The impact of health care reform on orthopaedic surgery in the United States and Canada.

Health care reform is not unique to the United States but reflects fundamental changes in attitudes to health care worldwide. Orthopaedic surgery must examine its role in the context of the overall health care delivery system, rather than in the narrow focus of our specialty, if we are to grow and continue to improve in the future. This lecture describes the evolution of the Canadian Health Care system and draws parallels to the current American environment from which valuable lessons may be learned. There are 5 reasons why health care costs more in the United States than in all other countries which are independent of the fact that the United States has the highest quality of medical care available in the world. These are excessive administrative costs and manpower; oversupply (and hence underutilization) of expensive technology and services; the "medicalization" of social costs; and the tremendous cost of medical liability and malpractice litigation. There are a number of steps that can be taken to enhance the role of orthopaedic surgery in health care without eliminating choice and impairing innovation, which are the critical elements in a high-quality health care system. The Canadian and American systems will be more similar in the future despite the different paths that we are taking in reform, and I believe we can look to the future with optimism and confidence if appropriate measures are taken to ensure that our contributions are effective and efficient.