% Canadians coming to US for treatment

Chico David, BSN, RN · Jul 26, 2011

Hopefully, some of the posters on this thread can help me with my search for some data.
I'm trying to get a hold of some objective information on the numbers of Canadian residents who come to the US for treatment. There is actually quite a bit out there on this, but everything I've been able to find so far indicates very small numbers (the highest figure I saw was still less than 1/2 of 1% of the Canadian population). This doesn't jive with the anecdotal stories that are circulating that seem to indicate far higher numbers.
I've checked both the Heritage and Cato Foundations but found nothing useful. Any other suggestions?

Maybe your inability to find data that supports the higher anecdotal numbers is related to the fact that those higher anecdotal numbers are just made up out of thin air and the low, data based numbers are actually real. That low number is not an annual number by the way, but a lifetime number. So despite the fact that most of the Canadian population lives within an hour's drive of the border, less than 1/2 of 1% have ever in their lives come to the US for care. The studies I've seen do exclude those who were already traveling in the US and became ill or injured and needed care as a result.

Home Health Columnist / Guide · Aug 19, 2011

Created a new thread and moved your posts.

Info found in journal Health Affairs article from 2002:

Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States

PROLOGUE: Over the past three decades, particularly during periods when the U.S. Congress has flirted with the enactment of national health insurance legislation, the provincial health insurance plans of Canada have been a subject of fascination to many Americans. What caught their attention was the system's universal coverage; its lower costs; and its public, nonprofit administration. The pluralistic U.S. system, considerably more costly and innovative, stands in many ways in sharp contrast to its Canadian counterpart. What has remained a constant in the dialogue between the countries is that their respective systems have remained subjects of condemnation or praise, depending on one's perspective.
Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada's methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that "refugees" of Canada's single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.
This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system. Katz is an associate professor in the Departments of Medicine and Health Policy and Management at the University of Michigan. Karen Cardiff is a research associate at the University of British Columbia's Centre for Health Services and Policy Research. Also at the University of British Columbia are Morris Barer, professor and director at the Centre for Health Services and Policy Research's Department of Health Care and Epidemiology, and Robert Evans, professor at the Centre for Health Services and Policy Research's Department of Economics. Marina Pascali is a Dallas-based health care consultant.

Not_A_Hat_Person, RN · Aug 22, 2011

How many Canadians who come to the US for medical care are paying for care out of pocket? How many were sent to the US by their provincial government?

loriangel14, RN · Sep 11, 2011

I think you answered your own question. The stories suggesting high numbers of Canadians going to the US for care are just that - stories.

Also I know that some data includes Canadians that were in the US when they became ill.They weren't down the specifically for medical care.

RN4MERCY · Sep 12, 2011

If you do a little research, you'll find that there are complaints about "wait times" in both Canada and the US. A Commonwealth Fund study found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 57% waited 4 weeks or more to see a specialist, vs. 23% in the U.S., but Canadians had more chances of getting medical attention at nights, or on weekends and holidays than their American neighbors without the need to visit an ER.

In the United States, access to health care is primarily determined by whether a person has access to the money to pay for treatment and whether or not services are available in the area and by willingness of the provider to deliver service at the price set by the insurer.

In Canada the wait time is set according the availability of services in the area and by the relative need of the person needing treatment. However, Canadians aren't restricted to seeking treatment only at the hospital closest to them; they have implemented a system so patients and providers can self-refer for an appointment to be seen and treated at any available hospital.

Canadians are, overall, statistically healthier than Americans and show lower rates of many diseases and enjoy a longer life expectancy. So, regardless of what anyone says about lines and wait times, the Canadian system is more just and the evidence shows a longer lifeline as the outcome.

tewdles, RN · Sep 14, 2011

the US health outcomes are going to continue to fall as compared to Canada and other countries as our numbers of unemployed, and therefore uninsured citizens, continues to grow.

The notion that the private sector is going to improve this is wishful thinking. Our government is charged with protecting the general welfare of the citizenry, not private industry.

dissent · Sep 19, 2011

Canadians are, overall, statistically healthier than Americans and show lower rates of many diseases and enjoy a longer life expectancy. So, regardless of what anyone says about lines and wait times, the Canadian system is more just and the evidence shows a longer lifeline as the outcome.

Controlling for lifestyle choices (obesity, smoking) and heterogeneity of the US population (ie with infant mortality) you do not see the same difference in life expectancy. These things are not health care system related- they are population/lifestyle related. This is not to say the US system is perfect but it is academically dishonest to compare dissiimilar populations. Think about what would happen if a new cardiovascular drug showed improved mortality yet the they had 10% fewer obese people than control?

Answer- it wouldn't pass peer review unless it controlled for these.

dissent · Sep 19, 2011

Oh and to answer the original question, you are probably not going to find a large percentage of the Canadian population that come to the US. Only those who are wealthy and are waiting for cancer tx or ortho surgery are likely to come.

RN4MERCY · Sep 20, 2011

Controlling for lifestyle choices (obesity, smoking) and heterogeneity of the US population (ie with infant mortality) you do not see the same difference in life expectancy. These things are not health care system related- they are population/lifestyle related. This is not to say the US system is perfect but it is academically dishonest to compare dissiimilar populations. Think about what would happen if a new cardiovascular drug showed improved mortality yet the they had 10% fewer obese people than control?
Answer- it wouldn't pass peer review unless it controlled for these.

Let's face it; there are distinguished professors and plenty of wealthy people who are overweight and who smoke. What you are calling a life-style "choice" may be influenced by bio-metabolic, psycho-social, and/or genetic factors and it's intellectually dishonest to ignore those facts and disparage individuals rather than blame the commodification of health care in this country. If you have money and employer subsidized health insurance, you can afford your co-pays and deductibles. You will have access to treatment, counseling, medications, decent housing, sick leave and, your health outcomes will be better than those who have limited or no access. In Canada, everyone has access.

The OECD has an extensive peer review process and their data has been referenced and published in many well-respected and peer- reviewed journals, such as the American Public Health Association. Your hypothetical question and comment is intended to make what point exactly? I suppose if you have a concern about the reliability and validity of their data, you should take it up with them. There are no confounding variables that limit the generalizability of the findings as far as most reputable health policy analysts are concerned and it requires a huge leap of faith to buy into your accusation of academic dishonesty on the part of the OECD. Where's the evidence and what's your motive for making that assertion?

If you look closely at the socio-economic demographics of the major studies on health outcomes, prematurity, low birth weight, and infant mortality statistics are higher in populations where maternal access to pre/perinatal health care services, pure water, wholesome food, decent shelter, and education is limited. Canada, for instance, made news by sending high risk infants to US hospitals for tertiary care when their own NICUs had to go on divert because they'd reached capacity. Unbelievable as it may seem to us here, the Canadian government's Medicare system paid for it.

And, here's another commentary you might find interesting, regarding the costs of care put forward in a column by nobel prize winning economist Paul Krugman. He quotes a Commonwealth Fund study, so if you have any concrete references, rather than conjecture or speculation, to substantiate any flaws in their methodology, take it up with Krugman. As he puts it, "Canadian health care is roughly comparable in quality to US care, except that everyone is covered-and it does so at far lower cost."

Be sure to read: Phantoms in the Snow: Canadians Use of Health Care Services in the United States. Among the references are several peer-reviewed journals. Enjoy!

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