The Health systems of Canada & the USA
OVERVIEW
The Five Pillars of the “Canada Health Act”
Living and Working in the Canadian System
The Canadian Health System: True or False?
The Canadian Health System: True or False?
The Canadian Health System: True or False?
International Comparison of Spending on Health, 1980–2008
Why is Does the US Health System Cost so Much?
Exhibit 12. High U.S. Insurance Overhead: Insurance-Related Administrative Costs
And it is also about Government Intervention and regulation
Pharmaceutical Spending per Capita: 1995 and 2007 Adjusted for Differences in Cost of Living
Annual Salary Range for Registered Nursing Jobs in Canada
How Medicine Is Practiced in Canada and the USA: From the Patient’s point of view – about the same
How do Doctors And Hospitals Get Paid in Canada and the USA
Payments in Canada
How Doctors Bill in Canada
How Doctors Bill in Canada (Cont..)
Outcomes in the Canadian Health System:Canada Doesn’t do too badly…
Overview: Americans and Canadians on Access and health Outcomes
But there are wide variations on Health Lifestyles
Comparison of U.S. and Canada: Outcomes
Specific Outcomes - Mortality Rates
Specific Outcomes- Mortality Rates
Wait Times
Summing It All Up
Canada – Health Policy strengths
What Canadians see as their Systems Weaknesses
USA - Strengths
USA - Weaknesses
Why do the Two Countries differ as to Health system preference?
Senator Mitch McConnell said Canadian Shona Holmes had “brain cancer” http://patientsunitednow.com/?q=search/node/enter%20keywords
Example of Media coverage in the USA
“U.S. Newspaper Coverage of the Canadian Health System: A Case of Seriously Mistaken Identity” Amer. Rev. of Canadian Studies – Spring 2006, pp 27-58
U.S. Newspaper Coverage …2
References for learning more
Resources for Learning more about Canada
Methodology: Commonwealth Fund International Health Policy Survey: Adults’ Health Experiences in seven Countries, 2007
Methodology: Commonwealth Fund International Health Policy Survey of Primary Care Physicians, 2006
Methodology: Specific Outcomes-Mortality Rates
Methodology: Measuring The Health of Nations: Mortality Amenable to Health Care, 2008
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Categories: medicinemedicine lawlaw

The Health systems of Canada & the USA

1. The Health systems of Canada & the USA

THE HEALTH 
SYSTEMS OF 
CANADA &  THE USA 
Pauline Vaillancourt Rosenau, Ph.D.
Division of Management, Policy, and 
Community Health 
UT Houston ­ School of Public Health 
[email protected]
for
Doctor of Nursing Practice students
Room 706
University of Texas School of Nursing 
Thursday, February 17, 2011

2. OVERVIEW

 OVERVIEW 
Describe the Canadian health system and 
clear up some myths
Compare the two countries on Costs
How patients experience it
 How hospitals and doctors experience it
Judging Canada and the USA on performance
Strengths and Weakness of each
Try to figure out why 
2

3. The Five Pillars of the “Canada Health Act”

THE FIVE PILLARS OF THE 
“CANADA HEALTH ACT”
Public administration
Comprehensiveness
Portability
Universality
Accessibility
3

4. Living and Working in the Canadian System

LIVING AND WORKING IN 
THE CANADIAN SYSTEM
With few exceptions, Canadians NEVER worry 
about incurring health care expenses.
Nor do Canadians have to submit claims to 
insurers.
Providers have ONE payer to submit claims to: 
the provincial government.
Canadian system is largely funded by general 
tax revenue  ­ 25­50% federal.
4

5. The Canadian Health System: True or False?

THE CANADIAN HEALTH 
SYSTEM:
TRUE OR FALSE?
Canada is “single payer” system?
False:  it is 10 payer provincial health systems with 
“portability” 
Each province is like one big HMO: True
The Canadian health system is “socialist”:
False, most providers do not work for the government but 
are rather paid by a piece rate system and hospitals are not 
owned by the government
5

6. The Canadian Health System: True or False?

THE CANADIAN HEALTH 
SYSTEM:
The Canadian government controls the health 
TRUE OR FALSE?
system top – down
False:  federal – provincial authorities negotiate the basics ; 
for example privatization
In Canada the bureaucracy wastes precious 
health care resources?
 False: 
The % of $ used for administration is much lower in 
Canada than in the USA 
Billing is straightforward and electronic with 95% of 
requested reimbursements completed.
6

7. The Canadian Health System: True or False?

THE CANADIAN HEALTH 
SYSTEM:
TRUE OR FALSE?
In Canada the government controls prices?
Canadians ration care by age, need, and SES
False: The government sets a budget, the doctors set 
the payment rates in most provinces
False:  there are no policies that restrict care on the 
basis of age, need, or socioeconomic status. Such 
discrimination is illegal
Canada allows euthanasia.
False: Some US states have laws permitting 
euthanasia but none of the provinces in Canada do.
7

8.

