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To the Editor.—In their comparison of hospital services, Dr Bell and colleagues¹ comment that waiting times were shorter in US hospitals while charges were higher in Canadian hospitals for patients who pay out-of-pocket. What the authors do not state is that for a patient who is covered under a provincial health care plan, the option of paying out-of-pocket does not exist. That is, even if the patient was willing to pay out-of-pocket for an insurance-covered service in Ontario (and possibly get to the head of the line), doing so is illegal. Aside from the occasional noncovered person, the situation simply never occurs.

As an orthopedic surgeon who formerly practiced in Canada, if I had the opportunity to have a large volume of patients who were willing to pay over and above the government fee (or even willing to pay cash that would not be subjected to a 10% retrospective . . . [Full Text of this Article]

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Shopping Around for Hospital Services: A Comparison of the United States and Canada
Chaim M. Bell, Matthew Crystal, Allan S. Detsky, and Donald A. Redelmeier
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