Physicians’ incomes were much more dominated
by government policy than those in the United
States, and their incomes were significantly below
those in the United States. As a result, a substantial
number of Canadian doctors migrated south for
better pay.
Canada’s system proved very popular with the
general public. A major criticism involved long wait-
ing times for treatment. Canadian hospitals invested
far less in expensive high-tech equipment than did
U.S. hospitals. However, such equipment was criti-
cized by U.S. observers who believed that patients
were being pressured into high-cost diagnostic pro-
cedures that may have little benefit. Abundant anec-
dotal evidence existed of Canadians seeking treat-
ment in the United States either to bypass long
waiting times or to secure top-of-the-line specialist
treatment for difficult conditions.
Impact By 2000, Americans and Canadians were
living longer and healthier lives. Many people
adopted healthier lifestyles, although a rise in obe-
sity rates threatened to increase problems such as di-
abetes. Overall, both the quantity and the quality of
medical resources improved. Canadians were gener-
ally satisfied with their government-financed medi-
cal care system. Americans were not satisfied with
the U.S. system—though most had good feelings
about their personal medical situation.
The United States was the world leader in medical
research and innovation. It spent a much higher per-
centage of the GDP on medical goods and services
than other countries and a far lower proportion of
government-financed medical care than most other
high-income countries. The rapid rise in medical
costs during the decade generated pressures for cost
control in the Medicare and Medicaid programs,
and some of these controls impaired incentives to
provide adequate supply.
For those in the upper half of the population by
income, those with more education, and the elderly
in general, U.S. medical facilities were probably
better than those in other countries. African Ameri-
cans, Latinos, and the low-income population, how-
ever, fared less well. There was chronic agitation for
a more comprehensive system of medical insur-
ance, one more nearly comparable to those in Can-
ada and in Europe, but opponents feared that the
attending cost controls would damage supply and
innovation.
Further Reading
Henderson, James W.Health Economics and Policy.
2d ed. Mason, Ohio: Thomson/South-Western,- This college text is designed for nonecon-
omists. Gives an excellent balance of facts and
theory.
Rejda, George.Social Insurance and Economic Security.
6th ed. Upper Saddle River, N.J.: Prentice-Hall, - A text for college undergraduates. Health
problems and policies are emphasized in chap-
ters 7 and 8.
Zweifel, Peter, and Friedrich Breyer.Health Econom-
ics. New York: Oxford University Press, 1997. A
comprehensive analytical survey with an interna-
tional perspective.
Paul B. Trescott
See also Abortion; AIDS epidemic; Alzheimer’s
disease; Antidepressants; Cancer research; Drug ad-
vertising; Health care reform; LASIK surgery; Medi-
cine; Pharmaceutical industry; Science and technol-
ogy; Stem cell research; Tobacco industry settlement;
Viagra. Health care reform
Definition Legislative initiatives proposed to
moderate health care expenditures and to
increase coverage of uninsured personsDuring this decade, increasing health care costs placed un-
due burdens on individuals, employers, and governments.
Reining in costs and expanding coverage were main aims
of the unsuccessful national health care reform initiatives.Per capita health care expenditures rose from
$1,101 in 1980 to $2,813 in 1990. The average an-
nual growth rate of health care expenditures had ex-
ceeded that of gross domestic product (GDP)
throughout the 1980’s, 10.8 percent compared to
7.8 percent. Total health care expenditures rose
more modestly throughout the 1990’s. By 1999, per
capita health care expenditures rose to $4,522, stabi-
lizing at 13.7 percent of GDP. The average annual
growth rate of health care expenditures exceeded
that of GDP throughout the 1990’s, 6.6 percent vis-à-
vis 5.3 percent. Total U.S. spending on health care
exceeded $1.1 trillion by 1997 and reached nearly
$1.3 trillion in 1999. As health care costs rose, so didThe Nineties in America Health care reform 411