<<  <  >  >>

Figure 10

Inequalities in the Use of Physician Services among Urban and Rural Patients in

British Columbia (per capita spending 1993–94)

$22.60

Urban

Rural

$13.50

$11.50

$8.60

$7.10

$6.50

$5.70

$5.70

$4.70

$2.80

$2.40

$1.00

Dermatology Neurology

OB/GYN

Pediatrics

Ps ychiatry

Thoracic

Surgery

Note: Based on fees paid to physicians for rendering services to patients living in the areas indicated, regardless of

the area in which the service was performed. All figures are age-sex standardized and expressed in Canadian dollars.

Source: Arminée Kazanjian et al., “Fee Practice Medical Expenditures Per Capita and Full-Time-Equivalent

Physicians in British Columbia, 1993–94,” University of British Columbia, 1995.

U.S. hospitals are ahead of their international

Figure 9 shows, that was not the case.

A comparison of

counterparts (see Figure 11).61 The average

Vancouver residents also enjoy about 60 per-

the British NHS

cent more GP services.

length of a hospital stay in the United States is

These examples are not isolated. Inequity

5.4 days compared to 6.2 days in Australia, 9.0

and Kaiser

of access to resources is pervasive. Spending

in the Netherlands, and 9.6 in Germany.

Permanente

on specialist services in Vancouver was almost

Whereas patients from other countries routine-

concluded that

four times as high as spending on specialists

ly convalesce in a hospital, American patients

in rural Cariboo. Per capita spending on all

are more likely to recover at home.

the per capita

services was almost three times as high in

It is an inefficient use of resources to fill an

costs of the two

Vancouver ($609) as in Peace River ($231).

acute care hospital bed with a patient waiting

Differences between the rural and urban

for nonemergency care, a geriatric patient

systems were

regions in British Columbia were especially

waiting to transfer to a nonacute facility, or

similar. However,

striking in certain specialties--a seven-fold dif-

simply because the hospital has not gotten

Kaiser provided

ference in spending on thoracic surgery, a

around to discharging that patient. This is

four-fold difference in spending on psychiatric

especially true when there are lengthy waiting

its members

services and a three-fold difference in spend-

lists for hospital admission. Generally, the

with more

ing on dermatology (see Figure 10).

more efficient the hospital, the more quickly it

will admit and discharge patients.62

comprehensive

Long-term care patients who should be in

and convenient

Myth No. 6: Countries with

nursing homes, in geriatric wards, or at home

primary care

National Health Insurance

are often found occupying acute care beds in

Britain--a practice known as "bed blocking."

Hold Down Costs by

services and

As a result, many patients must wait for

Operating More Efficient

much more rapid

admission and treatment because patients

Health Care Systems

access to special-

treated earlier are waiting for discharge to an

appropriate facility and thus "blocking" access

ists and hospital

to a bed. Officials estimate that about 3.3 per-

A widely used measure of hospital efficiency

admissions.

cent of beds are blocked at any given time.63

is average length of stay (LOS). By this standard,

11