"Cash-for-blood" companies still thriving in US.

Unlike Canada's voluntary blood-collection system, the US system routinely makes use of donations from paid donors. Milan Korcok reports that this is starting to cause some concern, since infection levels tend to be higher among those who are paid for their blood.

Financial troubles abound for new US medical grads.

Milan Korcok reports on the financial problems facing medical students in the US, who often face staggering debt loads upon graduation.

At least 12 US states refuse to recognize physician training accredited in Canada.

The easing of trade rules has done little to ease the movement of physicians between Canada and the US. Borders may be breaking down when it comes to the transfer of goods, Milan Korcok reports, but for physicians the moats in front of those borders appear to be getting deeper and more difficult to cross.

Deportation proceedings against Canadian MDs may hold lesson for others heading south.

Two Alberta physicians who emigrated to a medically underserviced part of Kentucky have learned a harsh lesson about American immigration law. Drs. David Zetter and Sabina Seitz had been settled in western Kentucky for 2 years when the US government launched deportation proceedings against them. American officials allege that they misrepresented themselves when they entered the US on a temporary visa. They may be allowed to stay following a public outcry against their deportation.

New York hospitals paid to teach fewer physicians.

In order to reduce the number of physicians being trained in the US, teaching hospitals in New York are going to be paid not to train residents. Participating hospitals will cut the number of residents they train by up to 25%, but for a time will be paid as if they are still teaching a full complement of trainees. Up to 400 residency positions will be cut annually under the plan.

Excess demand meets excess supply as referral companies link Canadian patients, US hospitals.

As waiting lists turn "touching it out" into a treatment option in Canada, more patients are willingly paying for prompt medical care in the US. Thanks to managed care and increased competition, the cost of care south of the border is dropping and referral brokers can often offer discounted prices to Canadians. Milan Korcok reports that American facilities are actively soliciting medical business from Canadians who have grown frustrated at having to wait for hospital beds, test, referrals and treatment.

Medicare, Medicaid fraud a billion-dollar art form in the US.

Medicare and Medicaid fraud costs billions of dollars each year in the US. Investigators have shown that fraud is found in all segments of the health care system. Even though the Canadian system has stricter regulations and tighter controls, can regulators here afford to be complacent about believing that such abuse would not happen here? One province has established an antifraud unit to monitor its health insurance scheme; it already has 1 prosecution under its belt.

After rejection in Canada, more Canadians pursuing career dreams at offshore medical schools.

Being denied admission to medical schools here isn't necessarily the end of the line for would-be Canadian doctors. The number of Canadians applying to medical schools in the Caribbean and Mexico is increasing, and graduates of some of them are winning respectable postgraduate training spots in the US, United Kingdom and even Canada. Milan Korcok looks at the calibre of these offshore medical schools and the impact they are having on training and accreditation in North America.

CMPA not alone in pursuing huge reserves, CMAJ survey of US firms reveals.

Although Canada and the US are two separate worlds when medical malpractice is considered, actuaries across North America are looking into their crystal balls in an attempt to set reserves for uncertain future claims. Given the relatively low rate of litigation in Canada, some feel the Canadian Medical Protective Association is hoarding cash as it continues to raise premiums even though it has close to $1 billion in reserves. However, some experts suggest that this is just a prudent way to do business in an unpredictable environment. Milan Korcok looks at the situation facing physicians on both sides of the border.

Capitation begins to transform the face of American medicine.

Canadian physicians only need look to the south to see that capitation can control not only their fees but also the amount of resources they use, the amount of care their patients can expect and the way doctors and patients relate to one another. In the US, capitation is rewarding doctors for doing less and penalizing them if they do too much. "Instead of a being cash source," says Dr. John Verhoff, a family practitioner in Columbus, Ohio, "a patient visit is a cash drain." Milan Korcok looks at the ways capitation is changing medicine in the US.

The lost generation: flood doors open as large numbers of Canadian FPs head south.

Newly trained physicians are leaving Canada in record numbers, a trend that is worrying medical educators and people who track physician migration. As American recruiters skim off many of our well-trained and cost-conscious young family physicians, concern is growing about whether a generation of young doctors will be lost to Canada, even though many underserviced areas need their skills.

Ontario's accelerated war against Medicare misuse another sign of leaner health care times.

A special-investigations unit is helping the Ontario Health Insurance Plan (OHIP) curb the fraud and abuse that has been draining millions of health care dollars from the province. The government is taking a tougher line on foreigners who use friends' or relatives' OHIP cards, people who use misplaced, stolen or counterfeit cards, and on snowbirds who deliberately bend residency requirements as they try to hang on to medicare benefits. In 1994-95, Ontario spent $74 million on health care for Ontarians travelling or living abroad.

Medicolegal hell in Texas.

In the "war zones" of Texas, lawyers use billboards, television commercials and Yellow Page advertisements to announce their availability to help the "unjustly injured," and medicolegal lawsuits are as common as the rain that sweeps in from the nearby Gulf of Mexico. Almost 75% of the suits are dismissed without award or settlement, since many are plainly frivolous. However, even these can mean torment for physicians, who have to hire lawyers, answer charges, collect paperwork, take time off work for depositions and consultations, and then worry about how insurers will react the next time premiums are due--even if they are cleared. Texas estimates that defensive medicine practised because of legal fears costs the state at least $702 million annually, spending that is bound to continue as long as one lawsuit is filed annually for every 5.3 doctors in the state.

The brave new world of managed care.

Canadian hospitals that think they can charge higher-than-normal rates to foreign visitors are learning a lesson as US-style managed care moves north of the border. Dr. Robert MacMillan, president and medical director of Florida-based Insurance Claims Management Systems and past president of the Ontario Medical Association, says that south of the border US-style managed care has already hauled in the reins on wild expectations about high payments, and it is expected to do the same for Canadian hospitals that charge private insurers "as much as the traffic will bear." He says it is no longer uncommon for a large Toronto hospital to charge a foreign patient $3000 a day for care that can now be purchased in a US hospital for one-third that price.