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Commentary
October 28, 2009

Health Care Choices and Decisions in the United States and Canada

Author Affiliations

Author Affiliations: Departments of Geriatrics and Palliative Care and Medicine, Mount Sinai School of Medicine, New York, New York, and Health Services Research and Development Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York (Dr Ross); Department of Medicine, Mount Sinai Hospital and University Health Network, and Departments of Health Policy, Management, and Evaluation and Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Detsky).

JAMA. 2009;302(16):1803-1804. doi:10.1001/jama.2009.1566

Media speculation about the scope of proposals for health care reform in the United States has led many Americans to be “very concerned” that changes will limit their choices in the future.1 Health care choices are made on 3 levels: insurance plans, sources of care (physicians and hospitals), and clinical decisions (diagnostic tests and treatments). In this Commentary, the extent to which Americans currently are able to exercise choices is discussed. For context, the US environment is compared with that in Canada, partly because the Canadian health system, with much greater government involvement, is often publicly portrayed in the United States as limiting choice.

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