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Biomedical subjects

E Vayda

Publications and source records attributed to E Vayda.

At least 37 records · Page 2Linked to original sources
PubMed1988

Medical politics and Canadian Medicare: professional response to the Canada Health Act.

The Canada Health Act of 1984 served as a lightning rod for profession/government conflict, culminating in a 25-day doctors' strike in Ontario. The act was perceived as threatening medical dominance and professional autonomy in its prohibition of user fees and extra billing. A post-strike survey of 2,397 physicians across the provinces, however, reveals important limits to physicians' ideological support for an unregulated medical market place. Rather, there are divisions within the profession on how to translate commitment to autonomy into appropriate policy objectives and political strategies.

Attitude of Health Personnel↗
PubMed1984

Five-year study of surgical rates in Ontario's counties.

The surgical rates for eight operations (hysterectomy, tonsillectomy/adenoidectomy, cholecystectomy, prostatectomy, appendectomy, mastectomy, colectomy and cesarean section) done in Ontario's 44 counties from 1973 to 1977 were examined. There was considerable variation among the counties for all the operations studied, although the degree of intercounty variation decreased over the 5 years. Differences in resources (hospital beds and surgeons) explained little of the variation in the rates, but this may be because people crossed county lines for certain operations. Although some counties had consistently high or low rates for individual operations during the 5-year period, only four had consistently high rates for four or more operations, and only five had consistently low rates for four or more. The five counties with teaching health science centres had the highest ratios of specialists and surgeons to population, and, with the exception of one county in 1973, had above-average numbers of hospital beds. Despite the greater resources in these counties, their residents had consistently low rates for cholecystectomy, appendectomy, mastectomy and tonsillectomy/adenoidectomy. However, three of these counties had the highest rates for cesarean section. The variation in the rates is likely due to lack of agreement about indications for surgery or to variation in the use of technology rather than to differences in the incidence or prevalence of disorders.

Academic Medical Centers↗
PubMed1984

The Canadian health care system: an overview.

Although health care is a provincial responsibility in Canada, universal hospital insurance was fully adopted by 1961; universal medical insurance followed 10 years later. Each province enacted universal insurance after the federal government offered to pay 50% of provincial hospital and medical care costs. Hospital insurance had wide public and provider support but universal medical care insurance was opposed by organized medicine. The federal government soon realized that it had no control over total expenditures and no mechanisms for controlling costs. In 1977 it enacted Bill C-37 which limited total federal contributions and made those contributions independent of provincial health care expenditures so that increased costs had to be met by the provinces. Since private health care insurance for universal benefits is prohibited by the federal terms of reference for health insurance, the provinces must raise the money by taxes and (in some provinces) premiums. Although prohibited by the terms of reference of the universal program, some provinces have adopted hospital user fees and are allowing their physicians to bill patients in excess of provincial fee schedules. The 1980s have seen increased confrontations between the federal and provincial governments and between the provinces and their providers. The issues are cost containment and control of the system. The provinces have two broad options. The first is more private funding through private insurance and user fees. The proposed new Canada Health Act will probably prohibit such charges. A second option involves greater control and management of the system by the provinces; this has already occurred in Quebec. Greater control is vigorously opposed by physicians and hospitals. The Canadian solution to health insurance problems in the past has been moderation. Extreme moves in either direction would represent a break with tradition, but they may prove to be unavoidable.

Canada↗
PubMed1982

Measuring surgical decision-making with hypothetical cases.

Hypothetical clinical cases were used to investigate surgical decision-making in relation to surgical rates across Ontario. Six procedures were studied (cholecystectomy, colectomy, inguinal herniorrhaphy, hysterectomy, cesarean section and tonsillectomy-adenoidectomy), and substantial differences of opinion regarding the choice of surgical or nonsurgical treatment were recorded. The decision to operate, however, was not made more frequently in Ontario counties with high operative rates, and none of the demographic variables studied were correlated with the decision to operate. Other variables that might have affected operative rates were not taken into account. There were also differences of opinion in referral decisions, but generally internists and pediatricians were less likely to refer the hypothetical cases to surgeons than were family physicians.

Cesarean Section↗
PubMed1982

Ten-year trends in Canada for selected operations.

Of 16 operations common in Canada the national rates over a 10-year period for the 9 discretionary procedures varied much more than those for the nondiscretionary operations. The rates of tonsillectomy and adenoidectomy, hemorrhoidectomy, varicose vein stripping and appendectomy decreased substantially, whereas those of extraction of lens, cesarean section and colectomy increased. The rates of hysterectomy and cholecystectomy first increased and then decreased. With the exception of Newfoundland the provinces generally followed these trends. Neither the Canadian nor the provincial rates were significantly associated with the availability of hospital beds or surgeons. Factors other than resources probably accounted for much of the variation among the provinces.

