NYT : Two Medical Systems, Two Pandemic Responses (Canada versus the US)

[Celerity]

A health economist who has taught on both sides of the border examines the difference between Canada and the United States.

https://www.nytimes.com/2020/05/01/world/canada/america-canada-coronavirus-comparison.html

After lamenting in a recent Canada Letter about my inability to find an expert who could offer an informed comparison of how the medical systems in Canada and the United States were responding to the coronavirus pandemic, I soon heard from Professor Peter Berman. He is particularly well placed for such an assessment, after spending 25 years teaching at Harvard, most recently as a professor of global health systems and economics at the T.H. Chan School of Public Health. Professor Berman is now based in Vancouver as the director of the school of population and public health at the University of British Columbia’s medical school.

I’ll begin the comparison with some numbers. Massachusetts, the previous home of Professor Berman, has a population of 6.8 million and British Columbia has slightly over 5 million residents. But the toll of the pandemic on the two areas has been significantly different. As off Friday afternoon in Massachusetts, there have been more than 62,000 reported cases and 3,562 deaths, or 52 fatalities for every 100,000 people. In B.C., there have been just 2,112 reported cases and 111 deaths or just two victims for every 100,000 residents.

Professor Berman cautioned that those numbers reflect a wide variety of factors outside the medical system like the demographic makeup of different cities and regions. But he noted that near his old office at Harvard “there must be thousands of the world’s best hospital beds and there are three top international top hospitals within a couple blocks.” So with resources like that, why is there such a great disparity with British Columbia?

Part of the answer, for Professor Berman, can be found in how hospitals are funded and managed by the public health care systems of Canadian provinces. “The kind of system we have in Canada — and I think in British Columbia we have a pretty well-run version of it — allows the public health authorities to essentially commandeer the hospital system. It’s a command and control thing, it’s not a coordination thing,” he said. In the United States, Professor Berman said, hospitals are largely private institutions without any overall control.

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