Canada and the United States have conducted a large-scale social experiment on the effects of alternative ways of funding expenditures for health care. Two very similar societies, with (until recently) very similar systems of providing health care, have adopted radically different systems of reimbursement. The results of this experiment are of increasing interest to Americans, because the Canadian approach has avoided or solved several of the more intractable problems facing the United States. In particular, overall health expenditures have been constrained to a stable share of national income, and universality of coverage (without user charges) eliminates the problems of uncompensated care, individual burdens of catastrophic illness, and uninsured populations. The combination of cost control with universal, comprehensive coverage has surprised some American observers, who have questioned its reality, its sustainability, or both. We present a comparison of the Canadian and American data on expenditures, identifying the sectors in which the experience of the two nations diverges most, and describing the processes of control. In any system, cost control involves conflict between providers and payers. Political processes focus this conflict, whereas market processes diffuse it. But the stylized political combat in Canada may result in less intrusion on the professional autonomy of the individual physician than is occurring in the United States.
Source Information
Division of Health Services Research and Development, University of British Columbia, Vancouver, Canada.
This article has been cited by other articles:
Bevan, G., Robinson, R.
(2005). The Interplay between Economic and Political Logics: Path Dependency in Health Care in England. Journal of Health Politics, Policy and Law
30: 53-78
[Abstract]
Antoniou, J., Martineau, P. A., Filion, K. B., Haider, S., Zukor, D. J., Huk, O. L., Pilote, L., Eisenberg, M. J.
(2004). In-Hospital Cost of Total Hip Arthroplasty in Canada and the United States. JBJS
86: 2435-2439
[Abstract][Full Text]
Brox, A. C., Filion, K. B., Zhang, X., Pilote, L., Obrand, D., Haider, S., Azoulay, A., Eisenberg, M. J.
(2003). In-Hospital Cost of Abdominal Aortic Aneurysm Repair in Canada and the United States. Arch Intern Med
163: 2500-2504
[Abstract][Full Text]
Khaykin, Y, Austin, P C, Tu, J V, Alter, D A
(2002). Utilisation of coronary angiography after acute myocardial infarction in Ontario over time: have referral patterns changed?. Heart
88: 460-466
[Abstract][Full Text]
Katz, S. J., Cardiff, K., Pascali, M., Barer, M. L., Evans, R. G.
(2002). Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States. Health Aff (Millwood)
21: 19-31
[Abstract][Full Text]
Iglehart, J. K.
(2000). Revisiting the Canadian Health Care System. NEJM
342: 2007-2012
[Full Text]
Luft, H. S.
(1999). Why Are Physicians So Upset about Managed Care?. Journal of Health Politics, Policy and Law
24: 957-966
Coyte, P. C., Wright, J. G., Hawker, G. A., Bombardier, C., Dittus, R. S., Paul, J. E., Freund, D. A., Ho, E.
(1994). Waiting Times for Knee-Replacement Surgery in the United States and Ontario. NEJM
331: 1068-1071
[Abstract][Full Text]
Blendon, R. J., Donelan, K., Leitman, R., Epstein, A., Cantor, J. C., Cohen, A. B., Morrison, I., Moloney, T., Koeck, C., Levitt, S. W.
(1993). Physicians' Perspectives on Caring for Patients in the United States, Canada, and West Germany. NEJM
328: 1011-1016
[Abstract][Full Text]
Redelmeier, D. A., Fuchs, V. R.
(1993). Hospital Expenditures in the United States and Canada. NEJM
328: 772-778
[Abstract][Full Text]
Rouleau, J. L., Moye, L. A., Pfeffer, M. A., Arnold, J. M. O., Bernstein, V., Cuddy, T. E., Dagenais, G. R., Geltman, E. M., Goldman, S., Gordon, D., Hamm, P., Klein, M., Lamas, G. A., McCans, J., McEwan, P., Menapace, F. J., Parker, J. O., Sestier, F., Sussex, B., Braunwald, E., The SAVE Investigators,
(1993). A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States. NEJM
328: 779-784
[Abstract][Full Text]
Duncan, R. P.
(1992). Uncompensated Hospital Care. Med Care Res Rev
49: 265-330
Rice, T.
(1992). Containing Health Care Costs in the United States. Med Care Res Rev
49: 19-65
Wood, B.
(1991). The Non-Achievement of Cost Containment in American Health Care: Explanations, and Lessons for Britain. Public Policy and Administration
6: 22-39
Feinglass, J., Holloway, J. J.
(1991). The Initial Impact of the Medicare Prospective Payment System on U.S. Health Care: A Review of the Literature. Med Care Res Rev
48: 91-115
Wood, B.
(1990). Policy Failure: The Non-Reform of American Health Care. Public Policy and Administration
5: 19-36
Sakala, C.
(1990). The Development of National Medical Care Programs in the United Kingdom and Canada: Applicability to Current Conditions in the United States. Journal of Health Politics, Policy and Law
15: 709-753
[Abstract]
Lomas, J.
(1990). Finding Audiences, Changing Beliefs: The Structure of Research Use in Canadian Health Policy. Journal of Health Politics, Policy and Law
15: 525-542
[Abstract]
(1990). Controlling Medical Professionals: The Comparative Politics of Health Governance. Journal of Health Politics, Policy and Law
15: 449-454
Morone, J. A.
(1990). American Political Culture and the Search for Lessons from Abroad. Journal of Health Politics, Policy and Law
15: 129-143
[Abstract]
Russell, L.
(1989). Some of the tough decisions required by a national health plan. Science
246: 892-896
[Abstract]
(1989). LESSONS FROM THE CANADIAN HEALTH INSURANCE SYSTEM. JWatch General
1989: 9-9
[Full Text]
Previous