 USA COSTS WAY MORE 
THAN OTHER COUNTRIES
8

9.

Health expenditure per capita varies widely across OECD
countries. 
The United States spends almost two­and­a­half times the OECD 
200
Average
7
1. Health expenditure is for the insured population rather than resident population.
2. Current health expenditure.
Source: OECD Health Data 2009, OECD
(http://www.oecd.org/health/healthdata).
9

10.

10
See slide : Commonwealth Fund International Health Policy Survey: Adults’ Health Experiences in seven
Countries, 2007 – for methodology

11. International Comparison of Spending on Health, 1980–2008

INTERNATIONAL COMPARISON OF SPENDING ON HEALTH, 1980–
2008
Average spending on health
per capita ($US PPP)
Source: OECD Health Data 2010 (June 2010).
Total expenditures on health
as percent of GDP

12.

12
See slide : Commonwealth Fund International Health Policy Survey: Adults’ Health Experiences in seven
Countries, 2007 – for methodology

13. Why is Does the US Health System Cost so Much?

WHY IS DOES THE US HEALTH 
SYSTEM COST SO MUCH?
Administration accounted for the largest 
share of this difference (39%),
Payments to MDs and hospitals accounted for 
(31%) of the next most important variables 
explaining difference
More intensive provision of medical services 
accounted for the was the third most 
important variable in explaining the 
difference (14%). 
Research by professors from Harvard and Un. Of California in 
summer 2010; Inquiry
13

14.

14
Pozen and Cutler. Inquiry. 2010 Summer;47(2):124-34

15. Exhibit 12. High U.S. Insurance Overhead: Insurance-Related Administrative Costs

EXHIBIT 12. HIGH U.S. INSURANCE OVERHEAD: 
INSURANCE­RELATED ADMINISTRATIVE COSTS
Spending on Health Insurance Administration
per Capita, 2007
Fragmented payers + complexity = 
high transaction costs and overhead 
costs
McKinsey estimates adds 
$90 billion per year*
Insurance and providers
Variation in benefits; lack of 
coherence in payment
Time and people expense for 
doctors/hospitals
* 2006
Source: 2009 OECD Health Data (June 2009).
* McKinsey Global Institute, Accounting for the Costs of U.S. Health Care: A New Look at Why Americans Spend
More (New York: McKinsey, Nov. 2008).

16. And it is also about Government Intervention and regulation

AND IT IS ALSO ABOUT 
GOVERNMENT INTERVENTION 
AND REGULATION
Canadians think they have “good 
government” 
Americans distrust their government
Canadians are comfortable with price 
controls in the health sector 
Price controls in the health sector yield 
lower costs 
Unlike other economic sectors unfettered 
market competition does not lower costs
16

17. Pharmaceutical Spending per Capita: 1995 and 2007 Adjusted for Differences in Cost of Living

PHARMACEUTICAL SPENDING PER CAPITA: 1995 AND 
2007
ADJUSTED FOR DIFFERENCES IN COST OF LIVING
*
* 2006
Source: OECD Health Data 2009 (June 2009).

18. Annual Salary Range for Registered Nursing Jobs in Canada

ANNUAL SALARY RANGE FOR 
REGISTERED NURSING JOBS IN 
CANADA 
Province
step One
Top of scale
Quebec
$40,927
$60,319
Ontario
$57,252
$81,315
$82,258 after 25 yrs of service
18

19. How Medicine Is Practiced in Canada and the USA: From the Patient’s point of view – about the same

HOW MEDICINE IS 
PRACTICED IN CANADA 
AND THE USA: FROM THE 
PATIENT’S POINT OF VIEW – 
ABOUT THE SAME
19

20.

20
See slide : Commonwealth Fund International Health Policy Survey of Primary Care Physicians, 2006– for
methodology

21.

21
See slide : Commonwealth Fund International Health Policy Survey of Primary Care Physicians, 2006– for
methodology

22.

22
See slide : Commonwealth Fund International Health Policy Survey of Primary Care Physicians, 2006– for
methodology

23.

