Health and Surgical Outcomes in Canada and the United States

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Abstract
Prologue:The health care system of every nation bears its own unique signature. Three decades ago, the systems operating in Canada and the United States were quite similar—reflecting in part our common culture and, for the most part, common language. Since then, Canada's provinces created publicly financed health insurance plans that provide universal coverage while constraining spending and largely protecting the clinical autonomy of physicians. Divergence of the two systems reflects the values that underlie the two societies, including Canadas greater willingness to entrust health financing to government. One dimension of the two systems that has not been thoroughly compared is how patients fare when they seek treatment for similar conditions. The Bush health plan misinterpreted earlier research on surgical outcomes in New England and Manitoba, emphasizing that “post-operative mortality … is 44 percent higher in Canada than in the United States for high-risk procedures.” As this paper shows, much of the short-term mortality differential is explained by the special problems of transferring hip fracture patients in sparsely populated Manitoba. The overall findings are dramatically different. Adjusting for case-mix, long-term survival after nine of ten procedures in fact favors Manitoba over New England. Leslie Roos, who holds a doctorate in political science from the Massachusetts Institute of Technology, is on the faculty of medicine at the University of Manitoba. Elliott Fisher, a graduate of Harvard Medical School, is affiliated with Dartmouth's Center for Evaluative Clinical Sciences. Ruth Brazauskas is a research assistant at the Manitoba Centre for Health Policy and Evaluation. Sally Sharp is a research associate at Dartmouth. Evelyn Shapiro, who chaired the Manitoba Health Services Commission from 1982 to 1988, is a professor of medicine at the University of Manitoba.