Fee controls as cost control: tales from the frozen North

Abstract

Uniform and binding fee schedules for physicians have been advanced as a cost-control strategy that can also improve patient access to care, as well as spread costs more equitably. Counter-arguments, however, predict very different effects on utilization and costs. Empirical evidence to challenge economic theories of physician behavior may be drawn from Canada. The experience of innovative policies of two provinces--within a national framework--emphasizes a multipronged approach to fees, practice patterns, and numbers of physicians; political will and ongoing negotiations are necessary.