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A comparison of cardiovascular procedure use between the United States and Canada
D K Verrilli1, R Berenson, S J Katz
1Radiology Management Sciences, Los Altos, CA 94022, USA.
Insights
Cardiovascular procedure use is 53% higher in the US than in Canada for elderly individuals, with significant age-related differences. Canadian global budgets appear to reduce cardiovascular service utilization in older populations.
Area of Science:
- Cardiovascular medicine
- Health services research
- Geriatric medicine
Background:
- Healthcare utilization patterns for cardiovascular services differ between the United States and Canada.
- Understanding these differences is crucial for evaluating healthcare system performance and resource allocation for elderly populations.
Purpose of the Study:
- To compare the volume and intensity of cardiovascular procedures, noninvasive tests, and diagnostic imaging in elderly individuals between the United States and three Canadian provinces.
- To analyze these comparisons by patient age.
Main Methods:
- Cross-sectional analysis of 1992 claims data from Medicare (US) and provincial health ministries (Canada).
- Volume measured using relative value units (RVUs).
- Services categorized into nine clinical groups and analyzed by service type and patient age.
Main Results:
- Cardiovascular procedure RVUs per elderly beneficiary were 53% higher in the US compared to Canada.
- Differences were most pronounced for surgical procedures and increased with age.
- US-to-Canada ratios for PTCA and CABG use were substantially higher in the oldest age groups.
Conclusions:
- Canadian global budgets are associated with lower cardiovascular service use among the elderly, especially the very old.
- Patient age is a more significant determinant of cardiovascular procedure use in Canada than in the US.
- The implications of higher US utilization rates for the very elderly on outcomes remain uncertain.
Objective:
To compare the relative volume and intensity of all types of cardiovascular procedures, noninvasive tests, and diagnostic imaging for all elderly individuals between the United States and the three largest Canadian provinces (Ontario, Quebec, and British Columbia) by patient age.
Data Sources:
Service volume data for the United States for a one percent random sample of claims obtained from Medicare's National Claims History System. Data for Canada were obtained from the Ministries of Health in the three provinces representing 100 percent of the claims received by each Ministry.
Study Design:
Design is a cross-sectional analysis of 1992 claims data.
Data Extraction Methods:
The volume of cardiovascular services was measured in terms of the relative value units (RVUs) used in the Medicare fee schedule to calculate payments. Services were disaggregated into nine clinical categories, and comparisons were made by type of cardiovascular service and patient age.
Results:
Overall, cardiovascular procedure RVUs per elderly beneficiary are 53 percent greater in the United States than in Canada. Differences are largest for surgical procedures such as carotid thromboendarterectomy and revascularization procedures and smallest for diagnostic imaging and noninvasive tests. The differences between the countries in the use of cardiovascular procedures increase markedly with age. For example, the United States-to-Canada ratio for PTCA use is 1.87 for persons age 65 to 69, but 7.68 for persons age 80 and older. For CABG, the ratios are 1.36 and 7.16, respectively.
Conclusions:
Our findings suggest that global budgets in Canada result in lower levels of cardiovascular service use among the elderly, particularly among the very aged elderly. Patient age appears to play a much more important role in determining the recipients of cardiovascular procedures in Canada than in the United States. Whether these higher rates of procedure use among the very elderly in the United States compared to Canada reflect profligate service use or contribute to improved outcomes is uncertain.