Vayda E, Morison M, Anderson G D
Can J Surg. 1976 May;19(3):235-42.
Canadian and provincial rates for eight elective and seven nonelective operations were determined from 1968 through 1972. Of the elective procedures considered, the Canadian tonsillectomy rate decreased substantially and rates for hysterectomy and cholecystectomy showed large increases. The provinces reflected national trends for these three operations. Except for coletomy, which increased 36%, rates for the nonelective procedures showed little change. Correlations between the numbers of surgical personnel and the elective surgery rates in the provinces were demonstrated in 3 of the 5 years; these are best shown at the extremes. Newfoundland had the fewest surgeons, a bed: population ratio below the national average and the lowest combined elective surgical rate; Alberta ranked high in all three categories. In the seven other provinces, there was less variation in the number of surgeons, hospital beds and elective surgical rates. Provinces with extensive insurance coverage prior to universal medical insurance reduced their combined elective surgery rate, while provinces where fewer people were insured showed increases. In the absence of different methods of payment for surgical services and marginal changes in the number of hospital beds and the number of surgeons, more insured persons produced more elective surgery.
1968年至1972年期间确定了加拿大及各省8种择期手术和7种非择期手术的手术率。在所考虑的择期手术中，加拿大扁桃体切除术的手术率大幅下降，子宫切除术和胆囊切除术的手术率则大幅上升。各省反映了这三种手术的全国趋势。除结肠切除术增加了36%外，非择期手术的手术率变化不大。在5年中的3年里显示了各省外科手术人员数量与择期手术率之间的相关性；这些在极端情况下表现得最为明显。纽芬兰的外科医生最少，病床与人口比率低于全国平均水平，择期手术综合率最低；艾伯塔省在这三个类别中排名靠前。在其他七个省份，外科医生数量、医院病床数量和择期手术率的差异较小。在全民医疗保险之前保险覆盖范围广泛的省份，其择期手术综合率下降，而保险覆盖人数较少的省份则有所上升。在没有针对手术服务的不同支付方式以及医院病床数量和外科医生数量的微小变化的情况下，更多的参保人员带来了更多的择期手术。
