post by Bill Gardner
There is one more difference between US and Canadian health care that may explain why Canadian care costs less:
There is a lot more health information technology in America.
Again, I could be overgeneralizing from Atlantic Canada. But there is substantially less computerization of health information. Much is still done on paper, or using obsolete programs running on obsolete hardware. Often comically obsolete: I've found applications running on floppy disks and VAXen. (Youngsters: Follow the links to find out how your pioneer ancestors broke the sod of data to bring you the information cornucopia of today). Fully functional electronic health records are not so common in the US, but they seem truly rare here.
This suprised me. I assumed that a single payer system committed to population health goals would take full advantage of information technology to marshall its data to improve care. Why has this not happened?
- There isn't a Canadian single payer system, there are 10 provincial systems. Most provinces have small populations and cannot easily afford the fixed costs entailed by a system-wide EHR.
- Canadian health care is funded out of general revenues. Therefore, possible health IT investments compete against money for roads, schools, lighthouses (well, maybe not so much in Saskatchewan), and so on.
- A lot of US health care information technology investments are devoted to managing the pathologies of billing multiple insurers for care. Billing is simple here.
If the last point is correct, it's possible that not spending money on health IT is another reason why Canadian health care is less expensive. They are not spending money on a problem they do not have.
I believe that the right kind of health IT will eventually help us deliver better care at lower cost. Eventually.