How well has Canada contained the costs of doctoring?

Article Abstract:

An evaluation is presented of the experience of three Canadian provinces (Quebec, Ontario, British Columbia - which contains 74 percent of the country's population) in their efforts to contain the costs of physicians' services. Data from these provinces and from the United States for the years 1975 to 1987 were obtained from a variety of sources, including Health and Welfare Canada, the US Health Care Financing Administration, and the American Medical and American Osteopathic Associations. Physicians' fees increased more slowly in Canada than in the US, although the two countries had similar increases in population and in the number of physicians. Although the overall and per capita costs of physicians were lower in Canada than the US, there was considerable variability in the cost of services from province to province: expenditures in Ontario rose more quickly than in the US, while those in Quebec rose much more slowly. These differences were due primarily to fee increases in Quebec, which proceeded at a slower pace than inflation prior to 1983. In Ontario, physicians' fees increased more rapidly than inflation, especially after 1982. In all provinces, utilization of physicians' services increased during the years studied. This may have been due to the increasing number of physicians, but other explanations are considered. The Canadian experience indicates that physician costs can be reduced when fees are capped or utilization is controlled. The US Medicare fee schedule, recently developed by Congress, aims to control increases in physician utilization; however, it is possible that doctors will find a way to bill ''creatively'' to maintain demand for their services. An additional concern will be the anticipated increase in the number of physicians in the coming years, a trend that threatens physicians' incomes when cost containment is also being promoted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Canada, Laws, regulations and rules, Social policy, Control, Medical fees

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Sources of the growth in Medicare physician expenditures

Article Abstract:

Expenditures under Medicare Part B increased 12.3% each year between 1985 and 1988, and much of this was a result of increased use of new technologies. Statistics from the Health Care Financing Administration show that the greatest increases occurred in the use of advanced imaging techniques and specialized surgical procedures - diagnostic as well as therapeutic. Charges for echocardiography increased 33.5% each year, and those for magnetic resonance imaging (MRI) increased over 400% each year. Among cardiovascular procedures, charges for coronary artery bypass increased 17% each year and charges for coronary angioplasty increased 79% each year. Of all orthopedic procedures, knee replacement surgery charges increased 14.8% each year. Charges for diagnostic endoscopy procedures increased 17.4% each year, and much of this was a result of a 60.2% increase each year in arthroscopy charges.

Evaluation, Medicare

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Digital Doctoring -- Opportunities and Challenges in Electronic Patient-Physician Communication

Article Abstract:

Information technology provides doctors with ways to communicate with patients, exchange information, conduct research, and manage patient care. Health care consumers are using the Internet to conduct research and communicate with others in large numbers. A 1997 survey determined that 43% of American adults had used the Internet to obtain health and medical information. E-mail can be useful for both doctors and patients to exchange information, and physicians using e-mail with patients report high satisfaction. Web sites can provide physicians with a means to answer frequently-asked questions, educate patients, and provide helpful Internet links. Doctors may soon find that patients prefer e-mail over telephone communications for privacy, expediency, and accuracy.

Editorial, Usage, Physician and patient, Physician-patient relations, Electronic mail systems, Email, Information services, Medical informatics

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