title: A comparison of ambulatory care and selected procedure rates in the health care systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States.
abstract: To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports. Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.
authors.affiliation: National Health Research and Development Program.
authors.forename: C A
authors.initials: CA
authors.lastname: DeCoster
authors.forename: M
authors.initials: M
authors.lastname: Smoller
authors.forename: N P
authors.initials: NP
authors.lastname: Roos
authors.forename: E
authors.initials: E
authors.lastname: Thomas
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007345:Insurance Claim Review; D007796:Laminectomy / Q000706:statistics & numerical data*; D008350:Manitoba / Q000453:epidemiology; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014600:Utilization Review