Canada Has as Good or Better Health Care than the U.S. (spending only half as much)

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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.

just a comment on that last system, is there any other way to measure the effectiveness of a healthcare system?

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.

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.

now, i think this highlights some of the inadequacies in the american system, though the article does go on to say that canada's healthcare system does have issues with waiting for operations, due to a shortage of operating rooms, so maybe we could come to an agreement on a universal healthcare system that can be effecient.

Well, I think there are a lot of other ways to measure the effectiveness of a medical system other than mortality rates. To me, that would be measuring doctor experience and competence, as well as access to medicines and diagnostic equipment, more than the actual system.

It's well known that many people come to the US for treatment because of the long waits in the Canadian system. So, we get some of your tough cases, and a certain percentage of them are going to die, which makes me question the mortality metric.

As for the administrative costs, that would be intuitively obvious, imo. If I, as a doctor, had to handle paperwork from a dozen HMO's plus Medicare/Medicaid. etc., it stands to reason that I'll be spending more time dealing with it than a doctor who only has to deal with the state.

This part of the study intrigued me:

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.

Canadian lifestyle advantage? Can somebody define that?

And contrary to what the researcher said, it is mho that your previous lifestyle does very much affect your chances of recovery, so this "Canadian lifestyle advantage", if one does exist, may be impossible to eliminate from the study after all.

Of course, this is just my .02.

Originally posted by jsobecky

Canadian lifestyle advantage? Can somebody define that?

I read that as a healthier lifestyle. Less McDonalds. I've seen some commercials from smaller burger chains, Checkers, et al and damn, my arteries harden just by watching the commercials.

This is an interesting topic. One thing I will say is that growing up in Canada, we never worried about medical bills. We didn't talk about them. It was a non-issue. If you were sick or hurt, you simply went to the doctor.

My parents had medical coverage through their work as well and I'm sure there were some dealings with it, but from my perspective it was universal constant. If you were sick...go to the hospital.

After moving to the US, one of my first girlfriends was sick and refused to go to the doctor for about 4 days. I kept pushing the issue and she informed me her family couldn't afford it. They had no medical coverage.

This was a real eye-opening experience for me. I went home and asked my parents about it. I did think it was a pretty screwed-up system.

[edit on 13-7-2007 by ZeddicusZulZorander]

Originally posted by intrepid

Originally posted by jsobecky

Canadian lifestyle advantage? Can somebody define that?

I read that as a healthier lifestyle. Less McDonalds. I've seen some commercials from smaller burger chains, Checkers, et al and damn, my arteries harden just by watching the commercials.

It would be interesting to compare life expectancies, rates of death from various lifestyle-affected criteria, etc.

I wonder how much Canada practices preventative medicine? That includes encouraging healthy lifestyles? In the US, the TV commercials are stuffed full of ads promoting the newest wonder drug. It must cost the pharms a ton of money to run those ads.

As a result of our lifestyle, our physicians are more like firefighters than gardeners.

Here's the report they are talking about, in case anyone wants to read the whole thing: www.openmedicine.ca...

Originally posted by jsobecky
Canadian lifestyle advantage? Can somebody define that?

The only things I can think of are diet (we are getting fatter, but not at the rate of the US), lower murder rate (more young people get shot, the mortality average will go down) and preventative care (as mentioned by jsobecky). When we get sick in Canada, we go to a doctor right away. That way you can get help before the problem turns into something worse.

Regarding pharma ads, they aren't allowed to run them in Canada. Just think how much less medicine would cost if they didn't have those big advertising budgets built into the cost.

Mortality rates? Are most people who go to the doctor dieing?

A better way to look at it, IMO, is to look at overall satisfaction of the patients as well as the effect that one person's health has on an unrelated person.

I don’t know about satisfaction, but I know that I would never be satisfied waiting 6 months for a needed MRI.

I go to my doctor and request an area of my body get an MRI and it is scheduled that week. If I need it, it can be done that day. If they don’t provide what I ask for, I take my money somewhere else.

It boils down to the socialist vs. capitalist arguments. I like having a doctor who works for my business, I feel I get better care that way; my doctor is greedy and wants my money, just the way I like it.

And I do have some experience with "free" health care from my days in the Army and later the VA. Sure, it was great making an appointment every time one of my kids got the sniffles. What wasn’t great was the lack of quality the care entailed. After all, I couldn’t take my business down the road so there was no reason to try and please me. "Broken arm? Take Motrin and stop smoking. What? That cyst growing on your neck? Oh here is some Motrin, and make sure to stay hydrated or it will spread."

No, I like choosing my doctor. I like the fact that my doctor knows that if he doesn’t fix me I will stop giving him money.

I just wish the government paid for a little less socialist medicine because it drives up the price for those of who work and have insurance. And not to mention the fact that I get paid less because part of my compensation package for WORKING is medical insurance, and then I get hit again to pay for Medicare for people that aren’t WORKING.

