What prosperous, highly educated Americans living in Canada think of the Canadian and US health care systems.

BACKGROUND: There are no reported head-to-head comparative assessments of health care in any two countries by people who have experienced both. We sought to report the experiences and views of Americans living in Canada who have used both health care systems as adults. METHODS: We surveyed a sample of Americans living in Canada. We used 5 communication strategies to obtain the sample and asked respondents to provide experience-based ratings of various dimensions of health system quality. RESULTS: The survey was completed by 310 people who met the inclusion criteria. This group was highly educated (58% with a master's degree or higher) and prosperous (51% of households had a yearly income > $100,000). Seventy-four percent rated the overall quality of US health care as excellent or good, compared with 50% who gave this rating to Canadian health care. Most preferred the American system for emergency, specialist, hospital and diagnostic services. Respondents rated the Canadian system more highly for access to drug therapy and expressed similar views of the two systems with respect to care from a family physician. The features of the US system rated most positively were timeliness and quality; those rated most highly in the Canadian system were equity and cost-efficiency. The most negatively viewed features of the US system were cost/inefficiency and inequity; those of the Canadian system were wait times and personnel shortages. Although respondents generally rated the components of the US system more favourably than Canada's, when asked which system they preferred overall, 45% chose the US system and 40% chose Canada's. CONCLUSION: Americans living in Canada generally rated the US health care system as being better than the Canadian system. However, they acknowledged the inefficiency and inequity of the US system, and nearly half preferred the Canadian system despite its perceived problems.