A Canadian healthcare study shows that perhaps the American form of health care is better than the Canadian... http://chealth.canoe.ca/health_news_detail.asp?news_id=11712 Canadians have higher death risk after heart attack: study Sep. 20, 2004 Provided by: Canadian Press Written by: SHERYL UBELACKER TORONTO (CP) - Canadians have a greater risk of dying within five years after a common type of heart attack than their American cousins, a study comparing treatments in the two countries suggests. The research, to be published in an upcoming issue of Circulation: Journal of the American Heart Association, suggests that more conservative treatments in Canada may be behind the difference in survival rates, said Padma Kaul, an epidemiologist at the University of Alberta and lead investigator of the study. Kaul found that within five years of initial treatment for a heart attack caused by a completely blocked coronary artery (about one-third of heart attacks are this type), the U.S. patients had a death rate of 19.6 per cent versus 21.4 per cent for the Canadians. That roughly two per cent difference may seem small, but on a population basis, it could represent thousands of lost lives. "One possible explanation is the difference in the revascularization rates between the two countries, and those were significantly different," said Kaul, explaining that U.S. doctors perform about three times the number of angioplasties and coronary bypass surgeries done by Canadian physicians. With angioplasty, a tiny balloon is threaded into a plaque-narrowed artery, then inflated to compress the obstruction and open up blood flow. Bypass surgery reroutes the blood through a blood vessel - often a vein taken from the leg - that's grafted to the coronary artery feeding the heart. Both procedures are known as revascularization. Almost one-third of the U.S. patients had angioplasty after a heart attack, compared to 11.4 per cent in Canada. More than 13 per cent of those in the U.S. group had bypass, while just four per cent of Canadian patients were referred for the open-heart surgery. "Traditionally, I think, the U.S. practises way more aggressively than Canadian practice in terms of using revasc procedures, and that's been shown repeatedly," Kaul said from Edmonton, noting that Canadian physicians are more apt to treat heart attack patients with only clot-busting drugs like TPA and streptokinase. Her study was an expansion on earlier research from 1990-1993 that examined heart function, quality of life and survival for Canadian and American patients after treatment for a heart attack. That study compared health outcomes after using different clot-busting drugs either alone or in combination. Doctors also ordered angioplasty or bypass at their discretion, she said. After one year, the earlier study found that U.S. patients had better outcomes for heart function and quality of life, said Kaul. However, the difference in survival at one year was less than half of one per cent - not enough to suggest changes in practice, she said. But in 2002, Kaul analysed records from 23,000 Americans and almost 2,900 Canadians in the original study to determine how many were still alive within five years of initial treatment. Even though the Canadian patients had better health profiles overall - fewer had diabetes or high blood pressure, for instance - survival rates were higher for the U.S. patients. "While the United States and Canada share a common border, these two countries differ substantially in how they organize, deliver and pay for health care," Kaul said. "The Canadian system is very centralized and we have fewer centres that provide revascularization services. . . . We have a hub-and-spoke kind of design where we bring all the patients to central centres where the procedures are done, whereas the U.S. has much more dispersed facilities across the country." As well, the study showed Canadian physicians were more likely to send heart attack patients home with a prescription for beta blockers to regulate their heart rate (62 per cent), compared with U.S. patients (53 per cent). Toronto cardiologist Dr. Beth Abramson, a spokeswoman for the Heart and Stroke Foundation of Canada, said the two per cent differential in death rates "suggests that the traditionally conservative Canadian approach may not be the best to care for our cardiac patients." "It's a small percentage, but very important when we look at the cause of death amongst Canadians," Abramson said Monday. "This can translate into thousands of lives." While Canadian physicians are performing more angiograms (a diagnostic procedure to detect artery blockage), angioplasties and bypass operations than they were 10 years ago, access to operating rooms and labs to perform angiograms and angioplasties still lags behind demand - and falls far short of what's available in the United States, experts say. "I would strongly suspect that the difference in practices seen between Canada and the U.S. in this paper are a reflection of a different health-care system and the funding for infrastructure and various procedures in the system," Abramson said. Kaul said large population-based studies are needed to confirm the results of her study. "The good news is that we are doing more (revascularizations), so clinical practice has changed since the early '90s," she said. "Whether we've addressed this gap is something that we are still going to keep working at."
