The Growth of Physician Services for the Elderly in the United States and Canada: 1987-1992

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Abstract
The authors compared the growth of expenditures, prices, and volume and intensity of physician services delivered to the elderly in the United States and Canada from 1987 to 1992 using claims-level data from U.S. Medicare and from Ontario, Quebec, and British Columbia. Services were classified into clinical categories and per capita annualized expenditure, price, and volume growth ratios were calculated for each category. The expenditure growth rate is higher in the United States than in Canada for evaluation and management services (8.8 percent versus 4.5 percent), but it is lower for procedures (2.9 percent in the United States versus 4.8 percent in Canada). For procedures, prices decreased 2.4 percent per year in the United States but increased 1 .0 percent per year in Canada, while volume increased faster in the United States (5.4 percent versus 3.8 percent in Canada). In both countries, high volume growth rates are observed in categories containing newly emerging procedures. Although policies to control prices appear easier to implement than policies to control the volume and intensity of medical care, their success in controlling expenditures is uncertain. Nonetheless, Canada has been more successful at controlling the growth in the volume of procedures than the United States.