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Hospitalization and mortality patterns may differ among Canadian and American children. From 1971 to 1987, researchers compared hospital use and death rates among North American children under 15 years old. Although overall childhood mortality decreased, mortality among American children fell less rapidly during this period compared to Canadian children. On the other hand, childhood hospitalizations were higher among Canadians than among Americans. American hospitalizations rates were influenced by prevailing trends in insurance compensation, falling sharply in 1983-1984 with the advent of prospective payment systems. Higher Canadian hospital use and higher American mortality rates may have many causes, such as adequate insurance coverage and limits on medical fees imposed by state law. Lower hospital use may not reflect the quality of medical care. Hospitalization rates at birth, due to birth defects, and due to injuries were similar in both countries and caused more than half of all deaths.