Oh well, I guess that is what happens when the socialist gunk starts to leak downhill to the real America. You crazy Canadians with your snowmobiles and hinged faces, stop trying to keep everyone alive.

[edit on 14-7-2007 by cavscout]

Originally posted by cavscout
I don’t know about satisfaction, but I know that I would never be satisfied waiting 6 months for a needed MRI.

Honestly, I wouldn't be thrilled with a wait time of 6 months either.

If I were in the unlucky position of needing a MRI for a non-emergency (emergency gets same or next-day scans normally), I would head to a private clinic, pay for it and then claim it back on my income tax as a medical expense.

Originally posted by cavscout
No, I like choosing my doctor. I like the fact that my doctor knows that if he doesn’t fix me I will stop giving him money.

Me too. That's why I'm pleased that I can visit any doctor I choose to.

Last night on c2c, a Canadian caller telling his story said that in Canada, he cannot sue his doctor, as people can do in the US.

Is this true? I know that the cost of malpractice insurance can be staggering, especially for young doctors. This would add to the higher "administrative costs" of our medical system.

We can sue doctors for malpractice in Canada, but there are some differences that probably result in lower insurance costs for doctors.

• Canadian tort cases are normally only heard by a judge; there is no jury deciding damages.
  
• Pain and suffering amounts have caps on them except in 'extreme cases' (I don't know what is defined as extreme, I just know that there have been awards over the capped amounts on occasion).
  
• There is generally no award for the cost of treatment because the patient didn't pay for it.
  

Another big factor is that the majority of doctors in Canada have their malpractice insurance from a non-profit they funded - The Canadian Medical Protective Association. By eliminating the middleman's need to make a profit and keeping the money 'in the family' so to speak, they reduce the costs. The government then reimburses the doctors their annual membership in the association.

Correction alert:

Technically I wasn't correct about the malpractice insurance - the CMPA is a mutual defense org. They provide the lawyers and then pay the awards from a fund. 95% of the doctors in Canada belong to it.




[edit on 14-7-2007 by Duzey]

Originally posted by cavscout
Mortality rates? Are most people who go to the doctor dieing?

A better way to look at it, IMO, is to look at overall satisfaction of the patients as well as the effect that one person's health has on an unrelated person.

I don’t know about satisfaction, but I know that I would never be satisfied waiting 6 months for a needed MRI.

extreme case, nonissue.

I go to my doctor and request an area of my body get an MRI and it is scheduled that week. If I need it, it can be done that day. If they don’t provide what I ask for, I take my money somewhere else.

alright, in a socialized system (this case malta) my dad got an MRI the SAME DAY without an appointment for either the doctor or the MRI...

It boils down to the socialist vs. capitalist arguments. I like having a doctor who works for my business, I feel I get better care that way; my doctor is greedy and wants my money, just the way I like it.

that's why you spend so much on healthcare...
and again, capitalism leaves 5 million children behind on this one because its' bad business to insure them.... i'll take the system that doesn't see treating sick kids as a bad thing

And I do have some experience with "free" health care from my days in the Army and later the VA. Sure, it was great making an appointment every time one of my kids got the sniffles. What wasn’t great was the lack of quality the care entailed. After all, I couldn’t take my business down the road so there was no reason to try and please me. "Broken arm? Take Motrin and stop smoking. What? That cyst growing on your neck? Oh here is some Motrin, and make sure to stay hydrated or it will spread."

um, that's the incredibly flawed VA system. nobody is saying that's the example. look at france, italy, or malta for a good example.

No, I like choosing my doctor. I like the fact that my doctor knows that if he doesn’t fix me I will stop giving him money.

in socialised systems you get to choose where you go. you aren't forced to go to a particular doctor. you're just spewing out one of the arguments people like reagan would use as a boogeyman
and in socialised countries they... get fired and pay cuts if they don't fix pepole. they even get raises for having healthier patients.

I just wish the government paid for a little less socialist medicine because it drives up the price for those of who work and have insurance. And not to mention the fact that I get paid less because part of my compensation package for WORKING is medical insurance, and then I get hit again to pay for Medicare for people that aren’t WORKING.

yeah, those damn retirees!
come on, everyone deserves health. life, liberty, pursuit of happiness. i'm pretty sure without health, life is kind of a pointless one to put on the list.

Oh well, I guess that is what happens when the socialist gunk starts to leak downhill to the real America.

You crazy Canadians with your snowmobiles and hinged faces, stop trying to keep everyone alive.

socialist gunk? um, this isn't gunk, it's one of the great things about other countries that america should incorporate.

america is in the 30s on the recent WHO list of countries ranked by healthcare. france, italy, and malta are in the top 5.

take a look at the movie sicko, it's fact-checked and accurate. nobody has yet to be able to debunk the facts presented in the movie. it'll open your eyes if you can take off the party-line blinders.