Good News about Difficult Decisions: The Canadian Approach to Hospital Cost Control

Health Affairs

Volumn 17, Issue 5, 1998, Pages 239-246

  Roos, Noralou P ^a   Brownell, Marni ^a   Shapiro, Evelyn ^a   Roos, Leslie L ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; CANADA; COST CONTROL; ECONOMICS; FEMALE; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH STATUS; HOSPITAL BED CAPACITY; HOSPITAL COST; HOSPITALIZATION; HUMAN; MALE; STATISTICS;

AGED; COST CONTROL; FEMALE; HEALTH CARE REFORM; HEALTH SERVICES ACCESSIBILITY; HEALTH STATUS; HOSPITAL BED CAPACITY; HOSPITAL COSTS; HOSPITALIZATION; HUMANS; MALE; MANITOBA; QUALITY OF HEALTH CARE;

EID: 0032162222     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.5.239     Document Type: Review

References (43)

1. P. Tully and E. Saint-Pierre, "Downsizing Canada's Hospitals, 1986/87 to 1994/95," Health Reports 8, no. 3 (1997): 33-39.
2. Ibid., for Canadian hospital spending. Also see K.R. Levit, H.C. Lazenby, and L. Sivarajan, "Health Care Spending in 1994: Slowest in Decades," Health Affairs (Summer 1996): 130-144. In the United States health care costs continue to increase. K.R. Levit et al., "National Health Spending Trends in 1996," Health Affairs (January/February 1998): 35-51.
3. Ibid., for Canadian hospital spending. Also see K.R. Levit, H.C. Lazenby, and L. Sivarajan, "Health Care Spending in 1994: Slowest in Decades," Health Affairs (Summer 1996): 130-144. In the United States health care costs continue to increase. K.R. Levit et al., "National Health Spending Trends in 1996," Health Affairs (January/February 1998): 35-51.
4. Ibid., for Canadian hospital spending. Also see K.R. Levit, H.C. Lazenby, and L. Sivarajan, "Health Care Spending in 1994: Slowest in Decades," Health Affairs (Summer 1996): 130-144. In the United States health care costs continue to increase. K.R. Levit et al., "National Health Spending Trends in 1996," Health Affairs (January/February 1998): 35-51.
5. J. Hurley et al., "When Tinkering Is Not Enough: Provincial Reform to Manage Health Care Resources," Canadian Public Administration 37, no. 3 (1994): 490-514.
6. "Manitoba Doctors Are Fed Up," Medical Post, 10 August 1993, 1; and "Manitoba Health Care Professionals Applaud Cabinet Shuffle: Hopeful of New Minister McCrae," Medical Post, 15 September 1993, 2.
7. "Manitoba Doctors Are Fed Up," Medical Post, 10 August 1993, 1; and "Manitoba Health Care Professionals Applaud Cabinet Shuffle: Hopeful of New Minister McCrae," Medical Post, 15 September 1993, 2.
8. The population health information system (POPULIS) has been described both in the December 1995 Medical Care Supplement and in N. Roos et al., "Population Health and Health Care Use: An Information System for Policy Makers," Milbank Quarterly 74, no. 1 (1996): 3-31.
9. L.L. Roos et al., "Comparing Clinical Information With Claims Data: Some Similarities and Differences," Journal of Clinical Epidemiology 44, no. 9 (1991): 881-888; L.L. Roos et al., "Using Adminsitrative Data for Longitudinal Research: Compansons with Primary Data Collection," Journal of Chronic Diseases 40, no. 1 (1987): 41-49; L.L. Roos et al., "Assessing Data Quality: A Computerized Approach," Social Science and Medicine 28, no. 2 (1989): 175-182; and L.L. Roos et al., "Registries and Administrative Data: Organization and Accuracy," Medical Care 31, no. 3 (1993): 201-212.
10. L.L. Roos et al., "Comparing Clinical Information With Claims Data: Some Similarities and Differences," Journal of Clinical Epidemiology 44, no. 9 (1991): 881-888; L.L. Roos et al., "Using Adminsitrative Data for Longitudinal Research: Compansons with Primary Data Collection," Journal of Chronic Diseases 40, no. 1 (1987): 41-49; L.L. Roos et al., "Assessing Data Quality: A Computerized Approach," Social Science and Medicine 28, no. 2 (1989): 175-182; and L.L. Roos et al., "Registries and Administrative Data: Organization and Accuracy," Medical Care 31, no. 3 (1993): 201-212.
