Reviewgreen2007

A systematic review of studies comparing health outcomes in Canada and the United States.

Gordon Henry Guyatt · Philip James Devereaux · Joel Lexchin · Armine Yalnizyan · David U. Himmelstein · Steffie J. Woolhandler +9 more

83 citations0/0 files storedPubMed Central

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Healthcare Policy and Management Healthcare Systems and Practices Global Health Care Issues

Abstract

BACKGROUND: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes. OBJECTIVES: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions. METHODS: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability. RESULTS: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better. INTERPRETATION: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

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References

1997Bias in meta-analysis detected by a simple, graphical test 1993Review papers : The statistical basis of meta-analysis 2002Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice 2003Costs of Health Care Administration in the United States and Canada 2000Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics 2002A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.1999Quality of Care in Investor-Owned vs Not-for-Profit HMOs 2004Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis

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