American Medicine at the Crossroads: Signs from Canada

Abstract

IN their incisive analysis of the Canadian health care system in this issue of the Journal^,1 Evans and his colleagues offer some illuminating observations on the position of the medical profession.In Canada, where government pays almost all the bills, doctors are paid according to fixed fees and are not allowed to charge patients more. In some provinces there have been bitter political contests between the government and the profession over these matters. Although compromises have usually been reached on levels of payment, government — supported by public opinion — has stood firm on the issue of "extra billing." . . .