[RcouF1uZ4gsC]

When you are designing a service, you can optimize for median latency or tail latency. Sometimes when you optimize for tail latency, median latency gets worse.

It is similar to the health care systems. The US system is awesome at doing really crazy life saving stuff. For example US is probably the best in keeping premature babies alive. In addition it has a ton of resources. If you want an MRI scan, you can get one in the US pretty quickly and easily. Also, the profits in the US subsidize worldwide drug development. This is why, if you look where all the really rich rulers decide to go for surgery or other complicated care, it is the US.

Canada and other countries optimize for the median case and rely on the US for their outliers. Look at the instances of Canadians coming to the US for surgery or MRI scans because they cannot get them in Canada in a timely manner.

[cmiles74]

I do not believe that this is accurate, in my opinion this assertion requires some documentation. I looked up the survival rate of premature babies and the neonatal mortality rate (28 days after birth) is higher in the US than in Canada.[0] I'm having trouble finding numbers on other procedures, in my opinion it may be because because the US is falling behind on them as well.

[0]: https://www.healthsystemtracker.org/chart-collection/infant-...

[RcouF1uZ4gsC]

I am talking about premature infants.

The one study I could find from 2000 that compares them showed

>Relative risks for infant death from all causes among singletons born at 32 through 33 gestational weeks were 6.6 (95% confidence interval [CI], 6.1-7.0) in the United States in 1995 and 15.2 (95% CI, 13.2-17.5) in Canada in 1992-1994;

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&as_vis...

[cmiles74]

I'm not entirely sure that this paper supports your theory. While they do establish that the risks for this subset of premature babies is higher in Canada than in the US, they do not attribute this to a better level of care from US hospitals or the US healthcare system. Reading through their conclusions, it sounds like they didn't even think that was an issue worth investigating. Instead they looked for population differences and end up theorizing that the difference might be due to age estimation errors.

The fact that the births of premature children in this category is lower in Canada could, perhaps, point to the opposite conclusion: because health care in Canada is less driven by profit, we are seeing better care before birth which could be lowering this number.

"Our results were fairly consistent between the United States and Canada. The RRs of mortality associated with mild and moderate preterm birth were generally higher in Canada. A small part of these differences in gestational age–specific mortality was explained by the lower absolute and relative mortality risks among US black vs white preterm infants, but the RRs for Canada remained substantially higher than those for the United States even after restricting the US analysis to non-Hispanic whites (ie, 8.1 vs 15.2 at 32-33 gestational weeks and 3.3 vs 4.5 at 34-36 gestational weeks for total infant mortality among all singleton live births). An even smaller part of the difference was the result of the slightly lower absolute risks for term (birth at ≥37 gestational weeks) births in Canada (ie, total infant mortality of 3.0 vs 3.1 per 1000 live births for Canada in 1992-1994 vs the United States in 1995). We are currently investigating other potential explanations and particularly whether the differences might be artifacts caused by errors in estimation of gestational age. Regardless of the explanation, however, the prevalence of births in these gestational age categories was much lower in Canada than in the United States, and the EFs were therefore similar in the 2 countries."

https://jamanetwork.com/journals/jama/article-abstract/19299...

[notadoc]

>This is why, if you look where all the really rich rulers decide to go for surgery or other complicated care, it is the US.

If that were true, why would a US Senator go to Canada for surgery then?

https://www.courier-journal.com/story/news/politics/2019/01/...

[s3r3nity]

This was one case where the best hospital in the world for THAT particular procedure was in Canada - and is primarily a PRIVATE hospital.

(Though the hospital also gets some $ from the government, so I'm not quite sure what it means to be "private"...)

I think you can have both claims to be true: the vast majority of complicated procedures are best-in-class in the US, but there are some centers of excellence elsewhere as well.