Coyte P C
J Public Health Policy. 1990 Summer;11(2):169-88.
This paper is concerned with the economic aspects of the trends in Canadian health care. Various myths and misconceptions abound regarding the applicability of economics to behaviour in the health care industry as well as to the interpretation of recent trends. Both issues are examined in this paper. While most discussions regarding health care trends begin with the share of health expenditures in Gross National Product, I propose an alternative share that adjusts for cyclical variations in both unemployment and labour force participation. Using this measure, I show that the "real" growth of resources devoted to the health care industry is much larger than that obtained with conventional measures, and that the difference in growth rates between Canada and the U.S. is narrowed considerably. The paper outlines and disputes the validity of three public health policy propositions. First, it is not empirically valid to say that the introduction of universal medical insurance in Canada successfully contained the growth in the share of society's resources devoted to the health care industry. Second, it is not correct to argue that the change in the federal funding for hospital and medical care in 1977 was a "fiscal non-event". And finally, the proposed "equity" funding formula for Ontario hospitals is unlikely to contain costs and will potentially skew hospitals towards the provision of complex forms of care instead of cost-effective community-based alternatives.
本文关注加拿大医疗保健趋势的经济方面。关于经济学在医疗保健行业行为中的适用性以及对近期趋势的解读，存在诸多错误观念和误解。本文将对这两个问题进行探讨。虽然大多数关于医疗保健趋势的讨论都始于医疗支出在国民生产总值中的占比，但我提出了一种经过调整的占比，该占比考虑了失业率和劳动力参与率的周期性变化。通过使用这一衡量标准，我表明用于医疗保健行业的资源的“实际”增长比传统衡量方法得出的结果要大得多，并且加拿大和美国之间的增长率差异也大幅缩小。本文概述并质疑了三项公共卫生政策主张的有效性。第一，声称加拿大引入全民医疗保险成功遏制了社会资源用于医疗保健行业的占比增长，这在实证上是站不住脚的。第二，认为1977年联邦对医院和医疗保健资金的变化是“财政无关事件”的观点是不正确的。最后，安大略省医院提议的“公平”资金分配方案不太可能控制成本，而且可能会使医院倾向于提供复杂的医疗服务形式，而不是具有成本效益的社区医疗替代方案。
