The authors also examine wait times, which are often cited as a problem in Canada. Though comparative information is limited, available data indicate much longer waits in Canada than in the U.S. to consult a specialist and to have non-emergency surgery like knee re-placements. The authors can also draw some inferences from a question about unmet medical needs. While the incidence of unmet needs is slightly lower in Canada (11 percent, vs. 14 percent in the U.S.), it is interesting to note that waiting time is cited as the reason by over half of Canadians who report unmet needs. By contrast, cost is cited as the reason by over half of Americans. The importance of long waits in Canada was recently highlighted by the Chaoulli case in Quebec which successfully challenged the government ban on private provision of medical services covered by the Canadian system. Private services are expected to alleviate shortage of facilities under the system and reduce wait times. Cases are being brought in other provinces.
In the final section of their paper, the authors consider several measures of the success of the two health care systems. The first and perhaps simplest measure is the level of satisfaction reported by patients. Americans are more likely to report that they are fully satisfied with the health services they have received and to rank the quality of care as excellent.
Finally, the authors examine whether Canada has a more equitable distribution of health outcomes, as might be expected in a single-payer system with universal coverage. To do so, they estimate the correlation across individuals in their personal income and personal health status and compare this for the two countries. Surprisingly, they find that the health-income gradient is actually more prominent in Canada than in the U.S.
The authors conclude that while it is commonly supposed that a single-payer, publicly-funded system would deliver better health out-comes and distribute health resources more fairly than a multi-payer system with a large private component, their study does not provide support for this view. They suggest that further comparisons of the U.S. and Canadian health care systems would be useful, for example to explore whether the higher expenditures in the U.S. yield benefits that are worth their cost.
