Hospital Trends in Canada

Transcription

1 Hospital Trends in Canada Results of a Project to Create a Historical Series of Statistical and Financial Data for Canadian Hospitals Over Twenty-Seven Years N a t i o n a l H e a l t h E x p e n d i t u r e D a t a b a s e

2 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system now known or to be invented, without the prior permission in writing from the owner of the copyright, except by a reviewer who wishes to quote brief passages in connection with a review written for inclusion in a magazine, newspaper or broadcast. Requests for permission should be addressed to: Canadian Institute for Health Information 377 Dalhousie Street Suite 200 Ottawa, Ontario K1N 9N8 Telephone: (613) Fax: (613) ISBN (PDF) 2005 Canadian Institute for Health Information TM Registered Trade-mark of the Canadian Institute for Health Information Cette publication est disponible en français sous le titre : «Tendances relatives aux hôpitaux canadiens, Résultats d un projet d élaboration d une série historique de données statistiques et financières sur les hôpitaux canadiens pour les vingt-sept dernières années» ISBN (PDF)

3 Hospital Trends in Canada Table of Contents Acknowledgements... i Highlights... iii Background... v Part 1 Hospital Statistics... 1 Section 1: Key Characteristics of the Hospital Data Hospital Databases Size of the Hospital Sector Response Rates... 3 Section 2: Summary of Results All Hospitals Admissions and Separations Average Length of Stay for Inpatients... 7 Section 3: Summary of Results Acute Care Hospitals Separations and Inpatient Days per 1,000 Population Average Length of Stay for Inpatients Section 4: Visits to Ambulatory Care Units Section 5: Methodology Issues in Matching and Extrapolating Data Comprehensiveness Beds Staffed and In Operation Extrapolation of Totals Peer Groups Were Responding Hospitals Representative of all Operating Hospitals? Conclusions Part 2 Hospital Expenditures Introduction Section 6: Hospital Expenditure Trends Section 7: Hospital Expenditure by Functional Centre Functional Center Breakdown Functional Centre Distributions in the HS-1 and HS-2 and the CMDB Trends by Type of Expense from to Section 8: Hospital Expenditure by Type of Expense Type of Expense Breakdown Expense Distributions in the HS-1 and HS-2 and the CMDB Trends by Type of Expense from to Section 9: Hospital Expenditure by Functional Centre and Type of Expense Functional Center and Type of Expense Breakdown Trends by Functional Centre and Type of Expense Conclusions... 40

4 Hospital Trends in Canada Table of Contents (cont'd) Data Tables Table 1 Series Statistics Table 2 Series Expenditure Appendix A Statistical Variables and Data Matching... A 1 List of Figures Figure 1 Trends in Hospital Beds, Canada, 1976 to Figure 2 Response Rates in HS-1 and HS-2 and CMDB, Canada, to Figure 3 Hospital Admissions, Canada, to Figure 4 Hospital Separations and Admissions, Canada, to Figure 5 Hospital Separations and Admissions in CMDB and HMDB, Canada, to Figure 6 Average Inpatient Days, Canada, to Figure 7 Hospital Beds Staffed and In Operation, Reporting Hospitals, Canada, Selected Years... 9 Figure 8 Inpatient Days per 1,000 Population, Canada, Selected Years Figure 9 Average Days per Separation, Canada, Selected Years Figure 10 Visits Ambulatory Care Units, Canada, to Figure 11 Distribution of Hospital Expenditure, Reporting Hospitals, Canada, Selected Years Figure 12 Alternative Measures of Hospital Beds, Canada, to Figure 13 Figure 14 Hospital Expenditure Trends from the NHEX Database and from the Reporting Hospitals to CMDB, Canada, 1976 to Distribution of Hospital Expenditure by Functional Centre, Reporting Hospitals, Canada, and

5 Hospital Trends in Canada List of Figures (cont d) Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 Figure 27 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Functional Centre, Reporting Hospitals, Canada, to Distribution of Hospital Expenditure by Type of Expense, Reporting Hospitals, Canada, and Share of Hospital Expenditure by Selected Type of Expense, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, to Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, to Distribution of Salaries and Benefits, Reporting Hospitals, Canada, and Distribution of Ambulatory Care Expense, Reporting Hospitals, Canada, and Distribution of Emergency Care Expense, Reporting Hospitals, Canada, and

