Evans Robert G, McGrail Kimberlyn M
Professor of Economics, University of British Columbia, Vancouver, BC.
Healthc Policy. 2008 Feb;3(3):18-28.
"Truth is the daughter of Time," said mystery writer Josephine Tey. This point, illustrated in her rehabilitation of the "villainous" King Richard III, is equally apt for a reconsideration of the 1991 Barer-Stoddart report on medical personnel. Canadian physicians have reviled these authors for "creating" a physician shortage by encouraging provincial cuts to medical school enrolment. Yet, data pre- and post-1991 are quite clear: their report did not and could not have had this effect. The physician-to-population ratio has been stable since 1989. Average physician hours of work have fallen, but per capita expenditures on physicians' services (inflation-adjusted) are rising rapidly. A flood of physicians from the major expansion of enrolments now in place threatens serious fiscal trouble over the next two decades, and is likely to pre-empt any significant system reform.
推理小说作家约瑟芬·铁伊曾说:“真相是时间的女儿。”这一观点在她为“邪恶的”理查三世平反一事中得到了体现,同样也适用于对1991年巴雷尔 - 斯托达特关于医务人员的报告进行重新审视。加拿大医生指责这些作者通过鼓励各省削减医学院招生人数而“制造”了医生短缺的问题。然而,1991年前后的数据非常清楚:他们的报告并没有也不可能产生这种影响。自1989年以来,医生与人口的比例一直保持稳定。医生的平均工作时长有所下降,但(经通胀调整后的)人均医生服务支出却在迅速上升。目前大量因招生大幅扩张而涌入的医生在未来二十年可能会引发严重的财政问题,并且很可能会使任何重大的系统改革无法进行。