Recent trends in expenditures on physicians' services in Canada

Analysis of Canada's restraints on the growth in volume of physicians' services can help shape the framework and direction of policy development in other countries. This paper analyzes trends in recent expenditures on physicians' services in Canada from 1982 to 1987. Growth in payments to physicians who were paid fee-for-service is broken down into three component parts in Canada nationwide and in four provinces: Ontario, Quebec, Nova Scotia and British Columbia. The three component parts are: (1) growth in the number of services billed; (2) physician service prices; and (3) the mixture of high- and low-priced services billed. Expenditure increases are disaggregated according to some major categories of medical services, both per physician and per capita. Increases in growth in physician payments were explained mainly by increases in prices, while some evidence of an increase in higher priced services per physician was found. The varying payment restraint policies across Canadian provinces were manifested in different patterns with respect to components of payment change. Higher rates of payment and volume growth were found for diagnostic/therapeutic and office medical services than for surgeries, although a few contrary patterns across provinces occurred. Interprovincial utilization growth, both per physician and per capita, was variable. This suggests that Canada's regionally administered system is neither uniform nor monolithic.