6 Hospital Trends in Canada List of Tables Table 1 Characteristics of CIHI Hospital Databases... 2 Table 2 Comparison of Statistics for Average Length of Stay, Canada, to Table 3 Hospital Beds by Type of Hospital, Canada, Table 4 Table 5 Table 6 Table 7 Table 8 Trends in Hospital Utilization per 1,000 Population, Canada, Selected Years Beds in Hospitals Reporting Admissions, Inpatient Days, Discharges as a Percent of Beds in Hospitals Reporting Any Statistics, and Bed Counts in Hospitals Reporting Any Statistics, Canada, to Hospital Expenditure and the Percentage Distributions by Functional Centre, Canada, Selected Years Expenditure Weights and Annual Rates of Increase, Administrative and Support Services, Canada, Hospital Expenditures by Functional Centre and Type of Expenses, Canada, List of Data Tables Table 1 Series Statistics Table 1.1 Selected Statistics, All Hospital Types, Canada, to Table 1.2 Table 1.3 Selected Statistics, General Public Hospitals Without Long Term Units, Pediatric Hospitals, and Private Hospitals, Canada, to Selected Statistics, General Hospitals With Long Term Units and Federal Hospitals, Canada, to Table 1.4 Selected Statistics, Teaching Hospitals, Canada, to Table 1.5 Table 1.6 Selected Statistics, Short Term Psychiatric Hospitals, Canada, to Selected Statistics, Long Term Psychiatric Hospitals, Canada, to

7 List of Data Tables (cont d) Table 1 Series Statistics (cont d) Hospital Trends in Canada Table 1.7 Selected Statistics, Other Specialty Hospitals, Canada, to Table 1.8 Selected Statistics, Rehabilitation Hospitals, Canada, to Table 1.9 Selected Statistics, Extended Care Hospitals, Canada, to Table 1.10 Selected Statistics, Other Hospitals, Canada, to Table 2 Series Expenditure Table 2.1 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars... 68

8 List of Data Tables (cont d) Table 2 Series Expenditure (cont d) Table 2.11 Hospital Trends in Canada Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 Table 2.17 Table 2.18 Table 2.19 Table 2.20 Table 2.21 Table 2.22 Table 2.23 Table 2.24 Table 2.25 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars... 83

9 List of Data Tables (cont d) Table 2 Series Expenditure (cont d) Table 2.26 Hospital Trends in Canada Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Table 2.27 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars... 85

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11 Acknowledgements The Canadian Institute for Health Information (CIHI) would like to acknowledge and thank many individuals who contributed to the development of this report and in particular, Vern Hicks, Health Economics Consulting Services; Brigitte Chavez and Rob Dunphy, Statistics Canada; and Jingbo Zhang, CIHI. For more information about this project or about this report please contact: Ms. Jingbo Zhang, Senior Analyst National Health Expenditures Canadian Institute for Health Information Suite Dalhousie Street Ottawa, Ontario K1N 9N8 Tel.: (613) Fax: (613) Web: i

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13 HOSPITAL TRENDS IN CANADA H IGHLIGHTS Highlights This report provides the first complete set of comprehensive statistical and financial data on hospital utilization and financial trends over the last 27 years. The data confirm fewer inpatient hospitalizations over the last 15 years and a reallocation of resources within the hospital sector as far back the mid-1970s. Highlights include: Relatively stable use of hospital inpatient care for approximately 15 years: 1. Hospital admissions and separations in Canada were relatively stable during the 15 years from fiscal to , with rates of growth in these statistics less than the rate of growth in the Canadian population. 2. The total number of hospital beds was relatively stable until the mid-1980s, but began to decline after Average length of stay for hospital inpatients remained stable during the 1980s. Rapidly changing utilization patterns during the last decade: 4. Hospital beds and inpatient utilization fell rapidly during the period of cost restraint and reorganization in the 1990s. Trends appear to be stabilizing at present. Changing patterns of resource allocation and hospital care: 5. Hospitals are the largest category of national health expenditure. Increases in hospital expenditure have been less than the average for all health expenditures, resulting in a drop in their share of national health expenditure from 45% in calendar 1976 to 30% in A considerable amount of hospital care and financial resources have been shifted from inpatient settings to ambulatory clinics. This trend is confirmed by both statistical and financial data. Visits to ambulatory care units have increased consistently. The number of patient visits to ambulatory units in acute care hospitals, including day surgery visits, is estimated to have exceeded 50 million in Ambulatory care, emergency departments and operating rooms have increased their share of hospital expenses. The shares of nursing inpatient and hospital support services have declined. 7. Staff salaries and benefits fell from 76% of hospital expenses in to 68% in Physicians remuneration, drugs and medical supplies have all increased their shares of expenditure. Utilization and financial data in this report were both projected to annual totals based on survey and administrative databases from Statistics Canada and the Canadian Institute for Health Information (CIHI). The project provided insights about the ability to match data between the Statistics Canada HS-1 and HS-2 surveys and CIHI s Canadian MIS Database to inform ongoing analysis and future development of hospital databases. iii

