The Not-So-Awful Truth About Canadian Health Outcomes

Toronto General Hospital (Wikimedia)

Toronto General Hospital (Wikimedia)

Someone was on Fox earlier this morning arguing that including a robust public plan in health care reform would lead the United States to a Canadian-style health care system, which would be terrible. This is closer to the mark than Oklahoma Senator Tom Coburn’s insistence that a public plan would be like the Veterans Health Administration, which he (also falsely!) claimed would be bad. Advocates of a public plan are proposing something very different from the Canadian health insurance system. But if a public plan were introduced, and then it succeeded in delivering consistently higher-quality, lower-cost care than all private insurance companies all across the country, US health care could evolve in a direction that would in some respects resemble Canada’s. How likely that really is is up to debate. But it could only happen if customers were to show a consistent and overwhelming preference for the public plan, in which case the public plan coming to dominate probably wouldn’t be such a bad thing.

Meanwhile, how’s health care in Canada? According to actual research it’s about the same as in the United States:

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

If you ask me, health care in the United States is not so great, so Canadian health care—which turns out to be of similar quality—is not so great either. But it’s a lot cheaper, so that’s nice. Alternatively if, like most conservatives, you deny that our system is broken and want to maintain that we have “the best health care in the world” then it turns out that Canada’s is probably slightly better, almost certainly no worse, and definitely cheaper.