Accommodating rapid growth in physician supply: lessons from Israel, warnings for Canada.
Most developing countries find themselves grappling with the implications of rapid growth in physician supply. The purpose of this article is to search for lessons or warnings for Canada (and, ultimately, elsewhere) in the manner in which Israel has chosen to accommodate its huge supply of physicians. Under extremely conservative assumptions about immigration, and assuming rates of domestic training of physicians at levels somewhat lower than at present, Canada's physician supply will continue to grow at rates in excess of general population growth for at least the next 45 years. In this article we describe the Israeli health care system from a perspective of identifying the consequences of accommodating a physician supply about 50 percent higher than that in Canada. A number of key "accommodation attributes" (low physician incomes, restricted access to hospitals for general practitioners, intramedical-professional conflicts over income and authority, a flourishing black market) are argued to be more than simply products of a unique cultural and political system, but also symptoms of a system vastly oversupplied with physicians. Early signs in Canada of similar "products" of a growing physician supply are noted. While a two-country comparison makes drawing lessons somewhat speculative, the coincidence of events suggests that these trends in Canada warrant, if not immediate action, at least careful monitoring.
Barer
M L
ML
Division of Health Services Research and Development, University of British Columbia, Vancouver, Canada.
Gafni
A
A
Lomas
J
J
D000328:Adult; D000368:Aged; D002170:Canada; D003469:Culture; D003695:Delivery of Health Care / Q000639:trends*; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D007557:Israel; D008875:Middle Aged; D010819:Physician's Role; D010820:Physicians / Q000600:supply & distribution*; D011057:Politics