Controlling health expenditures-The Canadian reality

American interest in the Canadian health care system appears to be on the rise, as evidenced in a three-part article by Iglehart (1-3) in The New England Journal of Medicine. Such interest has been intermittent in the past, depending in part on the position of national health insurance on the U.S. political agenda. In the early 1970s, the most recent period [as of 1989] during which national health insurance seemed imminent, Americans paid considerable attention to the structure, logic, and history of the Canadian system (4). At the time, that system had just been established in its entirety. Although its origins and organization were documented, there had been little experience with universal, public coverage, and data were not yet available on its performance. Universal hospital coverage was a decade or more old (in Saskatchewan, a quarter century), but the extension of insurance to cover physicians' services was very new. Then the moment passed, national health insurance moved off the American agenda, and after a variety of attempts to regulate the health care system at ann's length, competition and the marketplace became the dominant ideas of the 1980s. In this context the Canadian experience was of little relevance.