The Distribution of Medical Services before and after “Free” Medical Care — The Quebec Experience

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Abstract
Household interviews were conducted before and after the introduction in Quebec of a government-sponsored compulsory insurance program covering physician services. Physician visits per person per year remained constant at about five but were markedly shifted from persons in higher to lower income groups. The percentage of selected medical symptoms for which a doctor was consulted increased from 62 per cent to 73 per cent, with all the increase in lower income groups. Average waiting time for a doctor's appointment increased from 6.0 to 11.0 days, with the largest increases in the higher income groups. Waiting time in the doctor's office also increased, again with the largest increase in higher income groups. Eight per cent of the population considered the quality of medical care improved whereas 30 per cent thought it worse. For those who saw a doctor in the previous year, however, about 90 per cent were satisfied with the services received — the same proportion as before Medicare. (N Engl J Med 289:1174–1178, 1973)

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