Costs of care
Online posting: January 9, 1997
Published in print: Mar. 1, 1997 (CMAJ 1997;156:634)
Re: Factors explaining the increase in cost for physician care in
Quebec's elderly population, by Marie Demers, Can Med Assoc
J 1996;155:1555-60 [abstract / réumé].
Dr. Marie Demers recognizes that "the increase in physician
costs is more strongly related to the way the health care system
responds to the health problems of the elderly population than to
demographic factors."
Unfortunately, she does not discuss the value of health care.
The unique purposes of health care are to increase some or all of
comfort, function and life span. Treatments for disease and,
consequently, the costs of care, depend on the availability of
care that can succeed. The cost of care is low when no treatment
is available and higher when potentially successful treatment is
available.
Demers alludes to the influence of changes in knowledge on the
cost of care by stating that "the availability of new drugs,
diagnostic techniques and surgical techniques has made it
possible to treat older and more seriously ill patients than was
possible previously."
However, to assess the appropriateness of the increased costs
we need to know whether the costs were associated with increased
benefits; to assess the benefits of care we need reliable
information about each person's health status. Unfortunately, no
Canadian jurisdiction systematically collects information about
patient health before and after medical intervention.
Consequently, it may be impossible to learn whether the
increases in costs are worth while because they are associated
with increases in patient benefits.
It is surprising that Canadian physicians and health
administrators have not made a more serious effort to collect
information about the effectiveness of care since that
information is essential for proper allocation of financial
resources and management of our health care system.
David Zitner, MA, MD
Director, Medical Informatics
Dalhousie University
Medical Quality Consultant
Queen Elizabeth II Health Sciences Centre
Halifax, NS
david.zitner@dal.ca
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