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Editorials |

Controlling Medical Care Costs in Canada

Morris L. Barer, MBA, PhD
[+] Author Affiliations

Reprint requests to Centre for Health Services and Policy Research, University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, British Columbia, Canada V6T 1Z6 (Dr Barer).


From the Centre for Health Services and Policy Research, University of British Columbia, Vancouver.


JAMA. 1991;265(18):2393-2394. doi:10.1001/jama.1991.03460180099042
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Canadian experience has taken on increasing importance in the United States as Americans continue to wrestle with physician cost increases well in excess of those to the north. Fee levels in the United States have risen much more rapidly than those in Canada since at least 1960, while per capita utilization has increased somewhat faster in Canada. On balance, the relative importance of fee levels in the comparative cost experience has outstripped that of per capita utilization.1,2

But the "Canadian experience" has also shown itself to embody 10 unique provincial experiences. The difference in costs for physicians in Canada and the United States from 1971 through 1985 would have been far more, or far less, dramatic if the Canadian experience had mirrored that in Quebec, or that in British Columbia, respectively.1 In his article in this issue of JAMA, Hughes3 updates and extends these previous comparative analyses.

REFERENCES

Barer ML, Evans RG, Labelle RJ.  Fee controls as cost control: tales from the frozen north . Milbank Q. 1988;;66:1-64.
Barer ML, Evans RG.  Riding north on a south-bound horse? expenditures, prices, utilization and incomes in the Canadian health care system . In: Evans RG, Stoddart GL, eds. Medicare at Maturity: Achievements, Lessons and Challenges . Calgary, Alberta: University of Calgary Press for the Banff Centre School of Management; 1986;:53-163.
Hughes JS.  How well has Canada contained the costs of doctoring? JAMA . 1991;;265:2347-2351.
Fuchs VR.  Physician-induced demand: a parable . J Health Econ. 1986;;5:367.
Contandriopoulos AP.  Cost containment through payment mechanisms: the Quebec experience . J Public Health Policy . 1986;;72:224-238.
Barer ML.  Regulating physician supply: the evolution of British Columbia's Bill 41 . J Health Polit Policy Law . 1988;;13:1-25.
Iglehart J.  Canada's health care system: addressing the problem of physician supply . NEngl J Med. 1986;;315:1623-1628.
Brook RH, Vaiana ME. Appropriateness of Care: A Chart Book . Washington, DC: National Health Policy Forum; 1989;.
Lomas J. Quality Assurance and Effectiveness in Health Care: An Overview . Hamilton, Ontario: Centre for Health Economics and Policy Analysis, McMaster University; 1990;. Working paper 90-3.
Woodward CA, Stoddart GL.  Is the Canadian health care system suffering from abuse? Can Fam Physician. 1990;;36:283-289.
Evans RG.  Tension, compression, and shear: directions, stresses, and outcomes of health care cost control . J Health Polit Policy Law . 1990;;15:101-128.
Wennberg JE.  Outcomes research, cost containment, and the fear of health care rationing . N Engl J Med. 1990;;323:1202-1204.
Evans RC. Strained Mercy: The Economics of Canadian Health Care . Toronto, Ontario: Butterworths; 1984;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Barer ML, Evans RG, Labelle RJ.  Fee controls as cost control: tales from the frozen north . Milbank Q. 1988;;66:1-64.
Barer ML, Evans RG.  Riding north on a south-bound horse? expenditures, prices, utilization and incomes in the Canadian health care system . In: Evans RG, Stoddart GL, eds. Medicare at Maturity: Achievements, Lessons and Challenges . Calgary, Alberta: University of Calgary Press for the Banff Centre School of Management; 1986;:53-163.
Hughes JS.  How well has Canada contained the costs of doctoring? JAMA . 1991;;265:2347-2351.
Fuchs VR.  Physician-induced demand: a parable . J Health Econ. 1986;;5:367.
Contandriopoulos AP.  Cost containment through payment mechanisms: the Quebec experience . J Public Health Policy . 1986;;72:224-238.
Barer ML.  Regulating physician supply: the evolution of British Columbia's Bill 41 . J Health Polit Policy Law . 1988;;13:1-25.
Iglehart J.  Canada's health care system: addressing the problem of physician supply . NEngl J Med. 1986;;315:1623-1628.
Brook RH, Vaiana ME. Appropriateness of Care: A Chart Book . Washington, DC: National Health Policy Forum; 1989;.
Lomas J. Quality Assurance and Effectiveness in Health Care: An Overview . Hamilton, Ontario: Centre for Health Economics and Policy Analysis, McMaster University; 1990;. Working paper 90-3.
Woodward CA, Stoddart GL.  Is the Canadian health care system suffering from abuse? Can Fam Physician. 1990;;36:283-289.
Evans RG.  Tension, compression, and shear: directions, stresses, and outcomes of health care cost control . J Health Polit Policy Law . 1990;;15:101-128.
Wennberg JE.  Outcomes research, cost containment, and the fear of health care rationing . N Engl J Med. 1990;;323:1202-1204.
Evans RC. Strained Mercy: The Economics of Canadian Health Care . Toronto, Ontario: Butterworths; 1984;.
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