Is Quality of Care Better in Canada?

Many of today's measures capture problems of "underuse" by the uninsured population—where they fail to receive the screening or treatment indicated, based on agreed medical practice standards.

Life Expectancy and Mortality. The U.S. is not among top performers in terms of life expectancy. However, the researchers note that this rate is influenced by factors both inside and outside the healthcare system.

While U.S. life expectancy is at or below average in comparison with other developed countries, the higher rates of death not related to healthcare (such as suicide or gun-related) show the United States to be among the worst performers.

Quality of Care for Chronic Conditions. Findings on the quality of U.S. care for several chronic conditions also provide a mixed picture. Among industrialized countries, the United States ranked below average in adult asthma care when looking at hospital admission rates and mortality rates.

When looking at outcomes related to patients with end stage renal disease, Canadians had longer survival times while in hemodialysis or peritoneal dialysis programs, and after receipt of kidney transplant—even when extensive adjustment for comorbidity is done.

In the long run, it appears that the U.S. is among the best in some areas, such as cancer outcomes, "and nowhere near the best in others, such as prevention, and deaths from preventable or manageable illnesses," Berenson said.

"In other words, we may do better when people are already quite sick: the U.S. seems to emphasize 'rescue care,'" he said. "But we are not doing well in helping people not to get so sick in the first place. Ultimately, our life expectancy is nowhere near stellar when compared to what other industrialized countries have achieved."