Comparing Health and Health Care from a Subnational Perspective: Saskatchewan and Nebraska

Abstract

Both critics and apologists of the health-care system in the United States regularly invoke comparisons with Canadian health care. National comparisons are instructive but can lack the precision of subnational comparisons. In recent decades, the field of comparative politics has recognized the advantages of subnational comparisons. The Great Plains subnational entities of Saskatchewan and Nebraska share commonalities regarding cultural, historical, and ecological conditions, and thus a comparison of the health-care system components and health outcomes yields intriguing results. In terms of health-care components, there is some substantial variation (e.g., differing financing mechanisms), along with some similarities (e.g., provider shortages). Health outcomes show similarities between Saskatchewan and Nebraska (e.g., leading causes of death) and some differences (e.g., suicide rate). Overall, the results show that Saskatchewan and Nebraska face comparable challenges in improving the health of their populations. Further, this analysis shows that subnational comparison is a useful approach for creating learning opportunities to address policy problems and solutions.