At least they get treatment: http://www.hbns.org/newsrelease/uninsured8-01-01.cfm# A new study finds that patients with public health insurance are more likely to die from a heart attack than patients with private insurance, pointing to a seeming inequity in the delivery of costly life-saving procedures. Vice President Dick Cheney's recent hospitalizations underscored the potentially life-saving benefits of advanced medical care following a heart attack . However, the results of this new study suggest that these life-saving benefits -- which in the case of the vice president's recent surgery cost more than $30,000 -- may not be as readily available to heart patients who don't have the insurance to pay for them. Death rates after a heart attack vary according to insurance coverage and were lowest for patients with private insurance, says study author Jay J. Shen, Ph.D., of Governors State University in University Park, Illinois "In general, Medicaid and uninsured [heart attack] patients were about 20 percent and 30 percent more likely to die in the hospital than were Medicare [heart attack] patients, respectively," he says. Patients with private insurance, however, were 20 percent less likely to die when compared to Medicare patients. The study is published in the August issue of Health Services Research. The investigators reviewed records from 95,971 heart attack discharges from hospitals in 11 states with primary diagnosis of either heart attack or presumed heart attack complication. In addition to insurance coverage, the researchers examined the relationship between race and income on death rates from heart attack. Mortality did not differ between races and reduced income was only modestly associated with increased risk of dying following a heart attack. However, patients in the "extremely unfavorable group" (those who lived in a low-income area and were either uninsured or covered by Medicaid) not only were more likely to die, but also were sicker, stayed in the hospital longer, were less likely to receive certain procedures for heart disease and had higher hospital bills when compared to private insurance patients who lived in more affluent neighborhoods. "Patients with inferior insurance status may have other illnesses or more advanced disease as a result of financial limitations on sources and access to primary, preventive or even urgent care," Shen explains. Changing national policies to promote better medical care for uninsured and underinsured individuals could result in reduced deaths from heart attack for all Americans, says Shen. In addition to the ethical concerns, he points out that "these data demonstrate that disadvantaged patients experienced greater lengths of hospital stay, greater charges, as well as inferior outcomes. An increased focus on improving treatment of heart attack patients bearing multiple low socioeconomic attributes may be in the public interest from a cost-effectiveness perspective."
So, (i) if you're poor, you are better off health-wise in Canada, (ii) if you're rich, you are better off health wise in America. Haven't we known this for a while? I mean, don't a lot of rich Canadians just cross the border for major health issues?
america also spends almost 14% of its gdp on health care. whereas canada spends only about 10%. so perhaps they could fix their delays if they spent more money and we could fix our problems if we spent it properly instead of letting these big HMOS get fat off of it?
Just to throw this out there, and this isn't meant as a joke, it's true that cold weather puts more stress on the heart. It gets damned cold in Canada. Damned cold. I wonder if this was considered at all in formulating the numbers and the comparison.
And what do you think would happen to healthcare inflation if Managed Care were not there to control costs? What's the 'free' alternative that you're proposing?
Even though the Americans as a group had more comorbidities (such as diabetes and hypertension), the Americans still faired better. Unless Canadian heart patients are massing in the cold outdoors naked, I don't think the cold had more of an effect than those comorbidities. The variable they feel attributed most to the survival rate was revascularization.
I would happily accept the 1.8% increased risk if it meant that I wouldn't have to go deeply into debt to see the cardiologist in the first place.
Understandable, but that's not a small number when you're faced with it. Another way of looking at it is that almost 10% more will die in Canada. E.g., say 1000 people are treated, about 196 will die (in five years) in the US and 214 in Canada.
This comparasion also excludes the high number of uninsured heart attack patients more likely to die in the hospital. And it excludes the number of overall unisured patients havng heart attacks due to neglected symptons and being diagnosed in a late stage of illness, or hospitalized for a condition that could have been comletely avoided through timely medical care.