23
See slide : Commonwealth Fund International Health Policy Survey of Primary Care Physicians, 2006– for
methodology

24. How do Doctors And Hospitals Get Paid in Canada and the USA

HOW DO DOCTORS AND 
HOSPITALS GET PAID IN 
CANADA AND THE USA
24

25. Payments in Canada

PAYMENTS IN CANADA
 http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/index.html
http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/26.%20obstetrics_
gynecology.pdf
25
Fee for service for most primary care and specialists  ­ bills 
sent to the province
Extra­billing of patient is NOT permitted 
No individual bills are prepared for patients
Hospitals (largely private nonprofit) are paid on global 
budget system with funds sent by the province; some 
regional health authorities obtain population­based 
funding (west) (HiT 2004)
Payment for pharmaceuticals varies by province and 
formularies are set up at the provincial level 
What Canadian doctors are paid for treatments and 
procedures:  ex. Gynecologist paid  $45 for visit in B.C.

26. How Doctors Bill in Canada

HOW DOCTORS BILL IN CANADA
Billing is straightforward but lots of variation 
across provinces as each takes care of its on billing
Doctor must be registered as a practitioner in the 
province 
Doctor must have a billing number – and not 
automatic
Doctor must be eligible and qualified to bill for the 
specific code indicated: ex. neurologist won’t be paid 
for doing an appendectomy.
The amount billed must be for the amount allowed 
by the fee schedule (Medical Services Plan)
26

27. How Doctors Bill in Canada (Cont..)

HOW DOCTORS BILL IN CANADA 
(CONT..)
Bills are submitted electronically on forms online 
through the web or via a direct connection to the 
MSP office – daily or weekly­ and 98% reimbursed
The provincial payer organization sends payment 
twice monthly directly to the MD and pay interest 
on reimbursements that are delayed more than 30 
days.
Ease of billing is a big plus in Canada and doctors 
who have billed in both Texas and Canada are in 
agreement on this : “One insurer, one fee 
schedule, rarely any question of eligibility 
and no incentive to withhold payment – its 
heaven compared to the US”.
27

28. Outcomes in the Canadian Health System:Canada Doesn’t do too badly…

OUTCOMES IN THE 
CANADIAN HEALTH 
SYSTEM:CANADA 
DOESN’T DO TOO 
BADLY…
28

29. Overview: Americans and Canadians on Access and health Outcomes

OVERVIEW:  AMERICANS AND 
CANADIANS ON ACCESS AND 
HEALTH OUTCOMES
Very poor Americans are in poorer health than 
their Canadian counterparts
Wealthy Americans and Canadians – equally 
healthy
Little difference between insured Americans and 
Canadians as a whole ­­ on access to health care 
and health status
Americans without health insurance are – 
different, with low access to health care and more 
“unmet health care needs”
Alexis Pozen, David M. Cutler (2010) Medical Spending Differences in the United States and Canada: The Role of Prices, Procedures, and 
Administrative Expenses. Inquiry: Summer 2010, Vol. 47, No. 2, pp. 124­134. 
29

30. But there are wide variations on Health Lifestyles

 BUT THERE ARE WIDE VARIATIONS ON HEALTH 
LIFESTYLES 
30
Reference: Krueger, Bhaloo, & Rosenau; “Health Lifestyles in the U.S. and Canada: Are We Really So Different?
“Forthcoming Social Science Quarterly, December 2009

31. Comparison of U.S. and Canada: Outcomes

COMPARISON OF U.S. AND CANADA: 
OUTCOMES  
Indicator
Canada
United States
Low Birth Weight Babies
6% 
8% 
MDs per 10,000 population
19
27
Nurses and Midwives per  
10,000
100
98
Infant Mortality Rate
5.04
6.26
Life Expectancy – Female
83
81
Life Expectancy – Male
79
76
31
http://www.globalhealthfacts.org

32.

