First Advisor

Mark Kaplan

Term of Graduation

Summer 2006

Date of Publication


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Urban Studies


Urban Studies




Senior centers -- Canada, Senior centers -- United States, Medicare -- Canada, Medicare -- United States, Health insurance -- Canada, Health insurance -- United States



Physical Description

1 online resource (2, vii, 194 pages)


The growth of the elderly population is a major public concern in industrialized countries. Understanding the factors contributing to better health in late life is essential. Canadians appear to be healthier than Americans, yet concrete findings that determine whether older Canadians are healthier than older Americans are missing. The primary goal of this study is to examine the relative importance of the health care system in explaining why older Canadians may be healthier than older Americans. To achieve this goal, this study (a) assessed if older Canadians are healthier than older Americans; (b) investigated the impact of health care coverage among several cohorts in Canada and the United States; and (c) explored what would be the effect of extending Medicare to a younger age.

The Joint Canada/United States Survey of Health (JCUSH), 2003 was used to determine the health differences between Canadians and Americans, and to understand the impact of universal health coverage on health. Health status differences between the two countries were assessed using self-rated health, number of chronic conditions, number of functional limitations, and Health Utility Index Mark 3 (HUI3) scores.

The Health and Retirement Survey (HRS) 1992-2002 was used to examine the health impact of Medicare coverage among previously uninsured people 55 to 64 years old. The HRS is a longitudinal study that was designed to follow working people as they reach retirement. Health status will be assessed using self-rated health.

The results from the JCUSH indicated that, overall, older Canadians were in better health, had healthier lifestyle and greater access to regular care than their American counterparts. The findings also showed that middle-aged insured Americans reported lower self-rated health and HUI3 than their Canadian counterparts. Finally, the results from the HRS indicated that the decline in health of people who where uninsured prior to Medicare eligibility age stabilized when they became Medicare beneficiaries.

This study concluded that U.S. Medicare is valuable for those without insurance, however; providing coverage to all would not be sufficient to ensure better health in late life. Policy makers should concentrate their efforts toward achieving universal, affordable, and stable coverage.


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