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One of the first studies to directly compare the costs of surgery in Canada and the United States has found Canada's single-payer system is far more cost efficient, but it still has a lot of room for improvement.

The research, published in the Archives of Internal Medicine, found that heart bypass surgery, a common procedure, costs an average of $10,373 in Canada, compared with $20,673 in the United States. (For purposes of comparison, all figures are in U.S. dollars.)

And those are just hospital costs. The U.S. Medicare program reimburses an average of about $25,000 for bypass surgery, and many patients with private insurance pay more. Under Canada's medicare system, patients do not pay directly for medically necessary procedures, such as bypass surgery, which uses blood vessels to reroute blood flow around arterial blockages to improve the supply of blood and oxygen to the heart.

"The conventional wisdom is that health care is much more expensive in the U.S. and the conventional wisdom is right," said Dr. Mark Eisenberg, head of cardiovascular epidemiology at Jewish General Hospital in Montreal.

Despite the significantly higher costs in the United States (they are essentially double those in Canada), the rate of complications and death after bypass surgery was similar in both countries.

"All this extra technology, all this extra spending, does not lead to improved survival," Dr. Eisenberg said.

Americans spent $5,635 per capita on health care in 2003, compared with the $3,003 spent by Canadians. Put another way, health spending accounts for almost 15 per cent of gross domestic product in the U.S. and just under 10 per cent in Canada.

The large difference is usually attributed to high administrative costs in the United States and the penchant for overtreatment in the profit-driven U.S. system.

But the new study by Dr. Eisenberg and a Canadian-U.S. research team shows that, when it comes to heart bypass surgery, the reasons are more complex. The research shows that administrative and overhead costs in the United States are higher, but so are labour costs and the price of virtually every product and service, from basic pain-reliever pills on up.

"It's striking how much more everything costs: Gauze pads cost twice as much; stents cost twice as much," Dr. Eisenberg said.

In fact, the new research provides some striking cost comparisons. For example:

In the United States, it costs $1.56 to deliver an acetylsalicylic acid (ASA) pill to a bypass patient, while it only costs 97 cents in Canada.

A simple lab test to determine blood gas costs $21.61 in the United States, compared with $7.22 in Canada.

Catheterization (slipping a thin plastic tube into an artery or vein to determine the health of blood vessels ) costs $511.70 in the U.S. and $306.86 in Canada.

An hour of operating room time costs $397.05 in a U.S. hospital, compared with $313.76 in Canada.

One day in a surgical bed costs $561.53 in the United States and $360.10 in Canada.

The only area where the Canadian system proved slightly more expensive was an intensive-care bed, which cost $1,123.95 daily in Canada, compared with $1,121.81 in the United States.

The research also showed Canadian patients remain in hospital longer after surgery, an extra day on average, which adds substantially to the cost of bypass surgery.

"In Canada, there is no impetus to discharge patients. There is still room for improvement," Dr. Eisenberg said.

About 500,000 bypass operations are performed annually in the United States, compared with about 25,000 in Canada.

The study looked only at the cost of surgery, not appropriateness of treatment.

The study examined the treatment costs of more than 12,000 bypass-surgery patients at nine hospitals in Canada and in the United States. All the hospitals used identical accounting software, allowing direct cost comparisons.

About 74,600 Canadians died of heart disease in 2002, according to Statistics Canada.

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