Health Care: U.S. versus Canada

[Diane]

I think this is a rather good analysis: A systematic review of studies comparing health outcomes in Canada and the United States

Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92–0.98, p = 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

The authors say that Canada health care is about the same, better in outcomes for renal patients, at two-thirds the actual cost.

It's heavily subsidized by government in Canada although each citizen pays something out of pocket. I found my receipt from last year. For the whole year I paid $648 Canadian. That's about a tenth, I think, of what a U.S. citizen pays (maybe someone from the U.S. can verify). It covers medical coverage AND hospitalization, surgery, whatever I might need if I were in a car crash with LOC, 14 compound fractures, a collapsed airway, and blood gushing from every severed artery, etc etc.. Or if I collapsed from a stroke or heart attack. Or if I developed a disease like cancer and needed radiation and or surgery. Or if I developed a lingering malady and needed lots of office visits.

The study didn't mention meds, but those are cheaper here by far. There are seniors' "pill tour" buses that come up the west coast from California, bringing scores of elders up here so they can get their prescriptions legally filled. Even with the cost of the trip, it works out cheaper for them. Some Canadian doctors have even opened border clinics to look after them.

One more thing: part of the reason PTs in the U.S. are so eager to remain slaves to McJobs is because usually the employer will pick up at least a portion of this monthly gouge for them and their families.

[nari]

It is much the same in Australia as in Canada - we based our system on the Canadian system decades ago.
Regardless of extent of injury and wealth, all citizens are entitled to free medicine in the hospitals. People opting for free elective procedures get stuck on long waiting lists, but if a person is covered by insurance (about 40% are), they can elect to go to a private hospital, and can be seen within a few weeks.
Generally, it works well. People with good private cover are encouraged to go private; that premium costs around $1000 per annum, but they are not out of pocket, regardless of procedure. The only problem is that wealthy people still abuse Medicare.
I recently heard of a fellow who had three stenting procedures, plus four days in a private hospital; the total bill from the hospital and doctors was nearly $30000 and it was covered 100%.

Nari

[Diane]

Thanks Nari. We have people here like that too. So much so that the system is being forced to be revamped into a two-tier more like what you have in Aus. It's being "sold" as a way to speed up wait times for non-lethal surgeries, like hip replacements etc.

Just wanted to mention that I found the study on Eugene's PT blog.

[luca m]

It would be interesting to know if the conditions we commonly see in our practices have different outcomes between Canada and the United States. The Canadian/provincial governments makes heart, stroke, cancer etc. a priority, so the disparity wouldn't seem too great between Canada and US, as the study indicates. But MSK conditions seem to take a backburner (at least in Ontario) due to a lack of resources.

Experiencing both US and Canada as a provider, appropriate diagnosis seemed to come much quicker in the US. In the US, imaging and specialist consultations were available within hours/days, whereas, I have patients waiting 3-6 months for MRI's and neurologist/orthopedist visits in Canada. It was definitely free market driven in the US but made proper care more readily accessible.

Luca

[Diane]

I guess it depends on what exactly constitutes a medical emergency.

A lot of supposed MSK "stuff" melts away with good handling, as you may already have discovered. Non-medical therapy is often enough and can take the pressure off the med/surg lists. Pain is always an emergency until it is triaged, then if it isn't life-threatening it can go to somebody like us. We have to be ready to bounce it back to the "system" however, if it's not immediately amenable to treatment, like a missed hip stress fracture patient I saw.

I don't know how good it is to live in a country where it is simultaneously too easy to have benign persistent pain conditions become medicalized and too expensive to access health care when you actually have something life threatening. I should think people could get confused and miscategorized, depending on to what extent they could afford to be investigated.

[nari]

Diane, I agree that medicalisation of pain states that have been triaged, and over dependence on imaging can be a real problem, leading many up garden paths. That seems to be a problem with conditions that PTs see.

On the other hand, dependence on imaging is very useful for unusual pain. Distinguishing between the benign and the malignant (eg, a fracture, or worse) will always be difficult for medicos, and for us. The USA's system is probably so expensive due to over testing and medicalisation, and there are always those cases where it is essential. It can be a hard call to make.

Nari

[luca m]

This is Ontario's wait times website. Looks good for most cardiac and cancer treatments but look at the wait times for joint replacements and MRI's compared to the target wait time.

http://www.health.gov.on.ca/transfor...public_mn.html#

These provincial targets are not even considered by most MDs to be adequate.

I think the risk of medicalizing benign conditions equally exists in an overstressed, underfunded, universal healthcare system. My opinion is that it may actually increase the overall number of persistent pain conditions because of delayed care.

The idea of universal healthcare is wonderful and I prefer it over the US system, but somewhere along the way it has fallen of the tracks.

[Jon Newman]

Hi Luca,

I suppose that depends on when someone gets in line. Most hip and knee replacements here go through the first MD visit, then referral to PT or synvisc series and finally replacement. I'd be interested in what the duration is from first complaint of knee arthritis to replacement is here in the US. Anyone have any idea?