The BEST Outcomes Measure
32
See slide : Measuring The Health of Nations: Mortality Amenable to Health Care, 2008– for methodology

33. Specific Outcomes - Mortality Rates

SPECIFIC OUTCOMES ­ 
MORTALITY RATES
Seven diseases favored Canada
Colorectal cancer
Childhood leukemia
Kidney transplants
Liver transplants
One disease favors the U.S.
Breast cancer
Hussey, P. et al, “How Does the Quality of Care Compare in Five 
Countries?” Health Affairs 23(3) May/June 2004
33

34. Specific Outcomes- Mortality Rates

SPECIFIC OUTCOMES­ 
MORTALITY RATES
Overall RR of mortality 0.95 in favor of 
Canada (CI 0.92 to 0.98)
Results quite heterogeneous
No explanation for heterogeneity
Guyatt, G. et al, “A Systematic Review of Studies Comparing Health Outcomes in 
Canada and the United States”, Open Medicine 2007;1(1):E27­36
34

35. Wait Times

WAIT TIMES
Historically this has been the Achilles 
heel of the Canadian system
Result of budget cuts 1990’s
Today the situation is much improved
But the U.S. also has a “waiting times” 
problem, but for different reasons
In the US we wait because of cost…..
In Canada patients because of scarcity
35

36.

36
See slide : Commonwealth Fund International Health Policy Survey: Adults’ Health Experiences in seven
Countries, 2007 – for methodology

37.

37
See slide : Commonwealth Fund International Health Policy Survey: Adults’ Health Experiences in seven
Countries, 2007 – for methodology

38. Summing It All Up

SUMMING IT ALL UP
Strengths and Weaknesses 
And figuring out why….

39. Canada – Health Policy strengths

CANADA – HEALTH POLICY 
STRENGTHS
Federal leadership, with state 
autonomy on implementation, is a 
workable compromise
Access is best when it is universal
Choice is ok – one big HMO
Primary care emphasis is important
Electronic medical records are not 
essential
39

40. What Canadians see as their Systems Weaknesses

WHAT CANADIANS SEE AS THEIR 
SYSTEMS WEAKNESSES
Waiting lists can be overused as “supply side” 
control mechanisms even if the MDs are in 
charge.  
“Costs in Canada are too high.”  Really? I 
guess it is always relative to your perspective.
Tolerance of a private sector “safety valve” 
may be essential if universal access is to be 
preserved
http://www.oecd.org/dataoecd/51/48/41925333.pdf
40

41. USA - Strengths

USA  ­ STRENGTHS
Quality generally high
Lots of evidence that  “more is not always 
better” when it comes to healthcare
But many patients don’t understand this or 
believe it.
if  you are well insured…
if not insured or underinsured… ?
No waiting if you pay out of 
pocket. 
41
Medical technology is available…

42. USA - Weaknesses

USA ­ WEAKNESSES
Cost   ­ are way higher than in 
every other industrialized country 
with little to show for it.
Accessibility – may get better after 
2014 ?
Administrative costs are high and 
this is unlikely to change after 
health reform is implemented.
42

43. Why do the Two Countries differ as to Health system preference?

WHY DO THE TWO COUNTRIES DIFFER 
AS TO HEALTH SYSTEM PREFERENCE?
Culture – maybe but USA and Canada are converging; media, 
proximity, culture diffusion, geographic mobility and immigration
History – Yes 
More distrust of government in US
More emphasis on individual liberty
Form of government – yes
Presidential system in the USA
Roots in the constitution
Designed to require incremental policy rather than comprehensive 
policy
Parliamentary system in Canada
Good at implementing comprehensive change quickly and 
efficiently
 Responsible party model 
Important role for party leadership  
43

44. Senator Mitch McConnell said Canadian Shona Holmes had “brain cancer” http://patientsunitednow.com/?q=search/node/enter%20keywords

SENATOR MITCH MCCONNELL SAID CANADIAN SHONA 
HOLMES HAD “BRAIN CANCER” 
HTTP://PATIENTSUNITEDNOW.COM/?Q=SEARCH/NODE/ENTER%20KEYWORDS  
"I knew in my gut that I had to see someone 
and could not wait five to six months," she 
says. So she called Mayo Clinic and got an 
appointment the same day. 
Featured on the Mayo 
clinic website  
.http://www.mayoclinic.org/patientstories/story­
339.html
Diagnosis: Rathke’s 
Cleft Cyst on pituitary 
gland  ­­ a benign cyst
Wait time in Canada 
would have been three 
months with no copay, 
no deductible
Cost for removal at 
Mayo Clinic = $97,000
44

