Cahiers de sociologie et de demographie medicales最新文献

To meet the unique health needs of Aboriginal peoples (First Nations, Inuit and Métis), it is important to increase and encourage Aboriginal representation in health care. One Federal initiative, the Aboriginal Health Human Resource Initiative (AHHRI) at Health Canada, focuses on: (1) increasing the number of Aboriginal people working in health careers; (2) adapting health care educational curricula to support the development of cultural competencies; and (3) improving the retention of health care workers in Aboriginal communities. A health care system that focuses on understanding the unique challenges, concerns, and needs of Aboriginal people can better respond to this specific population, which suffers disproportionately from ill health in comparison to their non-Aboriginal counterparts. This report examines the supply of Aboriginal health care providers in Canada, based on geographic region, area of residence, Aboriginal identity, and occupation. Findings are drawn from the 1996 and 2001 censuses from Statistics Canada. Quantitative results provide a greater understanding of labour force characteristics of First Nation, Inuit, Métis, and non-Aboriginal health providers.

This paper analyzes if and to what extent the density of family physicians influences health related outcomes in Canada. The density of family physicians in a given region is assumed to serve as proxy for the access to and availability of desirable primary care services. We use self-reported general and mental health status as our overall health outcome measures. We also use several quality of care indicators reflecting whether or not an individual received influenza immunization, mammography, pap smear, and colorectal cancer screening if at high-risk. The empirical results of this study suggest that an additional family physician per 10,000 population has a statistically significant impact in the order of 2% to 4% on self-reported general health status, as well as, other quality of care outcomes. We also find important socioeconomic and demographic factors, such as income, education and immigrant status, influencing health related outcomes considered in this study. Understanding the influence of physician density and socioeconomic factors on health related outcomes are important considerations for health policy and planning.

The purpose of the paper is to forecast retirement of the specialist obstetricians and gynaecologists in Australia to 2025. The gender and hours of work of younger and older cohorts were compared to determine the likely impacts of the transition from older to younger cohorts. The paper used the Australian Institute of Health and Welfare's annual Medical Labour Force Surveys to examine trends in attrition of obstetricians and gynaecologists over the age of 45 years from the workforce and to predict their rate of retirement to 2025. The projection results show that between the years 2000 and 2025, 59% of the obstetricians and gynaecologists would retire. The rising proportion of women in obstetrics and gynaecology and shorter working hours of both men and women will have a compounding effect on physician retirement. The paper concludes that the changes in practice, increasing feminisation and retirement from the workforce coupled with higher female population growth in the childbearing years and slightly higher fertility mean that ensuring an adequate obstetricians and gynaecologists in Australia will be a significant challenge over the next 20 years. There is the potential for shortages in obstetric care with particular risks for rural areas.

This paper develops a simple theoretical model which compares resource allocation in the health care system when physicians are empowered with the decisions taken when patients are empowered. We show that even when there is no asymmetry of information, the institutional arrangement (empowered patient or empowered physician) matter. Ceteris paribus, we find that patients demand more time with physicians when they are empowered (relative to the situation when physicians are empowered), whereas physicians want to spend more time developing their expertise when they are empowered. The reaction of physicians and patients to changes in policy instruments also differs across institutional arrangements. The analysis draws attention to the design of the compensation scheme for physicians, and shows that a non-linear scheme is generally optimal for access to resources if physicians are empowered.

Initiatives such as primary care reform have allocated millions of dollars towards the Canadian health care system. The way physicians are remunerated affects the supply of physician services and as such is essential to these initiatives to facilitate policy goals. However, there exists a gap in understanding how different modes of remuneration affect physician-patient contact. This paper examines if there is a significant difference between the average full-time-equivalent (FTE) of family physicians (FPs) remunerated through fee-for-service (FFS), salary, and blended arrangements. We used Nova Scotia physician billings dataset which tracks every services performed by both FFS and salaried physicians over the fiscal year 2003 to 2004. We estimated two semi-logarithmic models to examine the relationship between (1) modes of remuneration and FTE, and (2) modes of remuneration and total services, using ordinary least squares method. The National Physician Survey shows a significant difference between the current modes of remuneration and the preferred modes of remuneration; thus ruling out the possibility of selectivity bias. The results show that compared to the FFS FPs, the salaried FPs and blended FPs produce on average 40.46% and 23.13% less FTE respectively. It also indicates that compared to the FFS FPs, the salaried FPs and blended FPs deliver 53.54% and 31.49% fewer services on average.

The health care system has been under pressure for some time to keep pace with its health human resource (HHR) requirements. Future demographic trends, however, are magnifying these pressures. Because of the lengthy training period for physicians, closing the physician supply and demand gap requires time. This paper attempts to explore the future utilization of physicians in terms of full-time equivalent (FTE) in Nova Scotia to the year 2025 by four general types of medical disciplines: General Physicians, Medical Specialties, Surgical Specialties, and Diagnostic Specialties. Further, it makes projections by most responsible diagnosis, in- and out-hospital status, age and sex of the patients. The study shows that for paediatric patients, the incidence of all diseases would decline and for patients between age 15 and 54, the incidence of disease would either decline or increase marginally. Consistent with the baby boom ageing wave, the prevalence of disease would increase significantly for those above 54 years. This would result in requirements for all categories of physicians to decline for patients below age 54, in contrast with those 55 years of age and over where the demand would substantially increase. It is found that the growth in the requirements would be highest for diagnostic specialists, followed by surgical specialists, medical specialists, and the general practitioners.

The objective of GEMS (General Emergency Medicine Skills) is to deliver an emergency skills program relevant to rural physicians. The cognitive component was disseminated by four interactive CD-ROM modules while the practice component consisted of skill practice on a human patient simulator (HPS) at a rural hospital. During the pilot year, 16 participants completed the program and filled in an evaluation survey to collect participant feedback. Modules facilitated maintenance of current knowledge, new knowledge acquisition, and confidence in dealing with emergencies. The HPS reinforced module knowledge, allowed practice of skills, and was necessary to fully benefit from the modules. The application process was easy and program administration was good. GEMS positively affected participants' delivery of emergency medicine and their willingness to continue the practice of rural emergency medicine. GEMS provides rural physicians relevant, interactive skills training at a rural setting.

Like many rural and remote regions around the world, Canada's Northern Ontario has a chronic shortage of doctors and other health care providers. Recognizing that doctors who have grown up in a rural area are more likely to practise in the rural setting, the Government of Ontario decided to establish a new medical school with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. The Northern Ontario School of Medicine (NOSM), a joint initiative of Laurentian University in Sudbury and Lakehead University in Thunder Bay, was established as a rural, community-based medical school. NOSM is a long-term sustainable 'strategy that is expected to lead not only to more skilled doctors and enhanced health care with improved health outcomes, but also to broader academic developments for the universities and substantial economic developments for Northern Ontario communities.