Through all entities in its public-private system, the US spends more per capita than any other nation in the world.

Although Canadians and Americans have each looked to the other for ways to improve their respective health care systems, there exists a substantial amount of conflicting information regarding the relative merits of the two systems.

In Canada, the US is used as a model and as a warning against increasing private sector involvement in financing health care. In the US, meanwhile, Canada’s essentially single-payer health system is seen by different sides of the ideological spectrum as either a model to be followed or avoided.

Canada’s system is designed to deliver a somewhat different product to a population that has somewhat different expectations than Americans.

Canada doesn’t have a single national health care plan. What’s true about health care in Saskatchewan is not necessarily true in Newfoundland and Labrador.

What Canada has is a national health insurance program that’s implemented via 13 different provincial and territorial health insurance plans.

The 13 provincial and territorial plans are structured to meet five federal conditions for funding defined in the Canada Health Act:

• The provision of all medically necessary services, defined as most physician and hospital services;
• The public administration of the system;
• The portability of coverage through Canada;
• The universal coverall of all citizens and residents;
• The absence of user charges at the point of care for core medical and hospital services.

All Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

In Canada, doctors run their own private practices. Every doctor deals with one insurer, the provincial government, which gives rise to the term “single-payer insurance.”

The system is funded by a mix of public (70 percent) and private (30 percent) funding, with most services delivered by private (both for-profit and not-for-profit) providers. Each province and territory determines, within a set of options, how to finance its share of the cost for its health insurance plan. Some have chosen to fund their share through premiums, others have relied on taxes or other revenues.

The US spends much more on health care than Canada, both on a per-capita basis and as a percentage of GDP.

In 2006, per capita spending for health care in the US was USD6,714;  in Canada, USD3,678.

The US spent 16.0 percent of GDP on health care in that year; Canada spent 10 percent. The difference amounts to about USD800 billion a year. The spending gap is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care.

Doctors in Canada do make less than their US counterparts–but they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers. They don’t spend several hours every day on the phone with insurance company bean-counters. And their malpractice insurance fees are lower. Canadians are far less likely to sue in the first place, partly because they don’t have to absorb financial losses in addition to any physical losses when something goes awry. No matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards don’t have to include coverage for future medical costs, which reduces the insurance company’s liability.

In 2006, 70 percent of health care spending in Canada was financed by government, versus 46 percent in the US. Total government spending per capita in the US on health care was 23 percent higher than Canadian government spending, and US government expenditure on health care was just under 83 percent of total Canadian spending (public and private).

Studies have come to different conclusions about the result of this disparity in spending. A 2007 review of all studies comparing health outcomes in Canada and the US in a Canadian peer-reviewed medical journal found that “health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.”

Life expectancy is longer in Canada, and its infant mortality rate is lower than that of the US, but there is debate about the underlying causes of these differences. One commonly cited comparison, the World Health Organization’s (WHO) ratings of “overall health service performance,” published in 2000, which used a “composite measure of achievement in the level of health, the distribution of health, the level of responsiveness and fairness of financial contribution,” ranked Canada 30th and the US 37th among 191 member nations.

This study rated the US “responsiveness,” or quality of service for individuals receiving treatment, as first, compared with seventh for Canada.

The average life expectancy for Canada was 80.34 years, compared with the US at 78.6 years.

However, the WHO’s study methods were criticized by some analyses. Some argue that Canada has had higher mortality rates for some conditions, such as heart disease being treated using particular medications.

Although there is a measure of consensus that life-expectancy and infant mortality mark the most reliable ways to compare nation-wide health care, a recent report by the Congressional Research Service carefully summarizes some recent data and notes the “difficult research issues” facing international comparisons.

A recent poll by Angus Reid Strategies drawing on respondents on both sides of the 49th parallel found that Canadians are more satisfied with their government-run health care system than Americans are with health care delivery in the US.

The poll found that 65 percent of Canadians have a “very positive” or “moderately positive” impression of single-payer health care in their country. A whopping 79 percent of Canadians have a negative opinion of health care in “the States.”

Although only 43 percent of Americans give thumbs-up to the US health care system, they aren’t about to embrace a Canadian-style single-payer system: Nearly two-thirds of  the Americans surveyed (65 percent) give it negative marks.