In an effort to determine how lower health care expenditures in Canada as compared with the United States translate into actual hospital services received, we examined discharge rates, lengths of stay, and the case-mix index (calculated from diagnosis-related group weights) for those 65 years of age and older hospitalized with cardiovascular disease in the United States and two Canadian provinces, Manitoba and Ontario, in 1981 and 1985. We expected that the effect of the prospective payment system might be reflected in changes between 1981 and 1985. Discharge rates for medical treatment of cardiovascular diseases were 2.9 percent higher in the United States than in Canada in 1981, but 1.8 percent lower in 1985; however, the case-mix index was 3.0 percent lower in 1981 and 4.8 percent higher in 1985. The case-mix index for combined medical and surgical discharges was 5.0 percent lower in the United States in 1981, but 10.7 percent higher in 1985. U.S. surgical discharge rates were 20 percent lower in 1981, but 20 percent higher in 1985. Rates of coronary bypass surgery were much higher in the United States in both years, but increased rapidly in both countries, particularly among those 75 and older. Elderly Canadians appeared to have access to cardiovascular surgery, with the exception of coronary bypass surgery, and to other hospital care for cardiovascular disease similar to that of elderly people in the United States.
Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.
Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of cardiac procedures and outcomes after acute myocardial infarction in elderly patients in the two countries.
We compared the use of invasive cardiac procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991.
The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P
Comment In: N Engl J Med. 1997 Oct 2;337(14):1008; author reply 1008-99312670
Comment In: N Engl J Med. 1997 Oct 2;337(14):1008; author reply 1008-99312671
Comment In: N Engl J Med. 1997 May 22;336(21):1522-39154775
Comment In: N Engl J Med. 2001 Mar 8;344(10):774-511236791