North America's two-way border trade in health

As the NHS lurches from crisis to crisis, Jeremy Laurance, Health Editor, asks if we should look abroad for radical solutions: Canada, where care - once you get it - is cheaper than the USA

There is a two-way trade in health across the Canadian/US border. Those in the US border states get cheaper medicines in Canada, 60 per cent below their price at home.

There is a two-way trade in health across the Canadian/US border. Those in the US border states get cheaper medicines in Canada, 60 per cent below their price at home.

For those on the Canadian side, where waiting lists for surgery are growing, there is the lure of quick treatment south of the border.

In some ways the Canadian health system is closer to the NHS in Britain than to the American system. It is largely tax-funded, although two provinces (British Columbia and Alberta) have moved back towards a contributions-based system, hospitals are publicly owned and GPs are gatekeepers, controlling referrals to specialists. Private insurance cover for core medical services provided by the provinces is banned under the 1984 Canada Health Act.

But insurance is permitted for ancillary services such as dentistry and drugs. In practice 65 per cent of Canadians take out cover for these services.

Waiting lists are a growing concern although, at an average 11.9 weeks in 1997, they would not turn a hair in Britain. In North America, those delays are regarded as unacceptable.

There are also problems with postcode prescribing and other differences in the range of services provided in different provinces, similar to those in the UK. Compared with other countries, Canada has a high length of stay in hospital, and some reviews suggest inpatients receive inappropriate, ineffective care with wide variations in treatment patterns. One analyst called the hospital inefficient and overused.

One survey showed Canadians reported fewer problems in receiving health care than Americans, taking account of the time it took to get treatment and the cost.

But those living in provinces with contributions-based funding may find they have no coverage.

In British Columbia 105,000 people, 3 per cent of the population, were estimated to be without cover in one study.