DeCoster C A, Smoller M, Roos N P, Thomas E
National Health Research and Development Program.
Healthc Manage Forum. 1997 Winter;10(4):26-9, 32-4. doi: 10.1016/S0840-4704(10)60978-7.
To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports. Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.
为了确定不同医疗保健系统中医生服务是否存在差异，我们比较了加拿大曼尼托巴省、凯撒医疗保健组织（Kaiser Permanente）以及美国的门诊就诊率和三种外科手术的手术率。凯撒医疗保健系统实行单一支付方且经济障碍较低，与加拿大的系统并无不同。但是，在美国的大部分地区，主要的支付机制是按服务收费，患者需支付大量费用，这不利于预防性和早期初级保健。曼尼托巴省和凯撒医疗保健系统的数据是从计算机化行政记录中提取的。美国的数据则来自公开可得的报告。曼尼托巴省的初级保健医生就诊次数是美国的1.8倍，凯撒医疗保健系统是美国的1.2倍（若将联合健康护理就诊计算在内则为1.4倍）。对于所研究的外科手术，美国的手术率高于凯撒医疗保健组织或曼尼托巴省。我们得出结论：（1）美国的医疗系统导致更多的外科手术干预；（2）消除经济障碍会导致初级保健服务的更高利用率，而在初级保健中可以提供更多的预防性和改善性护理。
