Effects of “Free” Medical Care on Medical Practice — The Quebec Experience

Abstract Interviews with random samples of practicing physicians in Montreal were conducted before and after the introduction of a universal health-insurance plan. The size and composition of the physician population were not affected by the introduction of the plan. There was a reduction of 8 1/2 hours, however, in the physician's average workweek, from 54.8 hours to 46.3 hours, with large declines in time spent in telephone consultations and in seeing patients at home or in the hospital. Average daily patient contacts also fell — from 82,262 to 74,463 —owing to declines in telephone contacts and home and hospital visits. Patients seen in the office increased, however, from 23,840 per day to 31,509. Patients thought by doctors to have sought medical advice without reasonable cause rose from 1.1 per cent of all patients seen to 1.9 per cent, whereas those who physicians thought should have sought medical advice sooner fell from 2.6 to 1.8 per cent. (N Engl J Med 288: 1152–1155, 1973)