McGrail Kimberlyn M, Evans Robert G, Barer Morris L, Kerluke Kerry J, McKendry Rachael
Assistant Professor and Associate Director, School of Population and Public Health, Centre for Health Services and Policy Research, Vancouver, BC.
Healthc Policy. 2011 Aug;7(1):41-54.
Conventional wisdom holds that Canada suffers from a physician shortage, yet expenditures for physicians' services continue to increase rapidly. We address this apparent paradox, analyzing fee-for-service payments to physicians in British Columbia in 1996/97 and 2005/06. Age-specific per capita expenditures (adjusted for fee changes) rose 1% per year over this period, adding $174 million to 2005/06 expenditures. We partition these increases into changes in the proportion of the population seeing a physician; the number of unique physicians seen; the number of visits per physician; and the average expenditure per visit. Expenditures on laboratory and imaging services, particularly for the elderly and very elderly, have increased dramatically. By contrast, primary care services for the non-elderly appear to have declined. The causes and health consequences of these large changes deserve serious attention.
传统观点认为加拿大面临医生短缺问题，然而医生服务支出却持续快速增长。我们通过分析1996/97年和2005/06年不列颠哥伦比亚省按服务收费支付给医生的情况，来解决这一明显的矛盾。在此期间，按年龄划分的人均支出（根据费用变化进行调整）每年增长1%，使2005/06年的支出增加了1.74亿加元。我们将这些增长分为看医生的人口比例变化、看过的不同医生数量、每位医生的就诊次数以及每次就诊的平均支出。实验室和影像服务的支出，尤其是针对老年人和高龄老人的支出，大幅增加。相比之下，非老年人的初级保健服务似乎有所下降。这些巨大变化的原因及其对健康的影响值得认真关注。
