Family practice

Article Abstract:

Family practice physicians have strongly supported the concept of universal access to medical care. The passage of a Medicare payment plan, based on a Resource-Based Relative Value Scale, should improve health care access for many people. It will also result in increased payments to family practice physicians. Consequently, medical students will be more encouraged to select that specialty. This is important, because too few medical school graduates choose family practice each year and approximately 24,000 family and general practice physicians over 55 years of age. At the end of 1989, almost one-third of family practice residents were women, and one-sixth were minority members. Obstetrics, traditionally a part of family practice, is now practiced by fewer than half of all family physicians due to the high risk of malpractice litigation. Rural areas have suffered most by this decrease in available obstetrical services. New guidelines for family practice physicians are discussed regarding mammography and the use of oxytocin (a hormone) for inducing labor. The Clinical Laboratory Improvement Amendments of 1988 involved federal accreditation of all laboratories, even small office laboratories. Criteria such as proficiency testing were required. The American Academy of Family Physicians has listed simple laboratory tests that could be performed in small office laboratories, which would be exempt from most of these criteria. Other steps to create voluntary laboratory accreditation programs by family practice organizations are described. Use of the International Classification of Disease, Ninth Revision, Clinical Modification, which lists federal coding requirements for Medicare claims, facilitates correct coding, necessary for reimbursement from insurers. The American Academy of Family Physicians does not support the substitution of generic drugs for certain patients and particular illnesses. Overall, 1989 was a positive year for identifying the goals of family practice physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Economic aspects, Reports, Compensation and benefits, Family medicine, Medical laboratories, Biomedical laboratories, Obstetrics, Relative value scale payment systems (Medical care)

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Controlling medical care costs in Canada

Article Abstract:

Editorial comment is presented concerning efforts to control the costs of medical care in Canada, related to an article on that subject in the May 8, 1991 issue of The Journal of the American Medical Association. While physicians' fees in the US have increased faster than in Canada, rates of increase have not been uniform in all provinces of the latter country. Thus, costs in Ontario increased faster than in the US between 1975 and 1987. Utilization of physicians increased more in Canada than the US during the period studied, a fact that has forced Canada to evaluate its utilization management strategies. Controlling the costs of physicians is a complex issue, affected by the physician supply per capita, the amount of service provided by each physician, and the fee structure. All Canadian provinces confront a common problem, that of physician supply. If the supply increases in an environment where total expenditures are capped, the result must be a decline in physicians' incomes. This, in turn, would lead to a relaxation of controls on expenditures. The number of physicians is increasing in both the US and Canada as a result of decisions made by medical schools in the 1960s: in Canada, efforts are being made to reduce the supply of new doctors. The effects of physician supply on the quality of medical care remain to be determined. Policies that attempt to control physician utilization will never completely succeed and cannot affect health care in a global way, but they are desirable for preventing the delivery of inappropriate services. Nor is increasing the supply of physicians intrinsically beneficial to society; perhaps some of the resources required for training them could be better spent elsewhere. The issue of physician supply is likely to become an important one for health care planning in the US, as well as for its neighbor to the north. (Consumer Summary produced by Reliance Medical Information, Inc.)

Canada, Medical care, Cost of, Health care costs, editorial

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