A Fuzzy Approach to the Measurement of Leakages for North American Health Systems

This paper uses a fuzzy-fuzzy stochastic dominance approach to compare patients’ leakages in the Canadian and the U.S. health care systems. Leakages are defined in terms of individuals who are in bad health and could not have access to health care when needed. To carry his comparison we rely on the assumption that Canada is a strong counterfactual for the U.S. We first develop a class of fuzzy leakages indices and incorporate them in a stochastic dominance framework to derive the dominance criterion. We then use the derived criterion to perform inter-country comparisons on the global level. To provide more insight, we decompose the analysis with respect to gender, ethnicity, income and education. Intra-country comparisons reveal the presence of income based leakage inequalities in both countries yet, gender, ethnic and education based disparities appear to be present in the U.S. only. As for inter-country comparisons, results are in general consistent with the hypothesis that leakages are less important under the Canadian health care system.