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Health Care in Canada: Lessons for the United States

The Journal of Rural Health 1991年第3期7卷 210-221页

作者： Reamy, Jack DepartmentofHealthCareAdministration TexasWoman'sUniversityHouston77030.

ABSTRACT: This paper considers various aspects of the Canadian health care system and the implications for the improved delivery of rural health care in the United States. The major aspects examined are access to care, rural hospitals, and rural physicians. A search of the pertinent literature revealed a large amount of information concerning rural physicians in Canada, but less that dealt directly with rural hospitals and access to health care in rural areas. Universal access is the cornerstone of the Canadian health care system, which is operated by each province under certain mandates of the federal government, with both providing funding for the system. The diffusion of medical technology has been slower in Canada than in the United States, which is perceived by some as a major success of the system. Little distinction is made between rural and urban hospitals in Canada, with all hospitals funded by annual global budgets from the province, rather than by direct payment for each service provided. Funding for capital items must be requested separately. This method of reimbursement allows better planning in meeting the needs of each community. Physicians in Canada are mostly private practitioners who are reimbursed by fee for service. As in the United States, there has been difficulty in attracting physicians to rural areas. However, all but one province have incentive programs to encourage physicians to practice in underserved rural areas, with some having disincentives for those locating in overserved areas. Overall, the Canadian health care system has chosen to control costs by focusing on the provider rather than the consumer and appears to be more successful in providing access to health care in rural areas of the country. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：加拿大人口统计学财务管理医院卫生经费支出/统计学和数值数据卫生设施关闭卫生服务易得程度医院乡村/经济学国家卫生规划/组织和管理医师奖励计划医师/供应和分配工艺学医学/统计学和数值数据美国

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SALE OF DRUGS AND HEALTH-CARE UTILIZATION IN A HEALTH-CARE DISTRICT IN ZAIRE

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HEALTH POLICY AND PLANNING 1995年第2期10卷 181-186页

作者： COURTOIS, X DUMOULIN, J INST RECH ECON PROD DEV CNRSGRENOBLEFRANCE

Health centres of Idjwi district (Zaire) have been self-financed through the selling of drugs since 1985. Medical care is expensive and its use is low (24 visits per year per 100 inhabitants). In 1989 the medical team tried to reduce the cost of visits by changing the prices of drugs and prescriptions. A limited control was set up to assess this intervention. The study showed that although prescribed drug costs were stabilized compared to inflation, there was no increase in the use of medical care. Moreover, the reduction of drug profit margins for health centres seriously affected the health care institution by causing a drop in income. Six months after the intervention the monthly accounts showed a deficit in 6 centres out of 8. The need for health care centres to be self-financing is a major limiting factor in the use of health care in Idjwi district. There are no easy solutions for health centre managers that satisfy both low-cost access to care and health care self-financing. Some minimal financial participation from the state is required. Only then can the concept of financing health care through the selling of drugs be operational.

关键词：社区卫生中心/经济学社区卫生中心/利用刚果民主共和国发展中国家药费支出制药工业/经济学药物利用/统计学和数值数据筹资政府卫生经费支出/统计学和数值数据卫生政策/经济学

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Government funding of the UK National Health Service: What does the historical record reveal?

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Journal of Health Services Research and Policy 1999年第2期4卷 79-89页

作者： Appleby, J. Health Services Research King's Fund London W1M 0AN 11-13 Cavendish Square United Kingdom

Objectives: To examine the historic funding record of the UK National Health Service (NHS) by year (1948-1997), political administration and political party. Methods: Construction of a deflated expenditure series between 1948 and 1997 from published sources of cash spending for each UK country and by four main NHS budget heads using extrapolated NHS-specific inflation measures for each budget head. Analysis of the resultant real funding record for the UK NHS by year, political administration, political party and pre-general election years. Results: A historical funding record constructed from a number of official sources appears to show noticeable differences in volume levels of government spending on the NHS in the UK between political administrations and between political parties. All administrations (apart from the 1951-1955 Churchill/Eden government) have increased funds to the NHS over and above the level of NHS-specific inflation during their periods of office. Labour administrations have increased average annual real percentage funding by around 3.75% compared with an average increase of 2.33% for Conservative administrations. It does not appear that incumbent governments spend more than the long-run trend in pre-election (or, indeed, election) years. The economic difficulties of the mid 1970s (primarily the oil price shocks) appear to have realigned NHS spending at a lower level compared with spending rates in the 1950s, 1960s and early 1970s. Between 1950 and 1997, NHS cash spending as a percentage of gross domestic product increased by around 0.06% per year, with decreases in this proportion in 25 out of the 48 years examined. A comparatively crude analysis of changes in productive efficiency in the hospital and community health services sector between 1951 and 1991 suggests that there is no significant relationship between financial inputs (adjusted for NHS-specific inflation) and outputs (discharges and deaths). One explanation is that the NHS copes (at

关键词：数据收集效率组织筹资政府/历史筹资政府/统计学和数值数据大不列颠卫生经费支出/统计学和数值数据卫生经费支出/发展趋势膨胀通货/统计学和数值数据公费医疗/经济学公费医疗/历史历史 20世纪

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Healthcare in japan: Its professionals, institutions, and financing

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Hospital Topics 1991年第2期69卷 31-35页

作者： Al-Assaf, A.F. Payne, John Department of Health Administration University of Oklahoma Health Sciences Center OK United States

Like the United States, Japan's healthcare system is a conglomerate of government, employer, and individual financing--but that's about as far as the similarity goes. Universal access to basic healthcare has been achieved in Japan through comprehensive employer/employee plans and government subsidies. However, the United States should not be too hasty in emulating Japan, for culture plays a definite role in healthcare on both sides of the Pacific.

