Dr G. B. John Mancini on Payer System Differences Between the US and Canada

Care quality is high in both the United States and Canada, but there are commonalities in regard to drug access and cost issues, particularly with advanced medications, noted G. B. John Mancini, MD, professor of medicine; scientific director, Cardio Risk Clinic; and director of the Cardiovascular Imaging Research Core Laboratory, University of British Columbia.

Transcript

What are key differences in the accessibility, cost, and quality of cardiac care between the United States and Canada?

I think the quality of care is really very high in North America, both in Canada and in United States. Of course, the Canadian system has so-called universal health care where basic care is provided by the government. On the other hand, we don't have a national drug plan, and even so-called Medicare drug coverage in the US is more universal than in Canada—it's quite province specific in Canada. So those are a few differences.

The access to drugs is affected similarly, as in the US, with regards to the actual costs. And because most of those costs are paid by insurance companies, if a patient has insurance, usually through employment, then it becomes a big issue of access. And of course, out-of-pocket expenses can accumulate if patients don't have drug coverages. So some of the differences really wash out in the laundry, so to speak. There's a lot of commonality in terms of drug access and cost issues, particularly with advanced medications.

How do insurance coverage and reimbursement systems differ between the United States and Canada?

As best I am aware, in terms of gross domestic product, we don't spend as much as in the US, for example, but the outcomes are still relatively comparable. And so where we have a big difference is that each province has sort of a single-payer system, where it's the Ministry of Health that negotiates physician fees and then pays them as care is delivered. I don't believe that there's huge differences in that regard that affect quality. We do have currently, in Canada, a bit of a crisis in terms of primary care, where a lot of citizens don't have access to a primary care physician who would initiate access to specialists and so on. So that is perhaps one difference that is currently at play.