Vayda E
Faculty of Medicine, University of Toronto, Ont.
CMAJ. 1994 May 15;150(10):1583-8.
The financing, payment and organization of medical services are closely related. Canada's health care system is financed publicly, from tax revenue, and administered in each province by a single government payer. Although the chief method of payment to physicians is fee for service (FFS), the need to control costs and organize practice more efficiently has led to increased interest in FFS variants, such as capping payments at a certain level or fixing a budget, and alternative payment methods such as capitation-based payment, salary and combinations of these methods. Although solo practice is reportedly still the chief method of practice organization, it is being steadily replaced by arrangements in which physicians share expenses or calls, and by formal partnerships and group and team practices. As medical practice in Canada continues to shift from solo to group and team practice alternative payment methods that facilitate these models will become more common.
医疗服务的融资、支付与组织密切相关。加拿大的医疗保健系统由税收提供公共资金,并由每个省份的单一政府支付方进行管理。虽然支付给医生的主要方式是按服务收费(FFS),但控制成本和更高效地组织医疗实践的需求导致人们对FFS的变体(如将支付上限设定在一定水平或固定预算)以及替代支付方式(如按人头支付、薪资以及这些方式的组合)的兴趣增加。尽管据报道单人执业仍是医疗实践组织的主要方式,但它正逐渐被医生分担费用或值班的安排、正式合伙关系以及团体和团队执业所取代。随着加拿大的医疗实践继续从单人执业转向团体和团队执业,有助于这些模式的替代支付方式将变得更加普遍。