction of activity • International Comparisons • To make useful and meaningful comparisons of: • The health of Canadians and Americans • The strength of the relationships between health outcomes and selected determinants (including access to health care, insurance and socio-economic status)

6. Statistics on Disabilities and Activity Limitations • The joint survey will include 4 different measures of “functional health” - disability/restriction or limitation of activities • In recent years many national statistical agencies under the impetus of the WHO and UN have strived to come up with internationally comparable disability statistics. This culminated at the Washington city group on disability statistics earlier this year.

7. Statistics on Disabilities and Activity Limitations • While receiving much attention internationally, no universally accepted set of questions have been found to provide effective and accurate results • The joint survey will illuminate research on measuring disabilities/activity limitations using four separate sets of questions from Canada and the US

8. Statistics on Disabilities and Activity Limitations • The Canadian questions that are used in the joint survey employ the “Health Utility Index,” developed at Canada’s McMaster University and the Participation and Activity Limitation Survey filter questions found on the Canadian Census of Population questionnaire. • The US contributions to the joint survey employ both a form of it's own traditional measure – “Limitations of Activity” and and a form of a “Functional Limitations” scale developed by American researchers. • The order of these blocks of questions will be randomly chosen during the interview

9. Comparing Health and Health Determinants • The resulting data from the survey will be very useful in assisting researchers studying differences in health status, health care utilization, the determinants of health and socio-economic correlates of health between the two countries

10. Comparing Health and Health Determinants • In a Univariate and Bivariate framework researchers will be able to estimate prevalence's of various measures of health and health determinants by age and sex where possible • Medical consultations and hospitalization • Depression rates and contact with mental health professionals • Chronic conditions such as heart disease, diabetes, hypertension, etc. • Medication Use – the % of people using prescription medications in the past month

11. Comparing Health and Health Determinants • The data will also lend itself to studying more complex relationships • Researchers will be able to model the determinants of health and compare models across the two countries: • socio-economic status and obesity • insurance coverage and unmet health care needs • Poor/fair health and health care utilisation • Physical activity participation and other measures of health

12. Comparing Health and Health Determinants • There are some limitations to the data however. Due to the sample size of the two survey populations, the analysis of certain variables may be restricted • That is all variables may not have sufficient statistical power to provide estimates at the desegregated levels of both age and sex.

13. Comparing Health and Health Determinants • However, many meaningful comparisons of selected health indicators can finally be made between the two countries • Also researchers will be able to begin to examine and compare the factors (including health care systems) that may contribute to the level of health in each population

14. Final Thoughts • The harmonization of Canadian health concepts with those of the U.S. and the entire collaboration process between the two countries statistical agencies could potentially help develop a model for accepted practices worldwide • The joint survey is a move forward in the ongoing quest for internationally comparable health statistics and hopefully will lead to further collaborations with the US and other countries.

15. Data Release • Statistics Canada and the National Center for Health Statistics plan to release and distribute a Public Use Microdata File to all stakeholders in the fall of 2003. • A users manual and initial publication outlining major findings of the survey will be also be released • Information about the survey and the data will be made available on the STC and NCHS websites. • Contact numbers and names to be supplied?