Table 1

 Summary characteristics of health care systems for each country

Health system structureGPs’ position and financing in systemReimbursement of pharmacotherapies by public insurance% of GPs reported to recommend cessation and/or pharmacotherapyAdult smoking prevalence (%)*
MenWomen
*World Development Indicators, 2002; The World Bank, 2002.
GP, general practitioner; NHS, National Health Service.
Canada8,9Publicly financed, privately delivered universal health coverageMost are private practitioners; paid on fee-for-service basisCovered on a limited basis in some provincesAbout 50% of surveyed patients report having to initiate conversations with GPs about smoking cessation2723
France10,11Universal coverage supplemented by private insurance; about 50% of care provided in public facilities, 50% in private clinicsCare delivered primarily by private practitioners; GPs paid on fee-for service basis, directly by patientsNot covered by public insurance57% of GPs reported advising smoking patients to quit; 25% of smokers’ records indicated advice having been delivered3927
Spain12,13Universal coverage; direct public financing, all services free of charge; provision of care occurs mostly in public sectorAlmost all GPs are salaried employees in the public sectorNot presently covered by public insurance55% of GPs initiated cessation counselling; 98% provided counselling if patient initiated conversation about cessation or had symptoms of tobacco-caused disease (1998 survey)4225
Switzerland14,15Compulsory private health insurance (must comply with federal regulation); premiums are community ratedGPs are private practitioners; paid on a fee-for-service basisNot covered by compulsory insurance88% of patients recalled being asked by GP about their smoking habits, but only 34% recalled being counselled to quit3827
United Kingdom16,17Publicly financed universal coverageGPs are independent, self-employed contractors to NHS; terms and fees set by Secretary of StateCovered by public insuranceApproximately 50% of GPs advised smoking patients to quit during most or all consultations (1999 survey)2928
United States18,19Primarily privately financed health care and insurance; public sector finances significant amount of care for elderly, some for disabled and poorLarge shift in 1990s from fee-for-service arrangements to managed care; GPs paid as private or group contractors, or salariedNot covered by public insurancePatient smoking status identified in 67% of clinic visits, and cessation counselling provided in 21% (1995 survey)2822