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15 HOSPITAL TRENDS IN CANADA B ACKGROUND Background The Canadian Institute for Health Information (CIHI) maintains the Canadian MIS Database (CMDB), which consists of financial and statistical information primarily on Canadian hospitals. The CMDB replaced the Annual Return of Health Care Facilities Hospitals (traditionally known as HS-1 and HS-2), 1 which was carried out by Statistics Canada from 1932 until fiscal CIHI and Statistics Canada carried out a project in 2002 to match financial data from the two sources. The results were published as an Analytical Focus article in the publication, National Health Expenditure Trends, 1975 to Details about the data matching project and methods used to match data from the two databases are available in a documentation manual published by CIHI and Statistics Canada in 2003 which is available on CIHI s web site. 2 A second project was carried out in 2004 and 2005 to match statistical data from the two sources. Part 1 of this report presents the results of that project. An updated copy of the 2002 financial analysis is also included as Part The Annual Returns were submitted in two parts. Part 1 (HS-1) contained the most detail and primarily was used in this project. Part 2 (HS-2) contained audited information but at higher levels of aggregation. 2. A Project to Establish a Historical Series of Hospital Spending by Function and Type from 1976 to CIHI, Ottawa, Available at < v

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17 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS Part 1 Hospital Statistics SECTION 1: KEY CHARACTERISTICS OF THE HOSPITAL DATA 1.1 Hospital Databases CIHI maintains three distinct databases of hospital utilization data. 1. The Canadian MIS Database (CMDB) consists of financial and statistical information on Canadian hospitals. The CMDB is updated annually from data submitted by provincial and territorial health ministries. The database is intended to include all hospitals, including public hospitals operated by provinces/territories or health authorities, federal hospitals and proprietary or private hospitals. CMDB data are based on expenditure and statistical categories contained in CIHI s Guidelines for Management Information Systems in Canadian Health Service Organizations (MIS Guidelines). The first data submissions covered data from fiscal Data results are now reported annually. The CMDB replaced the Annual Return of Health Care Facilities Hospitals (HS-1 and HS-2), which was carried out and published in annual reports by Statistics Canada from calendar 1932 until fiscal In only the preliminary survey was carried out. The Statistics Canada survey was based on reporting standards defined in the Canadian Hospital Accounting Manual (CHAM), which was replaced by the MIS Guidelines in the mid-1990s. 2. The Discharge Abstract Database (DAD) contains complete clinical data for inpatient acute care hospital separations in Canada (excluding Quebec and non-winnipeg facilities in Manitoba). The DAD also contains partial clinical data from chronic, rehabilitation, psychiatric and same day surgery facilities. Source data are abstracted from clinical records. The database includes information on patient characteristics, diagnoses and procedures. Inpatient acute care cases are categorized using Case Mix Groups or CMG TM methodology and measures of relative resource use are assigned by a Plx TM classification system. Day surgery cases are categorized using Day Procedure Groups or DPG TM methodology. 3. The Hospital Morbidity Database (HMDB) is a national data holding that captures administrative, clinical and demographic information on hospital inpatient events. It provides national discharge statistics from Canadian health care facilities by diagnoses and procedures. Discharge data are received from acute care facilities and select chronic care and rehabilitation facilities across Canada. Discharge data from psychiatric facilities, as well as day procedures (e.g. day surgeries) and emergency department visits are not captured in this database. 1

18 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS See Table 1 for the summary of relevant key characteristics of the three databases. Table 1 Characteristics of CIHI Hospital Databases Data Characteristics CMDB DAD HMDB Scope of data Level of detail Central focus Inpatient Separations: Exclusions Financial and statistical Aggregate by institution Comprehensive financial and statistical data Inpatient separations and day surgery Case oriented* Acute care Inpatient separations Case oriented* Acute care 3,512,628 2,356,224 2,770,128 No systematic exclusions. All types of hospital care are intended to be included. Ambulatory clinics. Although all inpatient separations are included, the CMG grouping methodology focuses on acute care. Ambulatory clinics, chronic care hospitals in Ontario and BC, and Psychiatric hospitals. * Case oriented data in DAD and HMDB include certain characteristics of cases separated (e.g. age, sex, diagnosis). 1.2 Size of the Hospital Sector Canada spent $34.4 billion on the hospital sector in 2002, equivalent to 30% of total health expenditure. 3 In 1976, hospitals accounted for 45% of health expenditure. Hospital expenditures have grown during most of the last three decades except for three years between 1993 and In most years, the declining share of hospital expenditure in total health expenditure reflects more rapid growth of other categories of expenditure. The period during the mid-1990s when hospital expenditures decreased was a period of significant change in the Canadian health care system, as provincial governments restrained expenditure growth in most programs in order to balance budgets. In health care, there were initiatives to move the location of care from expensive inpatient acute care to day surgery or home care. In the three years from 1993 to 1996 the share of health expenditure allocated to hospitals dropped from 37.4% to 33.7%. The deployment of real resources in the hospital sector began to change during the 1980s. The number of beds approved by provincial governments peaked in at 179,256 (Figure 1). The number of beds declined slowly for the next three years but then increased in , mainly due to the reclassification of ten facilities in Ontario with 3,376 beds changing from residential care facilities to long term psychiatric hospitals. During the three years from to , the number of beds 3. National Health Expenditure Trends, 1975 to Canadian Institute for Health Information, Ottawa

