In other words, of the studies surveyed, some showed slightly better outcomes for the Canadian system and some showed slightly better outcomes for the U.S. approach, making it hard to draw any conclusion other than that, on balance, the two systems seem to yield only slightly different outcomes.
Money Doesn't Necessarily Buy Health
The study's authors highlight the fact that per capita spending on health care is 89 percent higher in the U.S. than in Canada. "One thing that people generally know is that the administration costs are much higher in the U.S.," Groome notes. Indeed, one study by Woolhandler published in The New England Journal of Medicine in 2003 found that 31 percent of spending on health care in the U.S. went to administrative costs, whereas Canada spent only 17 percent on the same functions.
Ho believes, however, that there are also inefficiencies in the Canadian system. In her own work on hip fracture, she found that Canadian hospitals held patients for longer periods because there was no incentive to discharge them. "These patients are easier to take care of," she explains, "and that helps [hospital administrators] justify their budget . I think there is room for economic incentives [in the Canadian system]."
"Personally," Ho adds, "my view is that the Canadian system is good for Canada and the American system is good for America. Neither side should switch, because the systems are a function of the population—the Canadian population believes much more in maintaining social safety nets."
This research may already be having an impact on policy debate: According to Woolhandler, Ohio democratic congressman and presidential candidate Dennis Kucinich has plans to circulate the results of this study to Congress. Woolhandler herself would like to see this study play a part in a slightly different debate—one over whether it it is better to be sick and insured in the U.S. or in Canada. "I'd like to see politicians giving up on this mythology that the quality of care for sick people in the U.S. is unique."