45. Example of Media coverage in the USA

EXAMPLE OF MEDIA COVERAGE IN 
THE USA
The Case of Shona Holmes:  
http://www.youtube.com/watch?v=cahvnCBVXXU&feature=related 
http://factcheck.org/2009/08/dying­on­a­wait­list/  same as above with Fact 
Check information
Mayo clinic charged 100,000$  ­   Shona’s story is no longer posted at Mayo 
Clinic’s website
Dr. Jason Huse, a pathologist at the Sloan­Kettering Cancer Center, in 
the USA . Factcheck.org says:  “He told us something different.” "By strict 
definitions it’s not even a tumor," he said, but a remnant of embryological 
structures that eventually develop into the pituitary gland. Huse stressed 
that without having examined Holmes, he couldn’t know the prognosis of 
her RCC: "It is not out of the realm of possibility," he told us, "that this 
could have been impeding her hormone secretions to the extent that it was 
a life­threatening situation." And of course, we don’t know what Holmes’ 
American doctors told her. However, Huse said, RCC "is not typically a 
malignant lesion and it is not typically life­threatening." 
45

46. “U.S. Newspaper Coverage of the Canadian Health System: A Case of Seriously Mistaken Identity” Amer. Rev. of Canadian Studies – Spring 2006, pp 27-58

“U.S. NEWSPAPER COVERAGE OF THE 
CANADIAN HEALTH SYSTEM: A CASE OF 
SERIOUSLY MISTAKEN IDENTITY” AMER. REV. OF 
CANADIAN STUDIES – SPRING 2006, PP 27­58
Objective: This study assesses the fairness, 
accuracy, and comprehensiveness of U.S. 
newspaper coverage of the Canadian health 
system in two of the most influential newspapers 
published in the U.S.  
Methods: Quantitative methods, interpretative 
assessments, and thematic analyses are 
employed to evaluate coverage of the Canadian 
health system in the New York Times and the 
Wall Street Journal between 2000 and 2005
46

47. U.S. Newspaper Coverage …2

U.S. NEWSPAPER COVERAGE …2
Findings: U.S. newspaper reporting on the topic of the Canadian health 
system is found to be poor.  Points of misinformation are indicated, 
misrepresentations are specified, and inadequate explanations are 
denoted.
 Overall, ongoing themes and controversial issues regarding the Canadian 
health system receive almost as much notice in U.S. newspapers as actual 
news events. 
 Anecdotal information plays nearly as great a role in coverage as facts 
and evidence.  
U.S. newspaper reports about the Canadian health system are found to be 
oversimplified.  
Information, all too often, is presented out of context and sources are not 
always sufficiently identified. 
 Coverage is incomplete: all provinces are underrepresented in the U.S. 
newspapers studied, except Ontario.  
Some articles are confused and a few were found to contain errors.  
Conclusions: These inadequacies in newspaper coverage mean that the 
U.S. public is sadly misinformed with regard to the Canadian health 
system.  
47

48. References for learning more

REFERENCES  FOR 
LEARNING MORE
And documentation for this lecture
48

49. Resources for Learning more about Canada

RESOURCES FOR LEARNING MORE ABOUT 
CANADA 
Listen or View: “Does Canada's Health Care System Need Fixing?  10 August 
2009”  NPR http://www.npr.org/templates/story/story.php?storyId=111721651 
Read: Ross and Detsky “Health Care Choices and Decisions in the U.S. and 
Canada”; JAMA 10/28/2009 ; 2009;302(16):1803­4, 
http://jama.ama­assn.org/cgi/reprint/302/16/1803
Read; Sanmartin, et al “Comparing Health and Health Care Use In Canada 
and the United States,” Health Affairs, vol. 25, July/August 2006 “ (Abstract ) 
http://content.healthaffairs.org/cgi/content/abstract/25/4/1133 
View : “Sicko” by Michael Moore; Scene Selection # 7 Only “Canada!”: about 10 
minutes that begins at minute= 40.  See especially the Conservative 
party member (golfer interview) at Minute 48 
http://freedocumentaries.org/teatro.php?filmID=133&lan=undefined&s
ize=undefined
Listen: Audio Interview and Review of “Sicko” by Jonathan Oberlander – 
University of North Carolina; for ‘NPR’s program, Fresh Air” 2007. only the 
first 15 minutes are relevant  ­ about  Sicko’s presentation of Canada 
http://www.npr.org/templates/story/story.php?storyId=11826524
And investigate other countries such as Britain, Germany, Japan, Taiwan, 
Switzerland at:  http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/
49

50. Methodology: Commonwealth Fund International Health Policy Survey: Adults’ Health Experiences in seven Countries, 2007