11. L.L. Roos et al., "Comparing Clinical Information With Claims Data: Some Similarities and Differences," Journal of Clinical Epidemiology 44, no. 9 (1991): 881-888; L.L. Roos et al., "Using Adminsitrative Data for Longitudinal Research: Compansons with Primary Data Collection," Journal of Chronic Diseases 40, no. 1 (1987): 41-49; L.L. Roos et al., "Assessing Data Quality: A Computerized Approach," Social Science and Medicine 28, no. 2 (1989): 175-182; and L.L. Roos et al., "Registries and Administrative Data: Organization and Accuracy," Medical Care 31, no. 3 (1993): 201-212.
12. L.L. Roos et al., "Comparing Clinical Information With Claims Data: Some Similarities and Differences," Journal of Clinical Epidemiology 44, no. 9 (1991): 881-888; L.L. Roos et al., "Using Adminsitrative Data for Longitudinal Research: Compansons with Primary Data Collection," Journal of Chronic Diseases 40, no. 1 (1987): 41-49; L.L. Roos et al., "Assessing Data Quality: A Computerized Approach," Social Science and Medicine 28, no. 2 (1989): 175-182; and L.L. Roos et al., "Registries and Administrative Data: Organization and Accuracy," Medical Care 31, no. 3 (1993): 201-212.
13. K. Hiebert-Pauls, "Pediatric Closure Rocks Hospital," Winnipeg Sun, 10 December 1992, 4; and D. Lett, "Care at Risk, Nurses Claim," Winnipeg Free Press, 20 September 1993, 1.
14. K. Hiebert-Pauls, "Pediatric Closure Rocks Hospital," Winnipeg Sun, 10 December 1992, 4; and D. Lett, "Care at Risk, Nurses Claim," Winnipeg Free Press, 20 September 1993, 1.
15. J.E. Wennberg et al., "Are Hospital Services Rationed in New Haven or Over-Utilized in Boston?" Lancet 1, no. 8543 (1987): 1185-1189.
16. N.P. Roos and E. Shapiro, Monitoring the Winnipeg Hospital System: The First Report (Winnipeg: Manitoba Centre for Health Policy and Evaluation, 1994).
17. Acute hospital days per capita fell from 767 in 1989 to 674 in 1992, and 600 in 1994. Only stays of fewer than sixty days are included; the data have been standardized for age and sex to the 1992 Manitoba population. This provides a fairer method of comparing hospital usage over time, since Manitoba's population is aging and would be expected to generate higher rates of use in recent years based on this factor alone.
18. M.E. Charleson et al., "A New Method Of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation," Journal of Chronic Diseases 40, no. 5 (1987): 373-383.
19. M.D. Brownell and N.P. Roos, Monitoring the Winnipeg Hospital System: The Update Report (Winnipeg: Manitoba Centre for Health Policy and Evaluation, 1996).
20. N.P. Roos and C.A. Mustard, "Variation in Health and Health Care Use by Socioeconomic Status in Winnipeg, Canada: Does the System Work Well? Yes and No," Milbank Quarterly 75, no. 1 (1997): 1-23. See also M.N. Haan et al., "Socioeconomic Status and Health: Old Observations and New Thoughts," in Pathways to Health, ed. J.P. Bunker et al. (Menlo Park, Calif.: Kaiser Family Foundation, 1989); G. Pappas et al., "The Increasing Disparity in Mortality between Socioeconomic Groups in the United States, 1960 and 1986," New England Journal of Medicine 329, no. 2 (1993): 103; and, for Canada, R.W. Broyles et al., "The Use of Physician Services under a National Health Insurance Scheme," Medical Care 21, no. 11 (1983): 1037-1054.
21. N.P. Roos and C.A. Mustard, "Variation in Health and Health Care Use by Socioeconomic Status in Winnipeg, Canada: Does the System Work Well? Yes and No," Milbank Quarterly 75, no. 1 (1997): 1-23. See also M.N. Haan et al., "Socioeconomic Status and Health: Old Observations and New Thoughts," in Pathways to Health, ed. J.P. Bunker et al. (Menlo Park, Calif.: Kaiser Family Foundation, 1989); G. Pappas et al., "The Increasing Disparity in Mortality between Socioeconomic Groups in the United States, 1960 and 1986," New England Journal of Medicine 329, no. 2 (1993): 103; and, for Canada, R.W. Broyles et al., "The Use of Physician Services under a National Health Insurance Scheme," Medical Care 21, no. 11 (1983): 1037-1054.
