Organized Medicine and the Assessment of Technology

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Abstract
OVER the past 18 years the Canadian health care system has been more successful in containing costs than its American counterpart. With provincial governments as the sole purchasers of almost all essential medical and hospital services, administrative economies are possible, and the flow of funds to physicians and hospitals can be, and has been, subjected to tighter controls.1 It might also be expected that the Canadian medical care system would more easily restrain the diffusion of new medical procedures and technology than the pluralistic system in the United States. To the extent that such diffusion has been limited, two mechanisms have contributed. First, hospital expenditures are determined prospectively, according to a fixed formula, and global (total) budgetary allocations thereafter provide a funding limit within which each institution must live for the following year. The result has been implicit rationing, with administrators and physicians taking a harder look at the cost implications of adopting innovations locally.2 3 4 Second, there has also been some explicit rationing of the use of sophisticated and expensive devices, with the purchase of such devices limited to major regional centers.1 Regionalization has proved to be possible in the case of equipment such as CT scanners and nuclear magnetic resonance imagers and in the case of programs for dialysis, open-heart surgery, transplantation, and cancer treatment.

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