关键词：卫生保健提供/组织和管理卫生经费支出/统计学和数值数据医院保险健康/组织和管理日本护士/供应和分配医师/供应和分配

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Medicare is fundamental to the health care of Australia

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第4期23卷 339-341页

作者： Brooks, P Univ Queensland Fac Hlth Sci St Lucia Qld 4067 Australia

This article emphasizes the importance of Medicare to the health care system of Australia. In civilised societies, governments have a responsibility to provide and control the vital services of health, education and the utilities. This is not to say that some elements of service provision in these areas might not be provided by the private sector, but the important thing is getting a balance and making sure that balance provides the best opportunities for society as a whole. No Government since 1975 has been able to resist the opportunity of linkering' in some way with the health system. Current concern is particularly focused on the level of private health insurance in Australia, which has dropped significantly since the introduction of Medicare. It would be fair to say that Medicare has been extraordinarily successful, given its resources. It has played a major role in controlling burgeoning healthcare costs and in particular, the blow out in costs of technology that have led the U.S. to spend around 14% of the GDP on health care.

关键词：澳大利亚卫生保健提供/组织和管理卫生经费支出/统计学和数值数据卫生工作重点预期寿命国家卫生规划/组织和管理需求估价公共卫生人类

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Impact of older adults on private dental practices, 1988-1998

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第8期131卷 1188-1195页

作者： Meskin, L Berg, R Univ Colorado Sch Dent Dept Appl Dent Denver CO 80262 USA Univ Colorado Sch Dent Adv Clin Training & Serv Program Denver CO 80262 USA

Background, A 1988 study indicated that older adults made up a substantial portion of regular patients seen in private dental practices. A follow-up study was conducted in 1998 to track changes over the decade in the participating practices. Methods, The authors collected data from respondents to the 1988 survey again in 1998. The authors received complete data from 41.7 percent of the original respondents who still were practicing at their 1988 addresses. Dentists kept a log of all procedures provided in their practices in one day. The authors attributed values of services in both years, using a 1997 national estimate of fees. Results, The authors found that the percentage of office visits, services provided and patient expenditures attributed to patients 65 years of age or older exceeded the percentage of the population in that age group. In four of the five age groups in which patients had the highest mean expenditures, patients were 60 years of age or older. Patients 60 years of age or older accounted for 28.8 percent of all patient expenditures, a 12.1 percent increase from 1988. Longitudinal analyses indicated that between 1988 and 1998, dentists 40 years of age or older experienced increases of 30.3 to 64.3 percent in the proportion of visits, services and expenditures by patients 65 years of age or older. Conclusions, The results of this investigation illustrate the importance of older adults to dental practices. Data from the practices of dentists who participated in both surveys show increases in the percentage of total dental visits, total eel-vices provided and total patient expenditures attributed to older adults. Clinical Implications, Older adults continue to have a disproportionate and positive impact on the surveyed dental practices and their financial well-being. Dentists should reevaluate the accessibility of their practices to this population. Rather than waiting for the practice to "age," dentists may want to structure their practices in ways th

关键词：队列研究老年人牙科医疗/经济学老年人牙科医疗/统计学和数值数据卫生经费支出/统计学和数值数据 Logistic模型人口动力学诊疗工作管理牙科/经济学诊疗工作管理牙科/统计学和数值数据美国成年人老年人人类中年人

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Does general practitioner gatekeeping curb health care expenditure?

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Journal of Health Services Research and Policy 2000年第1期5卷 22-26页

作者： Delnoij, D. Van Merode, G. Paulus, A. Groenewegen, P. NIVEL 3500 BN Utrecht PO Box 1568 Netherlands

Objectives: It is generally assumed that health care systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total health care costs. In this study, the following questions were addressed: do health care systems with GPs acting as gatekeepers to specialized care have lower health care expenditure than those with directly accessible specialist care? Does health care expenditure increase more rapidly in countries without a referral system than in those with the GP acting as a gatekeeper? Methods: Multiple regression analyses on total and ambulatory health care expenditure in 18 OECD countries. Results: Analyses showed only one statistically significant effect (P < 0.05) in countries with gatekeeping GPs: ambulatory care expenditure has increased more slowly than in non-gatekeeping systems. No significant effects of gatekeeping were found on the level of ambulatory care costs, or on the level or growth of total health care expenditure. As in earlier studies, the most important factor influencing aggregate health care costs and their growth is gross national product (GNP), followed by the share of public funding. Relationships that exist at a micro level (such as lower costs with a gatekeeping primary care doctor) did not show up in aggregate data at a macro level. Conclusions: Gatekeeping systems appear to be better able to contain ambulatory care expenditure. More research is necessary to understand micro level mechanisms and to distinguish the effects of gatekeeping from other structural aspects of health care systems.

关键词：费用控制/经济学费用控制/统计学和数值数据欧洲医疗服务限制/经济学医疗服务限制/统计学和数值数据卫生经费支出/统计学和数值数据日本医师的作用医师家庭/经济学医师家庭/统计学和数值数据转诊和会诊/经济学转诊和会诊/统计学和数值数据回归分析美国人类

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The costs and financing of dental education.

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Journal of dental education 1999年第12期63卷 873-881页

作者： Hardigan, J. School of Dentistry Virginia Commonwealth University Richmond 23298-0566 USA.

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