Posted on May 1, 2007

Quality of Healthcare at Least as Good in Canada as in U.S.


Comprehensive Analysis Finds Slightly Lower Death Rates in Canada
(Despite Far Lower Health Spending)

April 18 2007 — 8:30 A.M. EST

Steffie Woolhandler, M.D. 617-497-1268, 617-312-2766
David Himmelstein, M.D. 617-665-1032, 617-312-0970
Nick Skala 312-782-6006
Gordon Guyatt, M.D. 905-521-2100 x22160


A comprehensive study by a team of 17 leading Canadian and U.S. researchers finds that the quality of care in Canada is at least as good as that in the U.S. The research, which appears in the inaugural issue of the on-line journal Open Medicine, is a rigorous statistical compendium of every direct comparison of the outcomes of U.S. and Canadian patients with identical illnesses ever published.

The researchers analyzed every study that met two pre-specified criteria: 1) a comparison of patients with identical diagnoses in Canada and the U.S.; and 2) clearly measured outcomes, such as death rate. Medical librarians collaborating in the study identified 4,923 journal articles that might meet these criteria. The researchers reviewed abstracts and titles of these articles to winnow them to 498 articles that might possibly meet the pre-specified criteria. In order to eliminate any potential bias in study selection, librarians then blacked out the results of each of these 498 studies. Only then did a second team of reviewers decide which studies should be included in the final analysis. Finally, the 38 studies fully meeting both inclusion criteria were analyzed statistically.

Overall, 14 of the 38 studies showed better outcomes in Canada, while only 5 favored the U.S. The remaining 19 studies showed equivalent or mixed results in the two nations. When the studies were combined statistically, the mortality rate was 5% lower in Canada. However, the researchers urged caution in interpreting this small Canadian advantage. Among the highest quality studies examined, 5 favored Canada while only 2 favored the U.S. The one group of patients who clearly fared better in Canada were those with end stage kidney disease.

The findings are particularly striking since few uninsured patients in the U.S. — who probably suffer the worst quality care - were included in the studies examined. Indeed, all kidney failure patients in the U.S. have insurance,

Per capita health spending in the U.S. in 2006 was $7,129 — more than double Canada’s spending of $2,956 (U.S.) per capita. All Canadians are covered under that nation’s non-profit national health insurance program. The study comes on the heels of recent findings from the Joint U.S. Canada Health Survey that Canadians enjoy access to care similar to that for insured Americans, and far better than for the uninsured in the U.S.

Dr. Gordon Guyatt, Professor of Medicine at McMaster University and lead author of the study said “These results should be a wake up call to Americans. Canadian-style universal health care can deliver as good or better health outcomes at half the price.” Dr. Guyatt, who coined the term “evidence based medicine” is a leading expert on research methodology.

Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and a study co-author commented: “Americans pay inflated prices for inferior care. The extra $4000 each American spends annually isn’t buying us better quality. Most of it is pure waste, going for paperwork and insurance and drug company profits. National health insurance would maintain or even improve quality for those who now have coverage, cover the uninsured and still cost less than we’re now spending.”


Physicians for a National Health Program is an organization of 14,000 physicians that support single-payer national health insurance. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact or call 312-782-6006.