Why health care costs more in the US: Comparing health care expenditures between systemic lupus erythematosus patients in Stanford and Montreal

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Abstract
Objective. Recent studies to identify the causes of higher health care expenditure in the US versus Canada have relied on population‐based measures of health care utilization and have restricted their analysis to one sector, such as physician or hospital expenditures. We present a detailed comparative analysis of the direct costs (health services utilized) of treating systemic lupus erythematosus (SLE) patients in Stanford, CA and Montreal, Quebec. Methods. Using the self‐report Stanford Health Assessment Questionnaire, we assessed 6‐month direct costs incurred by 174 American and 164 Canadian SLE patients. We explored 3 potential reasons for the differential expenditure. These were 1) higher prices for health care inputs, 2) more severe disease in the patient case mix, and 3) greater resource utilization. Results. The direct health care costs for the American SLE patients exceeded those for the Canadian patients by almost 2‐fold ($10,530 versus $5,271, expressed in 1991 US dollars). The higher direct costs were explained by the higher price of health services in the US and the more severe disease mix. In fact, for all health resource categories studied, Canadians utilized at least as many services as their American counterparts. Canadians had longer hospital stays, made more emergency room visits, and used more medications. Conclusion. Despite significantly greater per capita health care expenditure in the US, our data show that Canadian SLE patients actually receive more medical services.