Shopping Around for Hospital Services: A Comparison of the United States and Canada

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Abstract

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 500 000.

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 ($26 805 vs $10 651; 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.

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