Canada’s health care system often figures in the debate about overhauling the U.S. system, mentioned by both critics and supporters.
But how does health care in Canada and other countries really stack up when compared with the U.S? Supporters of a health overhaul refer to a 2000 World Health Organization ranking that placed the United States 37th among all countries for health care. (France was number one.) But that report has also been criticized by some analysts for failing to follow a strict, consistent protocol and not adjusting for a wide variety of indicators from the responding countries.
Now a new study examines data from several health systems and highlights the role of health care quality in the midst of the current U.S. debate, which is often focused on improving access.
The study, which was conducted by Elizabeth Docteur and Robert Berenson and released in August by the Urban Institute, compared U.S. treatment outcomes and other quality indicators with that of at least 30 developed countries, including Australia, France and the United Kingdom.
Docteur, an independent health policy and research analyst, said she and Berenson wanted to see whether the scientific literature supported the idea that American medicine really is best – a notion often "bandied about in the health reform debate." They examined health care system research conducted during the past 10 to 15 years and found there was "no hard evidence" that U.S. health care quality stands out across the board. They did find that the U.S. had high scores in some specific treatment areas, such as cancer care. However, it didn’t do as well when compared to other nations at handling preventive care or treatment for acute conditions, including heart disease and hip fractures.
Perhaps one of the study's most unexpected findings—depending on your political point of view —is that the quality of health care in Canada tends to be higher than in the U.S. The researchers looked at 10 statistically adjusted studies of broad populations and found that five favored care in Canada. The U.S. came out better in two. Three were inconclusive. Docteur points out the universal coverage in Canada helps to ensure that Canadians receive the care they need throughout their lives. "I think the main point is that our study showed quite clearly that it is not the case that the U.S. is dominating Canada … in terms of quality of care," she said.
"The findings are not a surprise to policy wonks," said Bruce Siegel, a quality expert and professor at The George Washington University's School of Public Health and Health Services. Siegel—who was not involved in the study but said the authors used "the best information out there for comparison"—thinks their findings have the potential to be a "myth buster."
Docteur said she hopes that her findings will draw more attention to quality issues, which have been a "bit of a sleeper" in the current debate. The research made it clear that although it's necessary to find a way to cover more people to improve the country's health system, "just solving the problem of the uninsured is not going to be enough." She said she would like to see the debate reframed from a discussion on quality being at risk to a dialogue considering what the best performers are doing.