RESUMO
Conventional wisdom holds that Canada suffers from a physician shortage, yet expenditures for physicians' services continue to increase rapidly. We address this apparent paradox, analyzing fee-for-service payments to physicians in British Columbia in 1996/97 and 2005/06. Age-specific per capita expenditures (adjusted for fee changes) rose 1% per year over this period, adding $174 million to 2005/06 expenditures. We partition these increases into changes in the proportion of the population seeing a physician; the number of unique physicians seen; the number of visits per physician; and the average expenditure per visit. Expenditures on laboratory and imaging services, particularly for the elderly and very elderly, have increased dramatically. By contrast, primary care services for the non-elderly appear to have declined. The causes and health consequences of these large changes deserve serious attention.
RESUMO
WHAT DID WE DO?: This paper describes the creation of a population research registry as part of an information system to support primary healthcare (PHC) research in British Columbia. The population registry includes all residents of the province who were either eligible to use or actually used healthcare services, together with demographic, geographic, health status, registration and service use data. The PHC population research registry is built using administrative data inputs, and data are anonymized to comply with privacy and confidentiality standards. WHAT DID WE LEARN?: The registry provides data to undertake research into PHC needs and service utilization. It facilitates both population-based research as well as research on population subgroups. Combined with anonymous physician and utilization data, the information system can be used to study service utilization rates for population-based analyses. Over the longer term, the information will contribute to our understanding of PHC qualities and outcomes. WHAT ARE THE IMPLICATIONS?: Continued completeness of the population research registry depends upon full administrative source data. Planning to ensure complete data capture is critical both for the research registry and our ability to undertake population-based PHC research.
RESUMO
OBJECTIVES: To examine medical care use and costs, patterns of morbidity and co-morbidity, and other patient characteristics of high users of physician services in British Columbia. METHODS: This population-based study uses physician claims, hospital discharge summaries and vital statistics data linked at the level of the individual to compare characteristics of high users, other users and non-users of physician services in the Province of British Columbia, Canada. The study included all enrolled adults in the universal health care plan during fiscal year 1996/97. High users were defined as the most costly 5% of users of fee-reimbursed services. Key variables included age, sex, an ecological socio-economic status indicator and a comprehensive set of morbidity indicators, derived from the diagnoses recorded on the utilization records. RESULTS: The top 5% of users consumed a disproportionate 30% of spending on physician services. High users were overwhelmingly characterized by a significant burden of morbidity. Over 80% had at least six different types of morbidity during the study year compared with fewer than 20% of other users. High users were also much more likely to have major diagnoses that were both acute and chronic in nature. Co-morbidity involving psychosocial and chronic medical conditions was also very common. CONCLUSIONS: High users of physician services are overwhelmingly characterized by multiple and complex health problems. Policy tools based on a philosophy of deterrence such as cost-sharing are unlikely to have much impact on their costs and will likely do considerable harm.
