The average cost for coronary artery bypass graft surgery and related hospital care in the U.S. is about twice as high as in Canada -- $20,673 vs. $10,373 in U.S. dollars -- with no differences in clinical outcomes, according to a report published in the July 11 issue of the Archives of Internal Medicine.
Mark Eisenberg, M.D., the report's author and an associate professor of medicine at Jewish General Hospital/McGill University in Montreal, studied the outcomes and treatment costs of 4,698 patients at five U.S. hospitals and 7,319 patients at four Canadian hospitals between 1997 and 2001. After adjusting for clinical and demographic differences, the cost was 74.8% higher in the U.S. than in Canada.
"Even though we're only 30 miles away from the U.S., doing the exact same procedure, and using the same materials, the costs are less," Eisenberg said.
He added, however, that the differences are probably even more significant than the report suggested, as the study just compared costs incurred by the hospitals and didn't take into account physician fees or the final amount charged by the hospital and any profit it earned.
"The bill you'd get if you were paying out-of-pocket would be much, much higher than what we're reporting here," he explained.
Eisenberg also said that there is potential for the Canadian costs to drop further with the implementation of U.S. policies geared toward shortening the length of hospital stays. The average stay in U.S. hospitals was 8.7 days, compared to 9.5 days in Canadian hospitals.
Eisenberg said the costs differences are due in a large part to higher administrative overhead "and huge bureaucracies" in the U.S., where billing departments deal with many insurance companies, while Canadian hospitals have a single payer to answer to -- the government.
Other differences in cost may be attributable to defensive medicine practices by U.S. physicians, which call for more tests and treatments than Canadian physicians tend to prescribe, Rosenthal said.
"I think there's a feeling that Americans are litigious, so American doctors practice defensive medicine, which Canadian physicians don't find particularly helpful," Rosenthal said.
In addition to overhead and the costs of practicing defensive medicine, Rosenthal added that everything in the U.S. just costs more, including nurses' salaries, food and medical supplies. He noted that American hospitals pay twice as much for the same gauze pads that are used in Canada.
"In the U.S., the companies will charge as much as the traffic will bear," Eisenberg said. "They can't get away with that up here."
This is the third such study Eisenberg has published comparing U.S. and Canadian healthcare costs at the microeconomic level.
In the Nov. 10, 2003 issue of the Archives of Internal Medicine, Eisenberg and colleagues reported that the cost of abdominal aortic aneurysm repair averaged $23,299 in the U.S. and $15,852 in Canada. Their study in the Nov. 1, 2004 issue of the Journal of Bone and Joint Surgery reported that hip replacements in U.S. hospitals averaged $13,339 compared with $6,766 in Canadian hospitals.
Eisenberg said that rather than surgical procedures, their next study may compare disease treatments, which allow for more differences in the way care is delivered.