The Canadian Medical Association has been having its annual meetings this week in Ottawa and in honor of the event, let me put out another international comparison on physicians using data from the OECD Health Statistics 2013. The first chart (Figure 1) is a basic resource availability measure showing the number of physicians per 1000 population for the OECD countries circa 2011. The second chart (Figure 2) is a workload measure showing doctor consultations per capita circa 2011.
As Figure 1 shows, amongst the OECD countries Canada is well below the OECD average and in the bottom third when it comes to physicians per 1,000 of population. We are between Japan and the United States when it comes to this measure. The highest number of physicians, relative to population, is in Greece, Austria and Italy.
Figure 2 presents what could be termed a workload measure – physician/doctor consultation per capita. Here Canada is above the OECD average and in the top third lying between Belgium and Spain. What is interesting here is that Canada has a number of physicians per 1000 of population that is almost identical to the United States and yet when it comes to consultations per capita, we are nearly double those of the United States. This would suggest that Canadian physicians are working harder than physicians in the United States. Of course, we need to factor in not just the number of consultations but the number of consultations relative to the resource base.
So, Figure 3 tries to present a crude “workload intensity” measure by presenting the ratio of consultations per capita to physicians per 1000 population for each of these OECD countries. This is a crude measure because these numbers do not differentiate between GPs or specialists or types of specialty or composition of the cases or demographic differences across the populations in these countries that might account for differences in consultation numbers. Moreover, we do not know if these consultations are just five minutes or span a considerably longer period of time. Moreover, ideally one would want to look at physician workloads while controlling for many of these other confounding factors.
When it comes “workload intensity”, Canadian physicians are above the OECD average and again in the top third – this time between the Czech Republic and Slovenia. We are again well above the United States in this measure. What I also found interesting is that Greece has the highest number of physicians per 1000 population and is the lowest in the “workload intensity” measure.
So the final question one has to ask is if is there is any relationship between per capita health spending in these countries and the “workload intensity” of physicians – as measured by these crude and albeit imperfect numbers. Physicians are the gatekeepers for a lot of health spending so one might expect that there is a relationship between workload and the ultimate health care bill in these countries.
Figure 4 plots the physician workload variable from Figure 3 against total per capita health expenditure in US PPP$ for these OECD countries. A linear fit is also plotted. Higher workloads are associated with lower per capita total health spending while lower workloads are associated with higher per capita spending. There seem to be some outliers here – Korea, Japan and the United States. Korea and Japan have pretty high workloads and fairly low spending. The United States has a pretty low physician workload and very high health spending. Removing these three observations still results in a negative slope (not shown).
Based on Figure 4, I would venture that these crude numbers suggest that a given stock of physicians seeing more patients is in the long run associated with lower rather than more health spending. Could it be more frequent consultations are better for monitoring patient health and save money in the long term by keeping on top of medical condition? Is a factor in the US health system’s high spending the fact that doctors see patients less often so that when they finally decide to see a physician they are in much worse shape and more expensive to treat? Fascinating stuff.