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 services in Canada and the United States. Design.-A comparative analysis of 1992 claims data from Canadian provincial ministries of health and from the US Health Care Financing Administration. Patients.-All elderly individuals in the 3 largest Canadian provinces, Ontario, Quebec, and British Columbia, and a 1% random sample of US elderly Medicare beneficiaries not enrolled in health maintenance organizations. Main Outcome Measure.-The volume of physician services measured in terms of the relative value units used in the Medicare fee schedule to calculate payments, with services disaggregated into clinically meaningful categories. Results.-Canadian elderly receive a higher volume of physician services than US elderly. Because the provinces examined paid a much lower price per service, Canada had overall lower expenditures per elderly person than the United States, Canadian elderly received 44% more evaluation and management services, but 25% fewer procedures. Canada has a disproportionately lower volume of procedures for which there is low clinical consensus as to when they are indicated. Such procedures include cataract extractions and knee replacements. Conclusion.-The lower prices for physician services in Canada permit Canadian elderly to receive a higher volume of evaluation and management services with lower expenditures than US elderly. Expenditures for procedural services, on the other hand, are constrained by both price and volume. These differences in the volume of physician services may be the result of differences in facility and physician supply.