A DETAILED COMPARISON OF PHYSICIAN SERVICES FOR THE ELDERLY IN THE UNITED-STATES AND CANADA

Objective.-To assess the relative volume and price of physician servic es in Canada and the United States. Design.-A comparative analysis of 1992 claims data from Canadian provincial ministries of health and fro m the US Health Care Financing Administration. Patients.-All elderly i ndividuals in the 3 largest Canadian provinces, Ontario, Quebec, and B ritish Columbia, and a 1% random sample of US elderly Medicare benefic iaries not enrolled in health maintenance organizations. Main Outcome Measure.-The volume of physician services measured in terms of the rel ative value units used in the Medicare fee schedule to calculate payme nts, with services disaggregated into clinically meaningful categories . Results.-Canadian elderly receive a higher volume of physician servi ces than US elderly. Because the provinces examined paid a much lower price per service, Canada had overall lower expenditures per elderly p erson than the United States, Canadian elderly received 44% more evalu ation and management services, but 25% fewer procedures. Canada has a disproportionately lower volume of procedures for which there is low c linical consensus as to when they are indicated. Such procedures inclu de cataract extractions and knee replacements. Conclusion.-The lower p rices for physician services in Canada permit Canadian elderly to rece ive a higher volume of evaluation and management services with lower e xpenditures than US elderly. Expenditures for procedural services, on the other hand, are constrained by both price and volume. These differ ences in the volume of physician services may be the result of differe nces in facility and physician supply.