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

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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.

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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.
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N Engl J Med 1993; 329:964-966, Sep 23, 1993. Correspondence

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