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April 5, 1995

Health System Reform: Still Twitching-Reply

Author Affiliations

Cook County Hospital Chicago, Ill
San Francisco General Hospital San Francisco, Calif
Harvard School of Public Health Boston, Mass

JAMA. 1995;273(13):997-998. doi:10.1001/jama.1995.03520370037025

In Reply.  —The US health system is witnessing an alarming and rapid corporate transformation with profound implications for health care quality. Rather than addressing this disturbing reality, or engaging the 10 quality principles we outlined for US health system reform, Dr Noel echoes a series of inaccurate assertions about Canada, and instead offers the administratively unwieldy and inequitable remedy of medical individual retirement accounts.He misrepresents Canada as plagued by "medical cost inflation, shortage, long queuing, and rationing." Recent Canadian data show that average real per capita health expenditures increased only 1.4% annually from 1987 through 1993, and have actually decreased for the latter 2 years.1 While effectively containing costs, Canada provides more care— more physician visits, more hospital days, more procedures, and even more bone marrow transplantations (and at a more appropriate stage)—than the United States, while achieving the highest level of satisfaction in the world and winning

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