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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/jama.280.7.599

To the Editor.—In their comparison of hospital services, Dr Bell and colleagues1 comment that waiting times were shorter in US hospitals while charges were higher in Canadian hospitals for patients who pay out-of-pocket. What the authors do not state is that for a patient who is covered under a provincial health care plan, the option of paying out-of-pocket does not exist. That is, even if the patient was willing to pay out-of-pocket for an insurance-covered service in Ontario (and possibly get to the head of the line), doing so is illegal. Aside from the occasional noncovered person, the situation simply never occurs.