Di Matteo Livio
Department of Economics, Lakehead University, Thunder Bay, Ontario P7B 5E1, Canada.
Health Policy. 2014 Mar;115(1):18-35. doi: 10.1016/j.healthpol.2013.07.003. Epub 2013 Jul 26.
Physician spending is one of the fastest growing Canadian public sector health categories of recent years but despite their recent growth physician numbers are a relatively small contributor to the increases in total provincial government health expenditure. Regression models of the determinants of provincial government health spending are estimated and show physician numbers are a positive and significant driver of provincial government health care spending after controlling for other factors though the overall contribution is relatively small. From 1975 to 2009, the increases in physician numbers accounted for a range of 3.2-13.3 percent of the increase in real per capita total provincial government health expenditures ranging from a low of 1.9 to 7.6 percent for Manitoba to a high of 5.3 to 18.3 percent for Quebec. These are modest contributions to total health spending but vary more substantially across provinces when hospital and physician spending alone are considered particularly for Quebec and British Columbia. Nevertheless, these results suggest that physician numbers alone are a modest policy concern when it comes to restraining health costs and other factors such as utilization and fees are more important.
近年来,医生支出是加拿大公共部门医疗领域中增长最快的类别之一。尽管医生数量近期有所增长,但在省级政府医疗总支出的增长中,医生数量的贡献相对较小。对省级政府医疗支出的决定因素进行了回归模型估计,结果显示,在控制其他因素后,医生数量是省级政府医疗支出的一个积极且显著的驱动因素,不过总体贡献相对较小。从1975年到2009年,医生数量的增加在省级政府实际人均医疗总支出增长中所占比例在3.2%至13.3%之间,从马尼托巴省的低至1.9%至7.6%到魁北克省的高至5.3%至18.3%不等。这些对医疗总支出的贡献不大,但仅考虑医院和医生支出时,各省之间的差异更为显著,尤其是魁北克省和不列颠哥伦比亚省。然而,这些结果表明,仅医生数量在控制医疗成本方面只是一个适度的政策关注点,而诸如医疗服务利用率和费用等其他因素更为重要。