Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians

Article Abstract:

Guidelines for practicing medicine recently have begun to focus on the quality and appropriateness of care given rather than on cost control. Guidelines recommending decreases in the use of cesarean section were distributed to obstetricians in Ontario. To determine the effectiveness of these guidelines, hospitals and private practices were surveyed before and two years after guidelines were issued. The study found that a majority of the physicians were informed of the guidelines and agreed with the content. One third of the physicians and hospitals claimed to follow guideline recommendations and had changed practice accordingly, and obstetricians generally reported that the rate of performing cesarean section on women who had previously had a cesarean was reduced. However, the cesarean section rates, measured after guideline distribution, were actually higher than reported by physicians. When the physicians were asked about guideline content, there was a only a 67 percent correct answer rate. It was concluded that physicians were not moving closer to the recommendations stated in the guidelines. It is suggested that incentives to change should be implemented and incentives not to change should be eliminated. It appears that although the guidelines affect physician perceptions, in practice there is little evidence of changed behavior in response to the guidelines.

Standards, Medicine, Medical care, Practice, Medical practice, Obstetrics

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Controlling health expenditures - the Canadian reality

Article Abstract:

The costs of health care, and who is going to pay them, are of great concern to both Canada and the United States. To date, market forces and legislative policies regarding health insurance have failed to restrain the growth of health care expenditures in the United State. Canada, on the other hand, has developed a system with a radically different approach to providing reimbursement for health care that avoids or solves a number of the problems facing the US. The Canadian system allocates a proportion of the national income to cover general health expenditures, and citizens there are universally covered without being charged. Consequently, problems of uncompensated care, the explosive costs of catastrophic illness, and uninsured individuals are avoided. American observers question Canada's ability to sustain such a policy. Canadian and American expenditure data is compared, and those areas where the two systems diverge the most are analyzed. In general, Canada has opted to rely on political processes to resolve the natural conflict between the health care providers and those who must pay for it, while the US has permitted market forces to play that role. The Canadian approach may be less intrusive on the professional autonomy of the physician than the American system.

Analysis, Finance, Health insurance, Medical care, Cost of, Health care costs, Public opinion, National health insurance, Socialized medicine

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Hospital care for elderly patients with diseases of the circulatory system; a comparison of hospital use in the United States and Canada

Article Abstract:

There has been considerable interest in comparing the costs and services of the medical systems in the US and Canada, because the organization of hospital treatment and the availability of physicians is very similar. Despite these and other similarities the two countries have experienced very different financial trends in health care since the 1960s. From a period in which both countries spent approximately the same percentage of their gross national product (GNP) on health care, costs in the US escalated to 11.2 percent of GNP in 1987 while in Canada health costs comprised 8.6 percent of the GNP. Analysis has shown that patients are discharged sooner in the US as compared with patients in Canada, a trend that may have been produced by the Diagnosis Related Groups (DRGs), a system for cost-containment initiated by the medical insurance sector in the US. The rate of spending on elderly Canadians is less than similar spending in the US; the discrepancy is due in part to the greater use of coronary artery bypass surgery and expensive new imaging technologies (e.g., CAT scanning, MRI) in the US. No attempt was made to examine whether differences in spending resulted in different outcomes for the patients.

Aged, Elderly, Surgery, Cardiovascular system, Hospital utilization, Hospital stays, Cardiovascular surgery

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