How Much is Enough? The Payment of Doctors-Implications for Health Policy in Canada

Abstract

Incomes of physicians, and differentials in incomes of different kinds of physicians, are reviewed in Canada, where the federal-provincial medical care and hospital insurance plans have been grafted onto an essentially fee-for-service private enterprise system of medical practice. In a detailed discussion on the supply and distribution of Canadian doctors, concern is expressed about the continued simplistic use of doctor-population ratios for health manpower planning. The authors advocate a restriction on immigration of foreign medical graduates to Canada, and a closing of the present open-ended fee system, as well as the creation of a “medical establishment” or quota of doctors in each province who would derive their incomes from the publicly financed medical care insurance plan. They also strongly urge the support of community health centers as part of a restructuring of the health services under a national health insurance scheme. The implications are great for the experience about to unfold in the United States.