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


OBJECTIVE
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.


CONCLUSIONS
Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.
Guyatt
Gordon H
GH
Devereaux
Pj
P
Lexchin
Joel
J
Stone
Samuel B
SB
Yalnizyan
Armine
A
Himmelstein
David
D
Woolhandler
Steffie
S
Zhou
Qi
Q
Goldsmith
Laurie J
LJ
Cook
Deborah J
DJ
Haines
Ted
T
Lacchetti
Christina
C
Lavis
John N
JN
Sullivan
Terrence
T
Mills
Ed
E
Kraus
Shelley
S
Bhatnagar
Neera
N