Further proof of higher hospital prices in the U.S. comes from a new study of costs and outcomes from coronary artery bypass graft surgery. CABG surgery and its associated in-hospital treatments and related hospital care in the U.S. are 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, the report's author and an associate professor of medicine at Jewish General Hospital and 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 from 1997 to 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 that the differences are probably 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 said.
Eisenberg also said that there is potential for Canadian costs to drop further as hospitals there adopt U.S. policies for shortening hospital stays. The average stay in U.S. hospitals was 8.7 days, compared with 9.5 days in Canadian hospitals.
Eisenberg said the cost differences are attributable in 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 cost differences may be linked to U.S. physicians' defensive-medicine practices, which call for more tests and treatments than Canadian physicians tend to prescribe, Eisenberg 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," he said. Data published in the journal Health Affairs last week called into question that perception (See story above).
Besides overhead and the costs of practicing defensive medicine, Eisenberg 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."
Quentin Young, a Chicago internist and national coordinator for Physicians for a National Health Program, said the study provided "powerful confirmation" that his group's advocacy for a single-payer, national health insurance program has merit. He added that the study also underscores how huge savings could be realized by eliminating administrative costs, "which add nothing to the quality of care."
"I'm not surprised," Young said of the results. "Canada bashing is a national sport in the U.S., but they can and do practice good medicine at a significantly lower cost."
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.