The 20-Year Experiment: Accounting for, Explaining, and Evaluating Health Care Cost Containment in Canada and the United States

Since the late 1960s, concerns over the escalating costs of health care have been expressed with increasing vigor on both sides of the Canada-United States border. This is in sharp contrast with the previous 20 years, during which the principal policy concern was to meet needs by finding ways to expand the flow of resources into health care . In retrospect, the turning point in Canada was marked by the 1970 publication Task Force Reports on the Costs of Health Care (22). The 1970 Annual Report of the Economic Council of Canada (36) also expressed concern about the cost trends of the 1960s . Cost Containment became part of the American health agenda, at least rhetorically, at about the same time. As we attempt to assess the effects of efforts at containment, it is important to remember that before about 1970 no one was really trying . It is only since that time that policies can be said to have succeeded or failed. Perhaps even more important, not everyone is trying to contain costs now . By accounting definition, the costs of health care (total expenditures) are