The United States and Canada have different methods of financing and providing health care. The U.S. market-oriented system with limited governmental control is in sharp contrast to Canada's single-payer system, which covers most physician and hospital services and prescription medications. Canadian budgetary restraints have resulted in limited access to specialized care, such as invasive cardiac procedures and physician specialists, according to background information in the article. Health care expenditure per person is significantly higher in the U.S. compared with Canada, but whether there are differences in quality of care of many conditions is unknown.
Dennis T. Ko, M.D., of the University of Toronto, Ontario, and colleagues compared processes of care and 30-day and one-year risk-standardized mortality rates among 28,521 U.S. Medicare beneficiaries and 8,180 similarly aged patients in Ontario, Canada, who were hospitalized with heart failure from 1998 to 2001. Heart failure--a condition in which the ventricles, or lower chambers of the heart, are not able to pump blood effectively--is the most common cause of hospitalization for individuals aged 65 and older in both countries.
"More U.S. patients underwent left ventricular ejection fraction assessment [a test to evaluate the pumping action of the lower chambers of the heart] during hospitalization compared with Canadian patients (61.2 percent vs. 41.7 percent)," the authors write.
The authors also looked at the use of medications commonly prescribed for heart patients. "At discharge, patients in the United States were prescribed beta-blockers more frequently (28.7 percent vs. 25.4 percent), but angiotensin-converting enzyme inhibitors less frequently (54.3 percent vs. 63.4 percent)," they report.
The death rate at 30 days was significantly lower for U.S. patients--8.9 percent compared with 10.7 percent for Canadian patients. But at one year, the death rates for patients in both countries were similar--32.2 percent vs. 32.3 percent.
"In conclusion, we found that HF patients hospitalized in the United States had significantly better short-term mortality but equivalent long-term mortality compared with a sample of HF patients hospitalized in Canada," the authors conclude. "Further studies are needed to explore the reasons underlying this difference in outcomes and to gain additional insights to improve the care and outcomes of HF patients in both countries."
(Arch Intern Med. 2005;165:2486-2492. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Dr. Ko was supported by a research fellowship award from the Heart and Stroke Foundation of Canada, Ottawa, Ontario. Co-author Jack V. Tu, M.D., Ph.D., was a Harkness Associate of the Commonwealth Fund when this study was conducted and is supported by a Canada research chair in health services research. The EFFECT study was funded by operating grants from the Canadian Institutes of Health Research, Ottawa, and the Heart and Stroke Foundation of Canada.
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Archives of Internal Medicine