Physician Service in Montreal before Universal Health Insurance

We report here the results of three surveys conducted during 1969-70 as part of the first phase of a before and after study of the introduction of comprehensive health insurance in the Montreal metropolitan area. 1. Household Survey. In a survey of a random sample of 6,000 households over a 12-month period, no direct relationship was found between family income and use of physician service. However, an adjustment of family income for family size and composition resulted in a direct relationship with higher income families receiving more services than the lower; this relationship was particularly strong for children. In an attempt to see if the higher volume of services in high income families reflected greater need, symptoms of disease thought to require physician care were studied. These were found to be about the same for children in various income groupings but more frequent among adults in lower income groups. It was concluded that there were unmet needs for physician services in Montreal prior to the introduction of comprehensive health insurance and that these were related to income levels. 2. Work of Physicians. Interviews with a random sample of 497 practicing doctors in Montreal, between October 1969 and May 1970, showed that the average working day ranged from 9.7 hours for general internists to 11.7 hours for psychiatrists. The number of patients seen, excluding telephone consultations, ranged from 70 patients per week for psychiatrists and to 140 patients per week for general practitioners. 3. Use of Emergency Rooms. Interviews were conducted with 1,766 patients who attended emergency rooms in six Montreal hospitals for reasons other than an accident within 24 hours and with 1,694 who attended outpatient departments in two hospitals. The majority (83 per cent) of the emergency room patients interviewed had non-urgent conditions. Of those attending the two outpatient departments, 61 per cent claimed this as their usual source of care, and 70 per cent came without referral by a physician. While 70 per cent thought that continuity of physician care was important, two thirds said they would prefer the outpatient department even if all medical care were free. These three surveys are being repeated in 1971-72 approximately one year after the introduction of comprehensive health insurance.