METHODOLOGY: COMMONWEALTH FUND 
INTERNATIONAL HEALTH POLICY SURVEY: 
ADULTS’ HEALTH EXPERIENCES IN SEVEN 
COUNTRIES, 2007
Survey of comparing Adults’ health care experiences in Australia, Canada, 
Germany, New Zealand, the Netherlands, the United Kingdom and the 
United States.
Method:
Interviews with representative sample of adults, Age >17years, 2,500 in the United States 
and 3,000 in Canada. Funded by the Commonwealth Fund, partnered with the Health 
Council  of Canada to expand Canadian Sample.
Interviews conducted by telephone between 6 March and 7 May 2007 by Harris Interactive 
and Country affiliates
Conducted in different languages; French and English for Canada while Spanish and English 
in US
The margin of sample error for country averages is approximately + 2 percent for the US and 
Canada and + 3 percent for other five countries, at 95% confidence interval.
Peer Reviewed Publication Citation: Schoen, C., Osborn, R., Doty, MM., et al. Toward Higher­
Performance Health Systems: Adults’ Health Care Experience in Seven Countries, 2007. 
Health Affairs (2007) 26(6) w717­w734
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51. Methodology: Commonwealth Fund International Health Policy Survey of Primary Care Physicians, 2006

METHODOLOGY: COMMONWEALTH 
FUND INTERNATIONAL HEALTH 
POLICY SURVEY OF PRIMARY CARE 
PHYSICIANS, 2006
Countries involved are Australia, Canada, Germany, New 
Zealand, the Netherlands, the United Kingdom and the 
United States
Methods:
The survey consists of interviews with representative samples of primary care 
physicians in seven countries using common questionnaire.
Harris Interactive; country affiliates and in the Netherlands, the Center for 
Quality of Care Research, Radbound University Nijmegen, conducted interviews 
by mail and telephone from late February through July 2006
Survey was conducted in English in the US and Canada.
The margin of sample error ranges from +3 percent to +5 percent, at 95 percent 
confidence interval.
Peer Reviewed Publication Citation: Schoen, C., Osborn, R., Huynh, P.T., et al. 
On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences 
and Views in Seven Countries. Health Affairs 25 (2006) w555­w571
51

52. Methodology: Specific Outcomes-Mortality Rates

METHODOLOGY: 
SPECIFIC OUTCOMES­MORTALITY 
RATES
Joint US, Canadian authors from McMaster University, Hamilton, 
Canada
Meta­analysis of outcome studies
38 studies meeting most criteria for high quality (only one missed 
criteria allowed)
Publish or unpublished prospective or retrospective observational 
studies comparing health outcomes data for patients with any age 
with same diagnosis in US and Canada
Sources included: EMBASE (1980­Feb 2003), MEDLINE (1966­ Feb 
2003), healthSTAR (1975­Feb 2003), EBM (2003) and dissertation 
abstracts ondisc (1969­ Feb 2003).
Results were pooled using a random­effects model
Cochrane’s Q­test was assessed to check heterogeneity and relative 
risk was used as a summary statistics
52
Guyatt, G. et al, “A Systematic Review of Studies Comparing Health Outcomes in Canada and the 
United States”, Open Medicine 2007;1(1):E27­36

53. Methodology: Measuring The Health of Nations: Mortality Amenable to Health Care, 2008

METHODOLOGY: MEASURING THE 
HEALTH OF NATIONS: MORTALITY 
AMENABLE TO HEALTH CARE, 2008
Comparison of trends in deaths considered amenable to 
healthcare in the US, Canada and in 17 other industrialized 
countries.
Data and Analysis: 
Mortality and population data extracted from WHO files
Data include deaths coded according to ICD­9­CM and ICD­10 by
 sex and five­year age band. The general Age limit was set at 75 years.
The causes of death considered are bacterial infection, diabetes, CVD, treatable 
cancers, cerebrovascular disease and complications of common surgical procedures.
Age­standardized death rates (SDRs) per 100,000 population by sex was calculated 
for years 1998 and 2003.
Peer Reviewed Publication Citation: Nolte, E., & McKee, C. M. (2008). Measuring 
the Health Of Nations: Updating An Earlier Analysis. Health Affairs, 27(1), 58­71 
Previous Publication Citation: Nolte, E., & McKee, C.M. (2003). Measuring The Health Of Nations: 
Analysis Of Mortality Amenable To Health Care. BM, 327, 1129­34
53

54.

54
Chen, Duanjie, and Jack M. Mintz. 2009. “The Path to Prosperity: International Competitive Rates and a Level Playing
Field.” C.D. Howe Institute Commentary. No. 295. Toronto: C.D. Howe Institute. September
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