Hayward R A, Kravitz R L, Shapiro M F
University of Michigan, Ann Arbor.
Ann Intern Med. 1991 Aug 15;115(4):308-14. doi: 10.7326/0003-4819-115-4-308.
To evaluate U.S. and Canadian resident physicians' views about their health care systems.
Self-administered questionnaire survey in 1989.
Senior family medicine and internal medicine residents in Canada and in ten geographically representative American states.
American and Canadian residents had similar levels of professional satisfaction and almost universally agreed on the ethical obligation to provide care to persons of all social circumstances, but U.S. residents were more likely to perceive a serious access problem in their country (75% compared with 18%) and to think that current controls on the medical profession interfere with patient care (81% compared with 58%; P less than 0.001). In addition, U.S. residents were more likely than Canadian residents to believe that primary care salaries were too low (78% compared with 38%) and that salaries of medical subspecialists (57% compared with 17%) and surgeons (85% compared with 28%) were too high. In general, residents preferred their own country's predominant health care system. Whereas 87% of U.S. physicians supported private fee-for-service health care, 85% of Canadian physicians supported government-funded national health insurance. Nonetheless, 42% of U.S. physicians supported and only 17% strongly opposed national health insurance as an alternative approach. About two thirds of respondents from both countries opposed a salaried national health service.
American residents perceived greater problems with access, overall intrusions into medical practice, and fee disparities than did their Canadian counterparts. They preferred private fee-for-service health care, but few strongly opposed government-funded national health insurance as an alternative approach to the health care needs of the United States.
评估美国和加拿大住院医师对其医疗保健系统的看法。
1989年的自填式问卷调查。
加拿大以及美国十个具有地理代表性州的高级家庭医学和内科住院医师。
美国和加拿大的住院医师职业满意度水平相似，并且几乎普遍认同为所有社会阶层的人提供医疗服务的道德义务，但美国住院医师更有可能认为本国存在严重的医疗可及性问题（75%，而加拿大为18%），并认为当前对医疗行业的管控妨碍了患者护理（81%，而加拿大为58%；P<0.001）。此外，与加拿大住院医师相比，美国住院医师更有可能认为初级保健医生的薪资过低（78%，而加拿大为38%），以及医学专科医生（57%，而加拿大为17%）和外科医生（85%，而加拿大为28%）的薪资过高。总体而言，住院医师更倾向于本国占主导地位的医疗保健系统。87%的美国医生支持私人按服务收费的医疗保健，85%的加拿大医生支持政府资助的国家医疗保险。尽管如此，42%的美国医生支持，只有17%强烈反对将国家医疗保险作为一种替代方案。来自两国的约三分之二的受访者反对国家薪资制医疗服务。
与加拿大同行相比，美国住院医师认为在医疗可及性、对医疗实践的总体干扰以及费用差异方面存在更大问题。他们更喜欢私人按服务收费的医疗保健，但很少有人强烈反对政府资助的国家医疗保险作为满足美国医疗保健需求的替代方案。