Adenoidectomy↗
PubMed1982

A decade of surgery in Canada, England and Wales, and the United States.

Between 1966 and 1976, overall surgical rates in Canada remained relatively unchanged and consistently 60% higher than those in England and Wales. Overall United States rates were the highest of the three countries and increased 25% over the ten years. Numbers of surgeons per capita increased in both Canada and England and Wales but overall surgical rates in the two operative rates increased. During the decade, Canada had more hospital beds per capita than the United States while England and Wales had the fewest. Since 1970, the percentage of gross national product spent on health care has been greatest in the United States, intermediate in Canada, and lowest in England and Wales. These expenditures may better reflect national priorities and value and, thus be more important than per capita numbers of hospital beds or surgeons in explaining the cross-national difference in rates of surgery.

Aged↗
PubMed1981

Use of hypothetical cases to investigate indications for surgery.

Hypothetical case histories were used to investigate judgements to operate or to refer. Six procedures (cholecystectomy, colectomy, inguinal herniorrhaphy, tonsillectomy, cesarean section and hysterectomy) were selected and four cases were developed for each procedure. Control cases were those on which surgeons agreed and test cases were those on which there was disagreement regarding surgical or nonsurgical treatment. The case histories were mailed to 131 surgeons and referring physicians in one Ontario county. Among the 98 respondents 75% indicated that the cases were typical of problems seen in practice. This paper reviews the case histories and results for cholecystectomy and hysterectomy. Two of the cholecystectomy cases were controls with 83% of the surgeons opting for nonsurgical treatment in one and 94% opting for surgery in the other. For hysterectomy there was one control case with 90% agreement among gynecologists to operate; in the three test cases from 25% to 75% of the gynecologists favoured surgery. The combined results of all test cases indicated that younger surgeons were less likely to select operation than older surgeons. No consistent sociodemographic associations with the referral decision could be determined for referring physicians, possibly owing to the small sample size.

Adult↗
PubMed1979

Universal health insurance in Canada: history, problems, trends.

This paper describes the universal health insurance program in Canada and identifies the historical events and social values leading to its adoption. Universal hospital insurance was adopted in 1958, ten years before medical insurance, as a result hospital-based patterns of practice were solidified. Through cost sharing, the federal government influenced the provinces to enact relatively uniform universal plans. From 1951 to 1971 health care expenditures rose rapidly to 7.3% of the gross national product (GNP), but have since decreased and stabilized at about 6.9%. In contrast, health care in the United States represents 8.6% of GNP. Hospital use also increased rapidly in Canada to 1970 but appears to have stabilized and decreased slightly in this decade. Physician incomes rose rapidly before 1971, but since then the increases have slowed and relative incomes of physicians have fallen. Althouth the percent of GNP spent for health care has leveled, there are still substantial annual increases in expenditures that are paid for by government. Two federal initiatives, Bill C-37 and the Lalonde Report, have their roots in cost containment; Bill C-37 transfers greater taxing authority from the federal government to the provinces. To meet the goal of containing costs, provincial governments are moving in the direction of regionalization, decentralization, and greater coordination. In the short term, the provinces have limited hospital budgetary increases to percentages less than the rate of inflation. Cost constraints may be long overdue. Imposing fiscal limits encourages rational planning. It does not appear that the health of Canadians will be adversely affected or essential benefits curtailed by present budgetary restrictions or reorganization.

Adult↗
PubMed1979

Variations in surgery in Ontario.

In 1974 there was five-to eight-fold variation in the frequency with which tonsillectomy, colectomy, hysterectomy, cholecystectomy and appendectomy were performed in Ontario's 49 counties. All five procedures were resource sensitive; over 50 per cent of the variation in rates was explained by numbers of acute care treatment beds and physicians. Generally, counties with high or low rates for any one procedure had corresponding rates for the other four. The highest rates were found in less populous rural eastern Ontario counties, while university teaching centers ranked among the lowest for all five operations although they had the highest ratios of beds, general practitioners and surgeons. Linkages between university medical centers and community hospitals, widespread dissemination of surgical rate data, surgical audit and review of surgical indications and practices in university centers and community hospitals are proposed to aid in rationalizing surgical practices in Ontario.

Analysis of Variance↗