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The dynamic effects of public medical care insurance on access to physician services are examined in this paper. A special definition of access is employed where access is measured as the inverse of the proportion of families of a given economic class who have not used physician services in a given year. Data are presented for the period 1963 through 1968 for a large sample of families in the Province of Saskatchewan in Canada. The evidence suggests that low-income classes have less contact with physicians than high-income classes. This disparity in accessibility is reduced, but not removed, as experience with Medicare increases. It is concluded that public medical care insurance does result in increased relative accessibility to physicians for the low-income classes.

The basic premise explored in this paper is that patient flow in rural areas is based on the proximity to medical care. The hospital is defined as the center of care and hospital catchment areas are defined by patient movements. A methodology is described to analyze patient flow among an assemblage of hospitals. Finally, a model which mathematically replicates patient movement is introduced to act as an aid in the hospital planning process.