Canada's Health Care As Good Or Better Than USA's - Scientific American (Proving Pseudo-Free Market Right Wing Shills To Be Liars Again!).
Peter Muehlbauer
Despite spending half what the U.S. does on health care, Canada doesn't appear
to be any worse at looking after the health of its citizens.
By Christopher Mims
Whether it is American senior citizens driving into Canada in order to buy
cheap prescription drugs or Canadians coming to the U.S. for surgery in order
to avoid long wait times, the relative merits of these two nations' health care
systems are often cast in terms of anecdotes. Both systems are beset by
ballooning costs and, especially with a presidential election on the horizon,
calls for reform, but a recent study could put ammunition in the hands of
people who believe it is time the U.S. ceased to be the only developed nation
without universal health coverage.
Gordon H. Guyatt, a professor of epidemiology and biostatistics at McMaster
University in Hamilton, Ontario, who coined the term "evidence-based
medicine," collaborated with 16 of his colleagues in an exhaustive survey of
existing studies on the outcomes of various medical procedures in both the U.S.
and Canada. Their work appears in the inaugural issue of the new Canadian
journal Open Medicine, and comes at a time when many in Canada are debating
whether or not to move that country's single-payer system toward for-profit
delivery of care. The ultimate conclusion of the study is that the Canadian
medical system is as good as the U.S. version, at least when measured by a
single metric—the rate at which patients in either system died.
"Other people knew that Canadians live two to two and a half years longer than
Americans," says Steffie Woolhandler, an author on the paper and an associate
professor of medicine at Harvard Medical School, citing a phenomenon that many
attribute to differences in lifestyle between the two countries. "But what was
not known was once you got sick, was the quality of care equivalent in the two
countries."
Americans Less Likely to Survive Treatment
According to Woolhandler, by looking at already ill patients, the researchers
eliminated any Canadian lifestyle advantage and just examined the degree to
which the two systems affected patient deaths. (Mortality was the one kind of
data they could extract from a disparate pool of 38 papers examining everything
from kidney failure to rheumatoid arthritis.)
Overall, the results favored Canadians, who were 5 percent less likely than
Americans to die in the course of treatment. Some disorders, such as kidney
failure, favored Canadians more strongly than Americans, whereas others, such
as hip fracture, had slightly better outcomes in the U.S. than in Canada. Of
the 38 studies the authors surveyed, which were winnowed down from a pool of
thousands, 14 favored Canada, five the U.S., and 19 yielded mixed results.
Mortality Isn't the Only Measure That Matters
Not all experts agree with the implication that the Canadian system is better
than the U.S. system, however, or with the researchers' methodology. Vivian Ho,
who is the James A. Baker III Institute for Public Policy chair in health
economics at Rice University in Houston and has spent time living and
conducting research in both the U.S. and Canada, argues that the study's focus
on mortality could be misleading.
"When we look at health systems we look at other things than death," Ho
explains. In her own research on hip fracture, which was cited in Guyatt's
study, she found that the time a patient had to wait before surgery—which was
significantly longer in Canada than the U.S. because of a shortage of operating
rooms—made only a 1 percent difference in terms of mortality.
"But certainly if you ask people waiting in the hospital," Ho notes, "They're
going to say I'd rather have the U.S. system…. Waiting means there's a
significant amount of distress for an elderly patient, and also higher
complications for pneumonia because you have the patient immobile for so long."
Patti Groome, an epidemiologist at Queens University Cancer Research Institute
in Kingston, Ontario, said she believes that overall the paper was balanced.
"But when you get into [the] meat of [the] paper they can't sort out what's
going on…. There's way too much heterogeneity in these studies to come to a
conclusion about these systems." In meta-analyses such as this one,
"heterogeneity" in results corresponds to variations in the size of an effect
across the studies being reviewed.
In other words, of the studies surveyed, some showed slightly better outcomes
for the Canadian system and some showed slightly better outcomes for the U.S.
approach, making it hard to draw any conclusion other than that, on balance,
the two systems seem to yield only slightly different outcomes.
Money Doesn't Necessarily Buy Health
The study's authors highlight the fact that per capita spending on health care
is 89 percent higher in the U.S. than in Canada. "One thing that people
generally know is that the administration costs are much higher in the U.S.,"
Groome notes. Indeed, one study by Woolhandler published in The New England
Journal of Medicine in 2003 found that 31 percent of spending on health care in
the U.S. went to administrative costs, whereas Canada spent only 17 percent on
the same functions.
Ho believes, however, that there are also inefficiencies in the Canadian
system. In her own work on hip fracture, she found that Canadian hospitals held
patients for longer periods because there was no incentive to discharge them.
"These patients are easier to take care of," she explains, "and that helps
[hospital administrators] justify their budget…. I think there is room for
economic incentives [in the Canadian system]."
"Personally," Ho adds, "my view is that the Canadian system is good for Canada
and the American system is good for America. Neither side should switch,
because the systems are a function of the population—the Canadian population
believes much more in maintaining social safety nets."
This research may already be having an impact on policy debate: According to
Woolhandler, Ohio democratic congressman and presidential candidate Dennis
Kucinich has plans to circulate the results of this study to Congress.
Woolhandler herself would like to see this study play a part in a slightly
different debate—one over whether it it is better to be sick and insured in the
U.S. or in Canada. "I'd like to see politicians giving up on this mythology
that the quality of care for sick people in the U.S. is unique."
http://www.scientificamerican.com/article.cfm?id=canada-has-as-good-or-better-
healthcare-than-united-states&print=true