Papanicolaou Tests in Canada and the US - Does Type of Insurance Matter?
Notice bibliographique
Résumé
Objectives: The health care systems in the United States and Canada differ quite dramatically. Canadians are covered by a universal health care system while residents of the United States, if they are insured, obtain their insurance from various private or public sources. This study examines how the use of Papanicolaou test by women differs in the United States and Canada using data from Joint Canada/United States Survey of Health (JCUSH). Methodology: The probability of having the Pap smear is estimated separately for Canadian and American women using probit regressions. A question arises as to whether differences in the probability of the pap test are a result of (1) differences in the demographics between Canadian and American women or (2) differences in the estimated coefficients. A Blinder/Oaxaca type decomposition is used to determine the influence of each. Gomulka and Stern expanded this methodology for a dichotomous dependent variable using probit estimation. In their analysis, the probit estimates are transformed into changes arising from a change in the coefficients and changes arising from a change in the population. The Gomulka and Stern method is applied to this data. The analysis has two parts. The first part examines the full sample of American and Canadian women between the ages of 18 to 65 and a subsample of those under age 30. In the full sample, 87% of the Canadians have had a pap smear in the past 3 years (60% in the past year) compared to 93% of the American women (71% within the past year). However, for women under age 30, where the recommendation is for a pap smear every year, the differences are reversed with 79% of Canadians and 76% of Americans receiving the test. In the second analysis, privately insured Americans are compared to Canadians. This allows us to compare how the Canadian national health insurance and US private insurance differ in their influence the use of pap smears. Results: For the full sample, the decomposition shows that the differences between the Canadian and US women mostly occur because of differences in coefficients and not the distributions. For women less than 30 years old, the differences are due to both differences in distributions and coefficients. For insured US women the coefficient effect was even stronger. The only significant difference between US and Canadian women who did not have the test was that 6% of the Canadian women reported that they did not know where to go for the test (vs. 1% of the US). Also 91% of the US women compared to 85% of the Canadian women reported that their doctor recommended the test. Conclusions: Overall, women in the US health care system are more likely to have pap smears and the main driver is differences in the coefficients. Given that fewer Canadian physicians recommend the test, the differences can be attributed to differences in how the systems value the test.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,011 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».