Canada health system fares well in US comparison.

Neither the US or Canadian system rank nearly as high as many competing European (and other) systems in WHO rankings. If more non-insured Americans had been included in the study perhaps Canada would compare even better. Although money obviously is not the only factor as this study shows if more were spent to shorten wait times for some operations Canada's system would be much improved.



Canadian health system fares well in study


Apr 17, 2007 08:08 PM
Anne-Marie Tobin
Canadian press

Health outcomes for patients in Canada are as good as or better than in the United States, even though per capita spending is higher south of the border, suggest Canadian and U.S. researchers who crunched data from 38 studies.

The findings were published in the inaugural edition of Open Medicine, a new online medical journal launching Wednesday in the aftermath of a rift last year between some editors and the publisher of the Canadian Medical Association Journal.

"In looking at patients in Canada with a specific diagnosis compared to Americans with the same diagnosis, in Canada patients had at least as good an outcome as their American counterparts – and in many situations, a better health outcome," said one of the 17 authors, Dr. P.J. Devereaux, a cardiologist and clinical epidemiologist at McMaster University in Hamilton.

"And that is important because in the United States, they're currently spending a little over $7,100 per individual on health care annually, whereas in Canada we're spending a little over $2,900 per individual annually," he said in a telephone interview from Brantford, Ont.

The study covered data on patient populations in the United States and Canada from 1955 to 2003. To conduct their meta-analysis, researchers identified almost 5,000 titles and abstracts. Of these, 498 appeared potentially eligible on initial review. Eventually, 38 studies were deemed to be eligible.

Researchers began by asking the question: Are there differences in health outcomes (mortality or morbidity) in patients suffering from similar medical conditions treated in Canada versus those treated in the United States?

"Overall, Canada did better, and in fact we found a statistically significant five per cent mortality advantage to people with diagnoses in Canada compared to their counterparts in the United States," Devereaux said.

Because of the extreme variability in study-to-study results, the researchers suggested caution was appropriate in interpreting this finding.

Overall, 14 of the 38 studies showed better outcomes in Canada, while five favoured the U.S. The other 19 studies showed equivalent or mixed results in the two countries.

Canada really stood out in one area – lower risk-adjusted death rates for dialysis care.

"What it (the study) shows is that despite an enormous investment in money we do not see better health outcomes (in the U.S.)," Devereaux said.

"And importantly, where our two systems do diverge is that America has a mixture of private insurance in terms of the funding for health care whereas in Canada we have medicare system for hospital and physician services. The medicare system allows us enormous efficiencies in terms of cost saving relative to private insurance."

He said the Canadian health-care system does have issues and needs improvement, "but certainly using medicare funding and not-for-profit delivery is the best way to actually maximize health outcomes and in a cost-effective manner."

The public is barraged by people saying Canada's health-care system has problems and the solution is to move toward allowing two-tiered medicine, and for-profit health-care delivery, he said.

The researchers "wanted decisions made based on evidence, and not based on beliefs and ideologies," Devereaux added.

Few uninsured patients in the U.S., who probably suffer the worst quality care, were included in the studies examined.

Some explanations for the results include the fact that American health care has administrative inefficiencies that public funding – without multiple competing insurance companies – eliminates. And because drug prices are controlled, Canada saves on prescription drug costs.