National Health Insurance: Can We Learn From Canada?

National Health Insuranceprovides a useful single source of information on the Canadian experience with national health insurance, including its historical development, evaluation of its economic results, and an assessment of its effect on quality of care, supply and distribution of medical professionals, and professional trade unionism. Many of the issues discussed have particular relevance for the United States. For example, despite national health insurance, the movement of medical care prices, use, and expenditure is similar in the United States and Canada. In Canada, co-payments designed to reduce costs had little effect on utilization or costs. (Some participants believed that the Canadian experience was too limited to permit definite conclusions. I would concur.) Canadian officials have adopted a strategy to limit the future establishment of hospital beds as the best means of cost control. Fee schedules and peer review are relatively ineffective cost control mechanisms in a fee-for-service system because