Siemiatycki J, Richardson L, Pless I B
N Engl J Med. 1980 Jul 3;303(1):10-5. doi: 10.1056/NEJM198007033030103.
In November 1974, four years after national health insurance in Canada had eliminated all out-of-pocket payment for physicians' services, we surveyed 1559 households in a socially heterogeneous area of Montreal to assess social-class differences in the use of physicians' services. When reported health status as well as age and sex were taken into account, the rates of physician visits during the two-week period preceding the survey were essentially the same in the low, middle, and high economic classes, thus confirming that disparity of access had been reduced. However, relative to other groups, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter observations may indicate that the poor, as compared with other groups consulted the doctor for more advanced conditions. Official statistics showed no increase in the workload of the average physician, although the number of physician visits per person per year had risen steadily. There was no evidence of abuse of "free" medical care by the poor.
1974年11月，在加拿大国民健康保险消除了所有医师服务自付费用四年后，我们对蒙特利尔一个社会阶层多样的地区的1559户家庭进行了调查，以评估医师服务使用方面的社会阶层差异。当将报告的健康状况以及年龄和性别考虑在内时，在调查前两周内，低、中、高经济阶层的看诊率基本相同，从而证实了就医机会的差距已经缩小。然而，与其他群体相比，穷人仍大量利用医院诊所和急诊室进行初级保健，而且他们更多的就诊涉及开处方以及医生要求复诊。后一种观察结果可能表明，与其他群体相比，穷人因病情更严重而就医。官方统计数据显示，尽管每人每年的看诊次数稳步上升，但普通医师的工作量并未增加。没有证据表明穷人滥用“免费”医疗服务。
