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It's the Institutions, Stupid! Why U.S. Health Care Expenditure Is so Different from Canada's


  • Antoon Spithoven


The United States and Canada are rather similar in social orientation. However, this is not reflected in health care. Firstly, Canada implemented the principle of universal coverage much earlier than the United States. Secondly, U.S. health care continues to rely much more on private funding and private managing, while Canadian health care relies more on cost containing public funding and governmental budgeting. These differences can be explained, among other things, by their different paths of development since the American Revolutionary War: the United States followed an independent path while Canada was oriented on Europe (for a long period of time). The different governance structures of health care and associated institutions such as lobbying result in a much higher health care expenditure in the United States than in Canada.

Suggested Citation

  • Antoon Spithoven, 2011. "It's the Institutions, Stupid! Why U.S. Health Care Expenditure Is so Different from Canada's," Journal of Economic Issues, Taylor & Francis Journals, vol. 45(1), pages 75-96.
  • Handle: RePEc:mes:jeciss:v:45:y:2011:i:1:p:75-96
    DOI: 10.2753/JEI0021-3624450105

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