22. N.P. Roos and C.A. Mustard, "Variation in Health and Health Care Use by Socioeconomic Status in Winnipeg, Canada: Does the System Work Well? Yes and No," Milbank Quarterly 75, no. 1 (1997): 1-23. See also M.N. Haan et al., "Socioeconomic Status and Health: Old Observations and New Thoughts," in Pathways to Health, ed. J.P. Bunker et al. (Menlo Park, Calif.: Kaiser Family Foundation, 1989); G. Pappas et al., "The Increasing Disparity in Mortality between Socioeconomic Groups in the United States, 1960 and 1986," New England Journal of Medicine 329, no. 2 (1993): 103; and, for Canada, R.W. Broyles et al., "The Use of Physician Services under a National Health Insurance Scheme," Medical Care 21, no. 11 (1983): 1037-1054.
23. N.P. Roos and C.A. Mustard, "Variation in Health and Health Care Use by Socioeconomic Status in Winnipeg, Canada: Does the System Work Well? Yes and No," Milbank Quarterly 75, no. 1 (1997): 1-23. See also M.N. Haan et al., "Socioeconomic Status and Health: Old Observations and New Thoughts," in Pathways to Health, ed. J.P. Bunker et al. (Menlo Park, Calif.: Kaiser Family Foundation, 1989); G. Pappas et al., "The Increasing Disparity in Mortality between Socioeconomic Groups in the United States, 1960 and 1986," New England Journal of Medicine 329, no. 2 (1993): 103; and, for Canada, R.W. Broyles et al., "The Use of Physician Services under a National Health Insurance Scheme," Medical Care 21, no. 11 (1983): 1037-1054.
24. C.M. Jacobs and J. Lamprey, Adult ISD Criteria and Review System and Pediatric ISD and Review System (North Hampton, N.H.: InterQual, Inc., 1993).
25. C. De Coster et al., "Inappropriate Hospital Use for Medical Patients: Tips for Targeting Utilization Review," Canadian Medical Association Journal 157, no. 7 (1997): 889-900.
26. J.L. Rouleau et al., "A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States," New England Journal of Medicine 328, no. 11 (1993): 779-784; D.B. Mark et al., "Use of Medical Resources and Quality of Life after Myocardial Infarction in Canada and the United States," New England Journal of Medicine 331, no. 17 (1994): 1130-1135; and DA Rublee, "Medical Technology in Canada, Germany, and the United States: An Update," Health Affairs (Fall 1994): 113-117.
27. J.L. Rouleau et al., "A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States," New England Journal of Medicine 328, no. 11 (1993): 779-784; D.B. Mark et al., "Use of Medical Resources and Quality of Life after Myocardial Infarction in Canada and the United States," New England Journal of Medicine 331, no. 17 (1994): 1130-1135; and DA Rublee, "Medical Technology in Canada, Germany, and the United States: An Update," Health Affairs (Fall 1994): 113-117.
28. J.L. Rouleau et al., "A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States," New England Journal of Medicine 328, no. 11 (1993): 779-784; D.B. Mark et al., "Use of Medical Resources and Quality of Life after Myocardial Infarction in Canada and the United States," New England Journal of Medicine 331, no. 17 (1994): 1130-1135; and DA Rublee, "Medical Technology in Canada, Germany, and the United States: An Update," Health Affairs (Fall 1994): 113-117.
29. Brownell and Roos, Update Report. These results parallel assessments of the impact of the diagnosis-related group (DRG)-based prospective payment system on quality of care. That is, there was, if anything, improved quality of care as judged by lower mortality rates following the introduction of a DRG-based system and reductions in lengths-of-stay at U.S. hospitals. However, clinicians find these results totally nonintuitive, and it is always assumed that one more year of data or the examination of one more condition will confirm their conviction that shorter stays are bad. K. Kahn et al., "Measuring Quality of Care with Explicit Process Criteria before and after Implementation of the DRG-Based Prospective Payment System," Journal of the American Medical Association 264, no. 15 (1990): 1969-1973.
