Friday, May 1, 2009

US & Canadian Health Care

It's been a while since the last time someone asked me a health care question. This one came today from a Canadian author on I'll share my answer:

Q. As an expert, what do you think about the differences in health care between the two countries, United States and Canada?

A. Loaded question.

Here's a loaded answer:

The problem with Americans is they think death is an option. In other words, way too much money is spent on heroic measures during the final months, weeks, and days of life (as compared to Canada). Americans are more litiginous, meaning that the lawsuits and malpractice insurance expenses drive up the costs significantly. Same for demographics (our baby boomers are aging), and for drugs, technology, et. al.

On the other hand Canada (like UK), where there is national health insurance, translates to rationing. People die waiting for procedures that are readily available in the US. The latest technological innovations are not available in every city, like the US.

Quality, measured objectively, is better in the US, which is why so many Candians who can afford it come to the US for their care.

It's a much more complicated subject than what I just described above, but those are the highlights in general terms. Even in the US, there is great variability in regions of the country and based on socio-economic factors.

To summarize, using the five canons of health care as a basis for comparison:

Availability -More health care resources per capita are available in the US.
Accessibility - Waiting times are less in the US.
Continuity - The system is more coordinated in Canada.
Quality - For most procedures, outcomes are better in the US.
Cost - Health care services are more affordable in Canada, and I'm not talking just about the patient share; the overall cost is lower for the reasons mentioned above.

I have been studying this topic for more than 40 years, have written about it, have been on radio talk shows answering questions about it, and have taught about it at the university level.

Hope this answers your question. I can give a longer version if you want.

Followup 11/27/08:

Barbara from South Carolina responded -- "Boy, that's the truth. I'm currently in nursing school and the numbers we were told were (1) 1/3 of total US healthcare costs are spent on people who are dead within a month, and (2) 1/2 of total US healthcare costs are spent on people who are dead within six months...

(Regarding quality), we should also mention that life expectancy is longer in Canada than in the US. Canada ranks 8th in average life expectancy (81.16 years) while the US ranks 46th (78.14)."


My reply:

Good point about the life expectancy, Barbara, but the difference has to do with lifestyle rather than the health care systems.

US citizens drive too fast for the traffic, have more stress, smoke more, drink more, exercise less and eat more junk food. In other words, Canadians generally take better care of their bodies.

Best wishes,