FACTORS EXPLAINING THE INCREASE IN COST FOR PHYSICIAN CARE IN QUEBEC ELDERLY POPULATION

Objective: To examine what role demographic factors and increases in p hysician fees and utilization played in the rise in costs of physician services provided for elderly people in Quebec between 1982 and 1992, and to investigate changes in patterns of care (type and amount of se rvices) related to utilization. Design: Retrospective study of populat ion-based data. Setting: Province of Quebec. Subjects: Elderly people (65 years of age and over) in Quebec in 1982 (n = 589 800) and in 1992 (n = 803 600). Outcome measures: Proportion of the increase in physic ian care costs attributable to (a) aging (defined as a shift in the ag e distribution) of the elderly population, (b) the increase in the siz e of the elderly population, (c) the increase in physician fees and (d ) the increase in utilization of physician services; proportion of car e provided by general practitioners (GPs) and by specialists; proporti on of minor and complete examinations provided bq GPs; and rates of ho spital admissions and surgery. Results: Aging was responsible for 0.5% of the increase in physician care costs between 1982 and 1992, popula tion growth for 27.0% and the increase in physician fees for 25.5%, Th e increased utilization accounted for 47.0% of the total cost increase , Analyses of the utilization data revealed a shift toward more costly sen ices, more visits to specialists and higher rates of hospital adm issions and surgery in 1992 than in 1982. Conclusions: Aging and popul ation growth had minor effects on the increase in physician care costs between 1982 and 1992. Increased utilization was the most important f actor. The appropriateness of this trend needs to be verified.