30. "Moms Resent Plan," Winnipeg Sun, 12 November 1992, 2; and B. Oswald, "We're at the Breaking Point, HSC Doctor Warns," Winnipeg Free Press, 13 January 1994, B1.
31. "Moms Resent Plan," Winnipeg Sun, 12 November 1992, 2; and B. Oswald, "We're at the Breaking Point, HSC Doctor Warns," Winnipeg Free Press, 13 January 1994, B1.
32. J. Eyles et al., "A Needs-Based Methodology for Allocating Health Care Resources in Ontario, Canada: Development and an Application," Social Science and Medicine 33, no. 4 (1991): 489-500.
33. Although there may be some problems with equivalence in definition, if anything, administrative costs in U.S. hospitals, particularly for-profit hospitals, have increased in the 1990s. S. Woolhandler and D. Himmelstein, "Costs of Care and Administration at For-Profit and Other Hospitals in the United States," New England Journal of Medicine 336, no. 11 (1997): 769-774; and Organization for Economic Cooperation and Development, "The Reform of Health Care Systems: A Review of Seventeen OECD Countries," Health Policy Studies 1, no. 5 (1994): Table 4.
34. Although there may be some problems with equivalence in definition, if anything, administrative costs in U.S. hospitals, particularly for-profit hospitals, have increased in the 1990s. S. Woolhandler and D. Himmelstein, "Costs of Care and Administration at For-Profit and Other Hospitals in the United States," New England Journal of Medicine 336, no. 11 (1997): 769-774; and Organization for Economic Cooperation and Development, "The Reform of Health Care Systems: A Review of Seventeen OECD Countries," Health Policy Studies 1, no. 5 (1994): Table 4.
35. Tully and Saint-Pierre, "Downsizing Canada's Hospitals."
36. Money saved from the closure of an obstetrical unit at a Winnipeg Hospital has been targeted for an expanded budget for hip and knee replacement surgery. A. Paul, "Grace Gets Aid to Ease Waits for Surgery," Winnipeg Free Press, 10 January 1998, 14. Recently, the government has committed almost $1.5 million to reduce waiting lists for diagnostic imaging. Plans were announced to create a central registry so patients can go to whichever facility has an opening. Manitoba Government News Release, Information Services, Winnipeg, 12 January 1998.
37. G.F. Anderson, "In Search of Value: An International Comparison of Cost, Access, and Outcomes," Health Affairs (November/December 1997): 163-171.
38. K. Davis, "Equity and Health Care Policy: The American Experience," in Equity in the Finance and Delivery of Health Care, ed. E. Van Doorslaer et al. (Oxford: Oxford University Press, 1993).
39. U.E. Reinhardt, "A Social Contract for 21st Century Health Care: Three Tier Health Care with Bounty Hunting," Monitoring in Health Economics 5, no. 6 (1996): 479-499.
40. A.R. Chapman, "Developing Health Information Systems Consistent with Human Rights Criteria," in Health Care and Information Ethics, ed. A.R. Chapman (Kansas City: Sheed and Ward, 1997).
41. See Waiting Your Turn (Vancouver: Fraser Institute, 1992, 1993). Since the physician response rates to their surveys are so low (only 16 percent of Manitoba physicians responded in 1992 and 33 percent in 1993), the Fraser Institute surveys are fatally flawed.
42. D. Yankelovich and J. Immerwahr, "A Perception Gap," Health Management Quarterly (Third Quarter 1991): 11-14.
43. M. Rachlis and C. Kushner, Strong Medicine: How to Save Canada's Health Care System (Toronto: Harper Perennial, 1994), 189. The Walter Cronkite quote is taken from this book.