By Gordon H. Guyatt, P.J. Devereaux, Joel Lexchin, Samuel B. Stone, Armine Yalnizyan, David Himmelstein, Steffie Woolhandler, Qi Zhou, Laurie J. Goldsmith, Deborah J. Cook, Ted Haines, Christina Lacchetti, John N. Lavis, Terrence Sullivan, Ed Mills, Shelley Kraus, Neera Bhatnagar
Open Medicine | A peer-reviewed, independent, open-access journal.
Vol 1, No 1 (2007)
Canada and the United States are similar in many ways, and until 40 years ago their healthcare systems were nearly identical. At that time Canada adopted its national health insurance program.
Although both nations continue to rely largely on private funding for drugs, they now differ substantially in both the financing and delivery of physician and hospital services. With respect to financing, Canada has virtually first-dollar, universal public coverage of hospital and physician services. With respect to delivery, not-for-profit institutions provide almost all hospital services, and large for-profit organizations are almost entirely excluded from the provision of physician services. In contrast, the United States relies on a mixture of public and private insurance to finance health care, and leaves 16% of the population without coverage. Investor-owned for-profit providers play a substantial role.
Despite the limitations of the available studies, some robust conclusions are possible from our systematic review. These results are incompatible with the hypothesis that American patients receive consistently better care than Canadians.
Canadian health care has many well-publicized limitations. Nevertheless, it produces health benefits similar, or perhaps superior, to those of the US health system, but at a much lower cost. Canada’s single-payer system for physician and hospital care yields large administrative efficiencies in comparison with the American multi-payer model.
Policy debates and decisions regarding the direction of health care in both Canada and the United States should consider the results of our systematic review: Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost.
http://www.openmedicine.ca/article/view/8/1
Comment:
By Don McCanne, MD
The important policy lesson: Canada’s government-funded and government-administered single payer system dramatically reduced their rate of health care cost increases without having a negative impact on health outcomes. The cost savings alone is a compelling reason to adopt a national health insurance program in the United States.
Since this was a comprehensive review of studies of patients who had accessed the health care delivery system and were under treatment for specific disorders, it automatically excluded many individuals in the United States who were unable to access the system due to financial barriers (e.g., lack of insurance). We can only speculate as to whether including them would have had a negative impact on the measured outcomes for the Unites States. Canada’s system provides access to everyone since financial barriers are eliminated. The ability to provide affordable access to everyone is a second compelling reason for the United States to adopt a national health insurance program.
Incidentally, today’s article is from the inaugural issue of Open Medicine, a new on-line, independent, open-access Canadian medical journal. It represents a “milestone in independence and academic freedom of medical research publishing.” It should be a very valuable resource for us all.