The death and disease rates for patients in Canada are the same or lower than those for people with similar diagnoses treated in the United States — even though per capita health-care spending is higher south of the border, a study suggests.

The findings — from Canadian and U.S. researchers who crunched data from 38 studies — were published in the inaugural edition of Open Medicine. The online medical journal launched Wednesday in the aftermath of a rift last year between some editors and the publisher of the Canadian Medical Association Journal.

'What it shows is that despite an enormous investment in money, we do not see better health outcomes [in the U.S.]' — Study author Dr. P.J. Devereaux

"In looking at patients in Canada with a specific diagnosis compared to Americans with the same diagnosis, in Canada patients had at least as good an outcome as their American counterparts — and in many situations, a better health outcome," said one of the 17 authors, Dr. P.J. Devereaux, a cardiologist and clinical epidemiologist at McMaster University in Hamilton.

"And that is important because in the United States, they're currently spending a little over $7,100 per individual on health care annually, whereas in Canada we're spending a little over $2,900 per individual annually," he said in a telephone interview from Brantford, Ont.

The study covered data on patient populations in the United States and Canada from 1955 to 2003. To conduct their meta-analysis, researchers identified almost 5,000 titles and abstracts. Of these, 498 appeared potentially eligible on initial review. Eventually, 38 studies were deemed to be eligible.

"Overall, Canada did better, and in fact we found a statistically significant five per cent mortality advantage [of survival] to people with diagnoses in Canada compared to their counterparts in the United States," Devereaux said.

Canadian survival advantage

Devereaux said the Canadian public is barraged by people who argue that the solution to problems in the health-care system is to move toward two-tiered medicine and for-profit health-care delivery.

He said the researchers in the meta-study wanted to provide facts that can be used to make decisions about the system, instead of the debate being steered by beliefs and ideologies.

'The medicare system allows us enormous efficiencies in terms of cost-saving relative to private insurance.'—Dr. P.J. Devereaux

Researchers began by asking the question: Are there differences in death and disease rates in patients suffering from similar medical conditions treated in Canada versus those treated in the United States?

Overall, 14 of the 38 studies showed better outcomes in Canada, while five favoured the United States. The other 19 studies showed equivalent or mixed results in the two countries.

"What it [the study] shows is that despite an enormous investment in money, we do not see better health outcomes [in the U.S.]," Devereaux said.

"And importantly, where our two systems do diverge is that America has a mixture of private insurance in terms of the funding for health care whereas in Canada we have medicare system for hospital and physician services.

"The medicare system allows us enormous efficiencies in terms of cost-saving relative to private insurance."

Some explanations for the results include the fact that U.S. health care has administrative inefficiencies that public funding — without multiple competing insurance companies — eliminates. Canadians also save on prescription drug costs because drug prices are controlled.

Few uninsured patients in the United States, who probably suffer the worst quality care, were included in the studies examined.

Devereaux said the Canadian health-care system has problems and needs improvement, "but certainly using medicare funding and not-for-profit delivery is the best way to actually maximize health outcomes and in a cost-effective manner."