Originally posted by MR. MEOWGI This comparasion also excludes the high number of uninsured heart attack patients more likely to die in the hospital. It does? And it excludes the number of overall unisured patients havng heart attacks due to neglected symptons and being diagnosed in a late stage of illness, or hospitalized for a condition that could have been comletely avoided through timely medical care. Sound like all but the ones who died before treatment are included, no? As for the timeliness issue, that would require study since some queues in socialized-medicine nations are significant enough to compensate for some of the uninsured effect in the US.
To some/many/most(?) in the minority who have to pay the Cardiologist out of their pocket, yes. To the rest, no.
Question: isn't it difficult to compare both countries considering how different the systems are? Reason being, everyone gets health care in Canada, thus the statistics reflects, well, Canada. That's not to say that the system is better, there are pros and cons to both systems. We've all heard horror stories about how much longer it takes to get things done. However, what I'm getting at is that in the US, not everyone gets healthcare, thus, those that don't won't show up in the statistics. Generally, those who do get health care, can afford it, have a job that provides it, or can afford the insurance to pay for it. Everyone else, which is a significant percentage of the population, might not go to hospitals or have doctors. Generally speaking, in the US, if you can afford health care, and can get it immediatly, you are more likely to have better health than the "average person". This has been the double edged sword of the American health system and the Canadian one. In the US you can get superior health care, If you have the means to afford it. In Canada, you can get health care, and better health care if you can afford it. However, its still better to be a doctor in the US and even better if you work in pharmaceuticals (although don't get me started on the overdiagnosing of America).
I think there are a few significant logical problems with some of the arguments in the article and this thread. First, they are only talking about one problem, not the system as a whole. There are lots of reasons why standard procedure in one place may differ from another. Studies like this point out the differences in success rates and allow people to learn and change. There is no benefit to our system to have people dying. It doesn’t same the country any money to have productive working people (the demographic I assume many of these people will come from) die. If the reason for the difference can be pinpointed then it only makes sense to address it, if possible. The decentralization comment in the article as a comparison to the US is quite odd. Canada has a population of 32 million people in an area larger than the US. The fact of the matter is that we’re just a lot more spread out, and you just can’t have such facilities in every two whistle stop town. (Yes, the population of Canada is mostly in the bottom 1/3 of the land mass, but 1/10 the population in 1/3 the land mass is still much more spread out). Not everything is perfect in every aspect the Canadian system, or any system. I dare say that there are likely procedures where the results in Canada are better than those in the US. Taking an isolated example like this and trying to characterise the system by it is not sound logic, I suggest. Perhaps a better overall measure would be overall life expectancy and infant mortality, although I’m sure there are problems with these comparisons too. Infant Mortality: 4.82/1000 live births Canada 6.63/1000 live births US Life Expectancy 80 years in Canada 77.5 years in the US (http://www.cia.gov/cia/publications/factbook/) And I don’t think it’s generally true that you can get better heath care in the US if you have money. You can get it quicker, and the population base of the US means that certain things are available there that aren’t here. We also don’t duplicate some facilities. If there is relatively small need for a certain procedure or facility and it already exist in the US, then we’ll just send the patient down and our health system pays the shot. That’s cheaper than building and maintaining our own facilities in certain situations. So there are differences, but remember that no first world nation in the world has a system like the US one anymore. They’ve all gone to some variation of the Canadian and European ones, and they did it decades ago in most cases. There are things that need to be changed with the Canadian system and there are people calling for change, but no one is suggesting that we should go back to an American type system. That article was being a little provocative with that insinuation, but not even the most conservative main party in Canada supports going back to the US system.
That's why New Yorkers and other Yankees migrate to Florida for retirement. Seriously, my overall political bent trends toward the Republican camp, but on health care issues I trend toward the Democratic camp. This country has to do something substantive to improve healthcare coverage, i.e., making quality care affordable while increasing medical competency from physician to patient attendant. Alas, therein lies the problem. The party that can solve the healthcare/retirement conundrum effectively will win the hearts and loyalty of the American people for years to come.
