|Victor R. Fuchs|
|Alma mater||Columbia University (Ph.D.)(M.A.)
New York University (B.S.)
|Information at IDEAS / RePEc|
He is the Henry J. Kaiser, Jr. Professor at Stanford University, emeritus. Since 1962, he has been a research associate at the National Bureau of Economic Research, and is the co-director of the FRESH-Thinking Project, CASBS, at Stanford University. Fuchs was elected to the American Academy of Arts and Sciences in 1982, and to the American Philosophical Society in 1990. In 1995, he served as president of the American Economic Association.
A Comparison Between the United States and Canada
Also, Fuchs published a paper with James S. Hahn in the New England Journal of Medicine entitled "How Does Canada Do it? – A comparison of Expenditures for Physicians’ Services in the United States and Canada". This paper discusses the differences in the Canadian and US healthcare spending patterns and also discusses why healthcare expenditures are so much higher in the United States. They found that the higher US expenditures were entirely based on higher fees for services, at 234% higher than Canada, even though there are more physicians per capita in Canada. This proves that the typical view of Canada saving money by delivering fewer services is false, and that the insurance setup, being a single-payer system, is what gives them the edge.
This empirical analysis published in 1990 sharpened our understanding of the differences in physicians’ services between the United States and Canada regarding fees, spending, and utilization. The accentuating difference begins with the disparity in health care coverage; Canada operates under a universal health care system, which covers majority of their residents. On the other hand, the United States operates under a fragmented multi-payer system that inevitably fails to provide coverage for many Americans. Moreover, the lack of correspondence between both countries regarding health care coverage validates part of the narrative reported in the Fuchs and Hahn study, which concluded that the US spent more on physicians’ services than Canada.
Health care coverage in Canada provides more services at lower costs by virtue of negotiated physician fees between physician organizations and the provincial governments, as well as other limits placed on spending. Furthermore, the results from this study also suggest that higher expenditures in the US is a function of many factors including higher wages earned by US physicians, the difference of physicians on demand, billing costs, quality of health care, physicians’ workload, and superfluous amenities. Notably, these factors bring to question the underlying differences in health care delivery, in which the authors reported a larger number of general practitioners in Canada for visits per capita. The limited role of general practitioners in the US compared to Canada may imply that Canadian physicians are "more inclined to recommend additional evaluation and management services."
The lower quantity of physician services per capita coupled with higher expenditures is an example of the fundamental inefficiencies embedded within the fragmented multi-payer health care system in the US. Thus a concerted effort to reform these inefficiencies has been made by the US government, which resulted in the adoption of the Patient Protection and Affordable Care Act, a noteworthy addition to the health care system since the passage of Medicare and Medicaid in 1965. The advent of this key piece of legislation is shifting the payment of care in the US from the inefficiencies of fee-for-service to payment models grounded on improved outcomes and lower health care spending. Specifically, some of these models reduce costs through a team-based approach known as a medical home, which are often led by a general practitioner. Furthermore, congress is currently working on a “permanent doc fix” to control Medicare spending on physician services, also known as the Medicare Sustainable Growth Rate (SGR). Since the publication of the Fuchs and Hahn article in 1990, important changes in health care policy have taken place, the outcome of these policy changes have the potential to resolve the exorbitant expenditures for physicians’ services in the US.
- Leonhardt, David (25 August 2009). "Real Choice? It’s Off Limits in Health Bills". The New York Times.
- Victor R. Fuchs, Stanford University
- Fresh Thinking Project
- List of active members by class, October 24, 2014
- "Honors". American Economic Association.
- Fuchs, Victor; Hahn, James S. (27 September 1990). "How does Canada do it? – A comparison of expenditures for physicians’ services in the United States and Canada". The New England Journal of Medicine 323 (13): 884–890. doi:10.1056/NEJM199009273231306.
- "Comparing international health care systems". PBS Newshour (PBS). October 6, 2009.
- Folland, Sherman; Goodman, Allen C.; Stano, Miron (2014). The economics of health and health care (7th ed.). Essex, England: Pearson Education. ISBN 9781292020518.
- Cameron, David (July 11, 2012). "Moving beyond health care's fee-for-service". Harvard Gazette.
- Kliff, Sarah (February 7, 2014). "The Doc-fix is in: Congress actually has a plan to overhaul doctor payments". The Washington Post.