FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 328:772-778 March 18, 1993 Number 11 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Expenditures per capita for hospitals are higher in the United States than in Canada. If the United States had the same spending pattern as Canada, the annual savings in 1985 would have exceeded $30 billion.

Methods We used data from published sources, computer files, and institutional reports to compare 1987 costs for acute care hospitals on three levels: national (the United States vs. Canada), regional (California vs. Ontario), and institutional (two California hospitals vs. two Ontario hospitals). Expenditures per admission were adjusted for the case mix of patients, prices of labor and other resources, and outpatient visits.

Results The United States had proportionately fewer hospital beds than Canada (3.9 vs. 5.4 per 1000 population), fewer admissions (129 vs. 142 per 1000 population), and shorter mean stays (7.2 vs. 11.2 days). Higher costs per admission in the United States were explained in part by a case mix that was more complex by 14 percent and by prices for labor, supplies, and other hospital resources that were higher by 4 percent. Hospitals in the United States provided relatively less outpatient care, particularly in emergency departments (320 vs. 677 visits per 1000 population). After all adjustments, the estimate of resources used for inpatient care per admission was 24 percent higher in the United States than in Canada and 46 percent higher in California than in Ontario. The estimated differences between the two pairs of California and Ontario hospitals were 20 and 15 percent.

Conclusions Canadian acute care hospitals have more admissions, more outpatient visits, and more inpatient days per capita than hospitals in the United States, but they spend appreciably less. The reasons include higher administrative costs in the United States and more use of centralized equipment and personnel in Canada.

Source Information

From the Department of Medicine, University of Toronto, and the Division of Clinical Epidemiology, Wellesley Hospital Research Institute, Toronto (D.A.R.); and the Departments of Economics and Health Research and Policy, Stanford University, and the National Bureau of Economic Research, Stanford, Calif. (V.R.F.).

Address reprint requests to Dr. Redelmeier at Wellesley Hospital, Jones Bldg., Rm. 123, 160 Wellesley St. East, Toronto, ON M4Y 1J3, Canada.

Full Text of this Article

Related Letters:

Health Care in Canada and the United States
Schneider J. F., Roth S. L., Cornell C., Mendelssohn D.C., Skorecki K.L., Cardella C.J., Uretsky B. F., Redelmeier D. A., Fuchs V. R., Rouleau J. L., Braunwald E., Pfeffer M. A.
Extract | Full Text  
N Engl J Med 1993; 329:964-966, Sep 23, 1993. Correspondence

This article has been cited by other articles:

• Eisenberg, M. J. (2006). An american physician in the canadian health care system.. Arch Intern Med 166: 281-282 [Full Text]  
• Fuchs, V. R. (2005). Health Care Expenditures Reexamined. ANN INTERN MED 143: 76-78 [Full Text]  
• 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]  
• Rundek, T., Nielsen, K., Phillips, S., Johnston, K. C., Hux, M., Watson, D., for the GAIN Americas Investigators, (2004). Health Care Resource Use After Acute Stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas Trial. Stroke 35: 1368-1374 [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]  
• Klarenbach, S. W., Jacobs, P. (2003). International Comparison of Health Resource Utilization in Subjects With Diabetes: An analysis of Canadian and American national health surveys. Diabetes Care 26: 1116-1122 [Abstract] [Full Text]  
• Lumer, G.B, Roy, D, Talajic, M, Couturier, A, Lambert, J, Frasure-Smith, N, Thibault, B, Dubuc, M, Gagne, P, Nattel, S (2002). Amiodarone reduces procedures and costs related to atrial fibrillation in a controlled clinical trial. Eur Heart J 23: 1050-1056 [Abstract] [Full Text]  
• Booth, G. L., Zinman, B., Redelmeier, D. A. (2002). Diabetes Care in the U.S. and Canada. Diabetes Care 25: 1149-1153 [Abstract] [Full Text]  
• Cheng, D. C. H., Newman, M. F., Duke, P., Wong, D. T., Finegan, B., Howie, M., Fitch, J., Bowdle, T. A., Hogue, C., Hillel, Z., Pierce, E., Bukenya, D. (2001). The Efficacy and Resource Utilization of Remifentanil and Fentanyl in Fast-Track Coronary Artery Bypass Graft Surgery: A Prospective Randomized, Double-Blinded Controlled, Multi-Center Trial. Anesth. Analg. 92: 1094-1102 [Abstract] [Full Text]  
• Redelmeier, D. A. (1999). A Canadian Perspective on the American Hospitalist Movement. Arch Intern Med 159: 1665-1668 [Full Text]  
• White, J. (1999). Targets and Systems of Health Care Cost Control. Journal of Health Politics, Policy and Law 24: 653-696 [Abstract]  
• Aitken, G. K., Ma, S., Magee, B. D., Linquist, P. R., Redelmeier, D. A., Bell, C. M., Detsky, A. S., Crystal, M. (1998). Hospital Services in the United States and Canada. JAMA 280: 599-600 [Full Text]  
• Bell, C. M., Crystal, M., Detsky, A. S., Redelmeier, D. A. (1998). Shopping Around for Hospital Services: A Comparison of the United States and Canada. JAMA 279: 1015-1017 [Abstract] [Full Text]  
• Roush, R. E., Teasdale, T. A. (1997). Reduced Hospitalization Rates of Two Sets of Community-Residing Older Adults After Use of a Personal Response System. Journal of Applied Gerontology 16: 355-366 [Abstract]  
• Katz, S. J., Welch, W. P., Verrilli, D. (1997). The Growth of Physician Services for the Elderly in the United States and Canada: 1987-1992. Med Care Res Rev 54: 301-320 [Abstract]  
• Strum, D. P., Vargas, L. G., May, J. H. (1997). Design of RCSS: Resource Coordination Systems For Surgical Services Using Distributed Communications. J. Am. Med. Inform. Assoc. 4: 125-135 [Abstract] [Full Text]  
• Evans, R. G. (1997). Going for the Gold: The Redistributive Agenda behind Market-Based Health Care Reform. Journal of Health Politics, Policy and Law 22: 427-465 [Abstract]  
• Rasell, M. E. (1995). Cost Sharing in Health Insurance -- A Reexamination. NEJM 332: 1164-1168 [Full Text]  
• Goldberg, M. A., Marmor, T. R. (1995). The Relation between Universal Health Insurance and Cost Control. NEJM 332: 742-745 [Full Text]  
• Watson, A, Halpin, J (1994). Health care in the US and Canada. BMJ 308: 793-793 [Full Text]  
• Schneider, J. F., Roth, S. L., Cornell, C., Mendelssohn, D.C., Skorecki, K.L., Cardella, C.J., Uretsky, B. F., Redelmeier, D. A., Fuchs, V. R., Rouleau, J. L., Braunwald, E., Pfeffer, M. A. (1993). Health Care in Canada and the United States. NEJM 329: 964-966 [Full Text]  
• Iglehart, J. K. (1993). Community Hospitals. NEJM 329: 372-376 [Full Text]  
• Detsky, A. S. (1993). Northern Exposure -- Can the United States Learn from Canada?. NEJM 328: 805-807 [Full Text]