Comparing the U.S. and Canadian Health Care Systems
In discussions of health care reform, the Canadian system is often held up as a possible model for the U.S. The two countries' health care systems are very different-Canada has a single-payer, mostly publicly-funded system, while the U.S. has a multi-payer, heavily private system-but the countries appear to be culturally similar, suggesting that it might be possible for the U.S. to adopt the Canadian system.
Much of the appeal of the Canadian system is that it seems to do more for less. Canada provides universal access to health care for its citizens, while nearly one in five non-elderly Americans is uninsured. Canada spends far less of ...view middle of the document...
A similar argument may be made for life expectancy. The gap in life expectancy among young adults is mostly explained by the higher rate of mortality in the U.S. from accidents and homicides. At older ages much of the gap is due to a higher rate of heart disease-related mortality in the U.S. While this could be related to better treatment of heart disease in Canada, factors such as the U.S.'s higher obesity rate (33 percent of U.S. women are obese, vs. 19 percent in Canada) surely play a role.
To compare how the countries perform on other health outcome measures, the authors use the Joint Canada/U.S. Survey of Health, a survey of about 9,000 residents of the two countries conducted in 2002-2003. The authors begin by comparing self-reported health status. While this measure is subjective and may be influenced by factors outside the health care system, it is widely used by researchers. They find that self-reported health status is similar in the two countries-if anything, more people report themselves to be in excellent health in the U.S.
Next, the authors examine three other outcome measures: an index of overall health, a depression index, and a pain indicator. Focusing on whites (to sidestep differences in the racial composition of the two populations and the problem of racial disparities in health outcomes), they find that the two countries score similarly on the overall health index and pain indicator, while the U.S. has a slightly higher incidence of depression.
The final health status measure examined is the incidence of chronic conditions like high blood pressure, heart disease, and asthma. These measures are less subjective, but also are known to be influenced by behavior and other factors outside of the health care system. The authors find that the incidence of these conditions is somewhat higher in the U.S. However, respondents with these conditions are some-what more likely to be treated in the U.S.-in the case of emphysema, the treatment rate is twenty percentage points higher in the U.S.
Turning their attention to the availability of health care resources, the authors examine the use of cancer screenings including mammograms and PAP smears (for women), PSA screenings (for men), and colonoscopies. They find that the use of these tests is more frequent in the U.S. - for example, 86 percent of U.S. women ages 40 to 69 have had a mammogram, compared to 73 percent of Canadian women. The U.S. also is endowed with many more MRI machines and CT scanners per capita. The authors find evidence of the possible effectiveness of higher levels of screening and equipment by examining mortality rates in both countries for five types of cancer that could be affected by early detection and treatment. Because the incidence of cancer may differ for reasons other than the health care system, they compare the ratio of the mortality rate to the incidence rate - a lower ratio corresponds to a lower death rate for those with the disease. They find that...