Canada Trumps U.S. in Healthcare, Study Says

Americans are less healthy than Canadians and have poorer and less accessible healthcare despite spending about twice as much on it per capita, according to a study published by three Harvard Medical School scientists last week.

The authors, HMS instructor Karen E. Lasser and assistant professors Stephanie J. Woolhandler and David U. Himmelstein, concluded that Americans suffer more from chronic illnesses and obesity than Canadians, are less likely to have one regular doctor, and are almost twice as likely to forego medicine they need because they cannot afford it.

The authors also found that Canadians saw smaller disparities in healthcare access between immigrants and nonimmigrants, rich and poor, and racial minorities and the majority.

“In the United States cost was the principal barrier [to treatment], whereas in Canada waiting times were an issue,” the report reads.

The authors of the study said they were undecided, however, about how strongly its results are linked to Canada’s universal healthcare provision, and about the study’s implications for Massachusetts, which recently announced its own compulsory universal insurance plan.

Lasser was cautious about concluding that Canadians’ better health was a result of their universal healthcare system, pointing out that the nature of the study allowed the researchers to compare the two healthcare systems without isolating one specific cause for the differences.

Himmelstein, however, said the results indicated that universal insurance was preferable, although he remains skeptical about Massachusetts’ universal coverage scheme.

“It’s a disastrous plan that I guess Romney thinks he can run for President on,” he said, adding that he thinks the system of compulsory insurance will be expensive for those who will have to pay, and inadequate for those whose insurance will be subsidized.

Lasser, Himmelstein, and Woolhandler all work at the Cambridge Health Alliance, a network of hospitals and community health centers in the northern suburbs of Boston.

“The kind of patients I treat are the kind of patients who would benefit from universal healthcare,” said Lasser.

“I think it’s important that we extend health insurance to all sections of our society.”

They identify Canada’s main problem as one of funding, and America’s as one of structure.

There are a few standards by which the U.S. outperforms Canada. The study found Americans less likely to smoke, and more likely to have had cervical pap smears and mammograms.

Critically, Americans said that they were more satisfied with the care they receive than their Canadian counterparts. The report suggested this could be due to the shorter waiting times and better appearances of American hospitals.

Himmelstein, however, said he believes that American satisfaction stems from what he calls the “Iron Curtain.”

“Americans are not allowed to see what’s going on in the rest of the world” for fear that they would demand another system, he said.

Himmelstein said that administrative costs accounted for one cent of every dollar spent on healthcare in Canada, but 15 cents for every dollar in America.

“Americans are getting extraordinarily poor value for money in our healthcare system,” he said.

The results are based on the Joint Canada/U.S. Survey of Health, a random phone survey conducted in both countries in 2002 and 2003, and were published last Wednesday in the American Journal of Public Health.

—Staff writer John R. Macartney can be reached at jmacartn@fas.harvard.edu.