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August 19, 1998

Hospital Services in the United States and Canada

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(7):599-600. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-7-jbk0819-d

To the Editor.—The cost comparison of hospital costs in Canada vs the United States by Dr Bell and colleagues1 has a major flaw. Most nongovernmental hospitals in the United States have a multitiered pricing system. The highest level would likely be quoted with a telephone inquiry if a person were paying on a cash basis. The average actual reimbursement for all payers in the United States would likely be 30% to 60% lower than the high-level cash-basis quotation (Michael Laidlaw, Mills-Peninsula Hospitals, oral communication, July 15, 1998).

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