Working Paper: NBER ID: w10715
Authors: Sandra L. Decker; Dahlia K. Remler
Abstract: A strong association between lower socioeconomic status (SES) and worse health-- the SES-health gradient-- has been documented in many countries, but little work has compared the size of the gradient across countries. We compare the size of the income gradient in self-reported health in the US and Canada. We find that being below median income raises the likelihood that a middle aged person is in poor or fair health by about 15 percentage points in the U.S., compared to less than 8 percentage points in Canada. We also find that the 7 percentage point gradient difference between the two countries is reduced by about 4 percentage points after age 65, the age at which the virtually all U.S. citizens receive basic health insurance through Medicare. Income disparities in the probability that an individual lacks a usual source of care are also significantly larger in the US than in Canada before the age of 65, but about the same after 65. Our results are therefore consistent with the availability of universal health insurance in the U.S, or at least some other difference that occurs around the age of 65 in one country but not the other, narrowing SES differences in health between the US and Canada.
Keywords: universal health insurance; socioeconomic disparities; health gradient; US; Canada
JEL Codes: I1
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| being below median income (I32) | likelihood of being in poor or fair health (I14) |
| universal health insurance through Medicare (I13) | narrowing of SES-health gradient (I14) |
| age 65 (J14) | access to universal health insurance in the US (I13) |
| lack of universal health insurance (I13) | larger income disparities in lacking a usual source of care (I14) |
| availability of universal health insurance or age-related factors (I13) | narrowing health disparities (I14) |