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Shopping Around for Hospital Services
A Comparison of the United States and Canada
Chaim M. Bell, MD;
Matthew Crystal;
Allan S. Detsky, MD, PhD;
Donald A. Redelmeier, MD, MS(HSR)
JAMA. 1998;279:1015-1017.
Context.— Historical comparisons indicate that US hospitals are more expensive than Canadian hospitals, but health care system reform might have changed the relative costs and timeliness of health care in the 2 countries.
Objective.— To estimate the price and convenience of selected hospital services in the United States and Canada for patients in 1997 had they paid out-of-pocket.
Design.— Cross-sectional telephone survey conducted May 1996 to April 1997.
Participants.— The 2 largest acute care general hospitals from every city in the United States and Canada with a population greater than 500000.
Measures.— Each hospital was telephoned and asked their price and waiting time for 7 services: magnetic resonance imaging of the head without gadolinium; a screening mammogram; a 12-lead electrocardiogram; a prothrombin time measurement; a session of hemodialysis; a screening colonoscopy; and a total knee replacement. Waiting times were measured in days until earliest appointment and charges were converted to American currency.
Results.— Overall, 48 US and 18 Canadian hospitals were surveyed. Median waiting times were significantly shorter in American hospitals for 4 services, particularly a magnetic resonance imaging of the head (3 days vs 150 days; P<.001). Median charges were significantly higher in American hospitals for 6 services, particularly for a total knee replacement ($26805 vs $10651; P<.001). Individual services showed no association between shorter waiting times and higher prices within each country, with the exception of a total knee replacement in the United States.
Conclusion.— US hospitals still provide higher prices and faster care than Canadian hospitals for patients who pay out-of-pocket.
From the Department of Medicine and Health Administration (Drs Bell, Detsky, and Redelmeier and Mr Crystal) and the Program in Clinical Epidemiology and Health Care Research (Drs Bell, Detsky, and Redelmeier and Mr Crystal), University of Toronto; Department of Medicine, Sunnybrook Health Science Centre (Drs Bell and Redelmeier); Department of Medicine, the Mount Sinai Hospital (Dr Detsky); and Department of Medicine, The Toronto Hospital (Dr Detsky), Toronto, Ontario.
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