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The main differences between the us and canadian health care systems

The two countries' health care systems are very different-Canada has a single-payer, mostly publicly-funded system, while the U.

Is Canada the Right Model for a Better U.S. Health Care System?

Much of the appeal of the Canadian system is that it seems to do more for less. Canada provides universal access to health care for its citizens, while nearly one in five non-elderly Americans is uninsured.

Canada spends far less of its GDP on health care 10. O'Neill take a closer look at the performance of the U. The authors examine whether the Canadian system delivers better health outcomes and distributes health resources more equitably than the U. The authors begin by examining the evidence on health outcomes.

They note that the infant mortality rate and life expectancy are affected by many factors other than the health care system. For example, low birthweight-a phenomenon known to be related to substance abuse and smoking-is more common in the U.

Comparing the U.S. and Canadian Health Care Systems

For babies in the same birthweight range, infant mortality rates in the two countries are similar. In fact, if Canada had the same proportion of low birthweight babies as the U. Thus, the authors conclude that differences in infant mortality have more to do with differences in behavior than with the health care systems.

A similar argument may be made for life expectancy. The gap in life expectancy among young adults is mostly explained by the higher rate of mortality in the U. At older ages much of the gap is due to a higher rate of heart disease-related mortality in the U. While this could be related to better treatment of heart disease in Canada, factors such as the U.

Survey of Health, a survey of about 9,000 residents of the two countries conducted in 2002-2003. The authors begin by comparing self-reported health status.

While this measure is subjective and may be influenced by factors outside the health care system, it is widely used by researchers.

They find that self-reported health status is similar in the two countries-if anything, more people report themselves to be in excellent health in the U. Next, the authors examine three other outcome measures: Focusing on whites to sidestep differences in the racial composition of the two populations and the problem of racial disparities in health outcomesthey find that the two countries score similarly on the overall health index and pain indicator, while the U.

The final health status measure examined is the incidence of chronic conditions like high blood pressure, heart disease, and asthma. These measures are less subjective, but also are known to be influenced by behavior and other factors outside of the health care system. The authors find that the incidence of these conditions is somewhat higher in the U. However, respondents with these conditions are some-what more likely to be treated in the U.

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Turning their attention to the availability of health care resources, the authors examine the use of cancer screenings including mammograms and PAP smears for womenPSA screenings for menand colonoscopies. They find that the use of these tests is more frequent in the U. The authors find evidence of the possible effectiveness of higher levels of screening and equipment by examining mortality rates in both countries for five types of cancer that could be affected by early detection and treatment.

Because the incidence of cancer may differ for reasons other than the health care system, they compare the ratio of the mortality rate to the incidence rate - a lower ratio corresponds to a lower death rate for those with the disease. They find that the ratio is lower in the U. The authors also examine wait times, which are often cited as a problem in Canada.

Though comparative information is limited, available data indicate much longer waits in Canada than in the U.

The authors can also draw some inferences from a question about unmet medical needs. While the incidence of unmet needs is slightly lower in Canada 11 percent, vs.

By contrast, cost is cited as the reason by over half of Americans. The importance of long waits in Canada was recently highlighted by the Chaoulli case in Quebec which successfully challenged the government ban on private provision of medical services covered by the Canadian system. Private services are expected to alleviate shortage of facilities under the system and reduce wait times. Cases are being brought in other provinces. In the final section of their paper, the authors consider several measures of the success of the two health care systems.

The first and perhaps simplest measure is the level of satisfaction reported by patients.

Americans are more likely to report that they are fully satisfied with the health services they have received and to rank the quality of care as excellent. Finally, the authors examine whether Canada has a more equitable distribution of health outcomes, as might be expected in a single-payer system with universal coverage. To do so, they estimate the correlation across individuals in their personal income and personal health status and compare this for the two countries.

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Surprisingly, they find that the health-income gradient is actually more prominent in Canada than in the U. The authors conclude that while it is commonly supposed that a single-payer, publicly-funded system would deliver better health out-comes and distribute health resources more fairly than a multi-payer system with a large private component, their study does not provide support for this view.

They suggest that further comparisons of the U. The authors acknowledge financial support from the Achelis Foundation and the Weismann Foundation.

  1. Although there was an overarching federal plan there to get the individual provinces to coordinate and subsidize them, originally it was a provincial initiative. A study by Santerre et al.
  2. Lessons for the United States.
  3. In Canada, we left the hospitals as free-standing…. Some health [information] gets lost with the transfer from one provider to the next.
  4. No Easy Solutions, Ottawa, June 1991, p. Surprisingly, they find that the health-income gradient is actually more prominent in Canada than in the U.