This paper examines access to and use of the physician resources for ambulatory care by residents of Winnipeg and rural areas in Manitoba. Analyses were conducted on physician claims submitted to Manitoba Health in the fiscal years 1986-87 and 1991-92. The percentage of people who made contact with physicians, the number of visits per 100 residents, and the number of visits per user were used to asses changes between 1986 and 1991. There were important variations between residents of Winnipeg and the rural regions in access to and use of physicians' services across the years, and by physician specially. These variations accompanied a decrease in physician supply in the province.
This study examined (1) disparities in the proportion of persons who accessed a physician for treatment of a diagnosed mental disorder across 17 health regions in Alberta, Canada, and (2) the extent to which regional disparities in physician access could be explained by differences in regional demographies, population needs, or physician supply.
The study illustrates the use of ecological comparisons for regional health system performance evaluations. Regional characteristics were aggregated from four sources of data: the health insurance registry file (population denominators and regional demographies), physician claims data (treatment access), census data (social indicators of population need), and the medical directory of the College of Physicians of Surgeons (physician supply).
Regional variability in needs-adjusted measures of access to physician-based treatment services were comparatively small (varying by a factor of 1.6). Models containing adjustments for demography, need, and physician supply explained 41% of regional variation in access. Of the total variation explained, physician supply explained a smaller proportion (39%) in comparison to social demography and needs (61%). Few large regional imbalances were noted when needs-adjusted and supply-adjusted estimates were compared. Only two areas appeared to be underserviced in comparison to their local needs, reflecting approximately 6% of the provincial population.
While all three study factors proved important, findings support the broad conclusion that social demography and social risk (a proxy for need) will remain the key determinants predicting access to physician services for treatment of mental disorders in publicly funded health systems.
Between 1910 and 1970 the number of physicians in the United States increased 2.5 times, in Soviet Russia almost 25 times. The number of physicians per constant unit of population remained fairly stable in the United States, rising slightly in the last few years. In the U.S.S.R. that number increased 16 to 18 times, and now stands about 50 per cent higher than in the United States. About 10 per cent of American physicians are women; in the U.S.S.R. it is about 70 per cent. Neither society has resolved the problem of deploying physicians to the rural areas. American physicians are more specialized than their Soviet colleagues. The article concludes with general remarks about the two health systems, pointing out resemblances and divergences. The hypothesis of a possible "convergence" is entertained.