P2f.1. Although most of these services are for the
Proposal for Health Care Reform," Presentation to
elderly, some adults between the ages of 18 and 64
the Congressional Black Caucus and the
are clients as well. For instance, home alterations
Congressional Progressive Caucus, May 1, 2001.
are procedures designed to assist both the elderly
92. Tufts Center for the Study of Drug Development,
and the disabled living at home, as are home care
"Total Cost to Develop a New Prescription Drug,
services. Occupational therapy is related to teach-
Including Cost of Post-Approval Research, Is $897
ing and maintaining life skills, while day care and
Million," Press release, May 13, 2003.
home care services allow the elderly or disabled to
be cared for at home. See www.doh.gov.uk/public/
93. Grace-Marie Turner, "Foreign Countries Limit
comcare2001/tablep2f1.pdf.
Access to Prescription Drugs," Galen Reports, May
27, 2000, http://www.galen.org/healthabroad.asp?
103. "Waiting List Figures, November 2001," U.K.
docID=116.
Department of Health.
94. See Neil C. Campbell et al., "Secondary Preven-
104. Patients miss an estimated 10 million gener-
tion in Coronary Heart Disease: Baseline Survey of
al practitioner appointments totaling more than
Provision in General Practice," British Medical Journal
2.5 million hours each year. Survey published by
316, no. 7142 (May 9, 1998): 143034; and K. W.
the Doctor Patient Partnership and Institute of
Clarke, D. Gray, and J.R. Hampton, "Evidence of
Healthcare Management, August 14, 2001.
Inadequate Investigation and Treatment of Patients
105. Some physicians have called for a flat £10
with Heart Failure," British Heart Journal 71, no. 6
charge--approximately $14 to $15--to provide
(June 1994): 58487. In the United States, a newer
patients with an incentive to keep appointments,
class of drugs is now replacing beta-blockers.
but the British Medical Association is opposed.
95. Merrill Matthews Jr., "On a Bus to Bangor,
106. Gerard F. Anderson and Jean-Pierre Poullier,
Canadians Seeking Health Care," Wall Street
"Health Spending, Access, and Outcomes: Trends
Journal, July 5, 2002.
in Industrialized Countries," Health Affairs 18, no.
96. William McArthur, "Prescription Drug Costs: Has
3 (1999): 17892.
Canada Found the Answer?" National Center for
107. See Edward W. Campion, "A Symptom of
Policy Analysis Brief Analysis no. 323, May 19, 2003.
Discontent," New England Journal of Medicine 344, no. 3
97. William McArthur, "Canadian Health Care--A
(January 18, 2001): 22325; and John G. R. Howie et al.,
System in Collapse," Backgrounder, Fraser Institute
"Quality at General Practice Consultations: Cross
(January 27, 2000). See also Carolyn S. Dewa and
Sectional Survey," British Medical Journal 319, no. 7212
Paula Goering, "Lessons Learned from Trends in
(September 18, 1999): 73843. Note that the average
Psychotropic Drug Expenditures in a Canadian
general practitioner consultation was eight minutes in
Province," Psychiatric Services 52 (September 2001):
Britain, whereas the average consultation across all
12451247; and Devidas Menon, "Pharmaceutical
specialties in the United States was 18.3 minutes. See
Cost Control in Canada: Does It Work?" Health
also David Mechanic, Donna D. McAlpine, and
Affairs 20, no. 3 (May/June 2001): 192.
Marsha Rosenthal, "Are Patients' Office Visits with
Physicians Getting Shorter?" New England Journal of
98. Ibid.
Medicine 344, no. 3 (January 18, 2001): 198204.
99. OECD Health Data, 2002.
108. "Challenging Nicotine Addiction," Smoking
Cessation in Primary Care (SCRAPE), August 2001,
100. Frank Lichtenberg, "The Effect of Pharmaceu-
reported in "U.K. Physicians Lack Time to Help Patients
tical Utilization and Innovation on Hospitalization
Quit Smoking," Reuters Health, August 23, 2001.
and Mortality," National Bureau of Economic
Research Paper no. 5418, January 1996. Also, see
109. Patricia M. Danzon, "Hidden Overhead
Frank Lichtenberg, "Pharmaceutical Innovation,
Costs: Is Canada's System Really Less Expensive?"
Mortality Reduction and Economic Growth,"
Health Affairs 11, no. 1 (Spring 1992): 27.
National Bureau of Economic Research, NBER
Working Paper W6569, May 1998.
110. See S. J. Katz and T. P. Hofer, "Socioeconomic
Disparities in Preventive Care Persist Despite
101. "Statistical Bulletin--Ambulance Services,
Universal Coverage: Breast and Cervical Cancer
England: 20002001," UK Department of Health,
Screening in Ontario and the United States," Journal
2001, Table 1.
of the American Medical Association 272 (August 17,
1994): 53034.
102. "Community Care Statistics 20002001,
Referrals, Assessments and Packages of Care for
111. John C. Goodman and Philip K. Porter,
Adults," UK Department of Health, 2001, Table
"Political Equilibrium and the Provision of Public
25