19 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS dropped by 20.7%, while expenditure decreased by 5.7%. Hospital expenditure began increasing again in The number of beds continued to drop until , when they leveled out at approximately 115,000 with small year-to-year variations. Expenditure data in Figure 1 are not adjusted for price inflation. Price inflation was relatively high in the 1970s and 1980s, but dropped to a range of 2% to 3% in the 1990s. Figure 1 Trends in Hospital Beds, Canada, 1976 to 2002 Expenditure ($ millions) 40 Beds (000) Expenditure (per calendar year) 25 Beds (per fiscal year) Year Sources: Canadian Institute for Health Information and Statistics Canada. The striking changes to the hospital sector outlined above have led to public debate about overall levels of funding for health care, waiting times for hospital care and the adequacy of support programs for patients who now spend less time in hospital or have care provided on a same-day basis. Solid information on the utilization of hospital resources is required in order to inform debate on these important public issues. These circumstances illustrate the relevance of a valid series of hospital utilization data and provide context to the project to create a consistent series of hospital statistics. 1.3 Response Rates Circumstances that increase the difficulty of producing a consistent series of hospital data include the switch from a mandatory survey by Statistics Canada to CMDB data submitted directly by provinces/territories, with a one-year gap in Response rates (beds in reporting hospitals as a percentage of beds in all operating hospitals) were lower during the four years from to , although they have recovered during the 2000s to levels similar to response rates under the Statistics Canada surveys in the early 1990s (Figure 2). 3

20 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS A growing gap between approved beds and beds staffed and in operation was a second confounding factor. Beds staffed and in operation were 3.0% less than approved beds in By , the gap had increased to 9.8% and in reached 22.8%. Bed counts shown in Figure 1 are approved beds until Under the CMDB provinces/territories report only one set of bed counts. In most jurisdictions reported approved beds but some provinces have since switched to beds staffed and in operation (see discussion in Methodology section). A third issue is the classification of beds in certain facilities. Statistics Canada reports that between and over half the decline in the number of approved beds occurred in extended care hospitals and long term care units of general hospitals. 4 Many of these institutions were reclassified to residential care facilities, which were not included in the HS-1 and HS-2 surveys. The change in accounting and reporting standards from the CHAM to the MIS Guidelines also create difficulties in time series analyses. These circumstances provided limitations and challenges to analysts who carried out the match between Statistics Canada s HS-1 and HS-2 and CIHI s CMDB hospital data. The summaries of results that follow discuss the strategies to improve comparability as well as limiting factors % Figure 2 Response Rates in HS-1 and HS-2 and CMDB, Canada, to % 80.0% 70.0% 60.0% Year Sources: Canadian Institute for Health Information and Statistics Canada. 4. Tully, P, Saint-Pierre E. Downsizing Canada s hospitals, 1986/87 to 1994/95. Health Reports, 1997-V8 (4), pg

21 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS S E C T I O N 2 : S U M M A R Y O F R E S U L T S ALL HOSPITALS 2.1 Admissions and Separations Hospital admissions provide a highly aggregate indicator of access, and utilization of hospital resources. Admissions would not necessarily follow the same trend as number of beds. Changes in care patterns, such as shorter stays and higher bed occupancy rates, would allow more admissions for a given bed complement. Average length of stay is discussed later. Bed occupancy rates in acute care hospitals increased from 84.7% in to 90.9% in and then dropped back to 86.6% by Admissions tended to be fairly constant between and at approximately 4.0 to 4.2 million per year (Figure 3). Admissions began declining in , dropping from 4.2 million in to 4.1 million in During the following years the number of admissions continued to drop, leveling out at 3.3 million to 3.1 million between and (000) 4,500 Figure 3 Hospital Admissions, Canada, to ,500 Raw data Extrapolation 2,500 1, Year Sources: Canadian Institute for Health Information and Statistics Canada. The estimates in Figure 3 include raw data reported by hospitals and an extrapolation that adjusts for the drop in survey response rates during the early 1990s and the initial years of the CMDB. Estimation techniques are discussed in the Section 5. Admissions also include newborns, which represent approximately 10% of total admissions. 5. CIHI data prepared for OECD Health Data. 5

22 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS While the exact numbers in the extrapolated series are subject to a degree of uncertainty, the trends in beds and admissions are compelling. Between and , the number of beds and admissions reported by provincial/territorial governments dropped by 36% and 26% respectively. Hospital separations are defined as the number of cases discharged plus the number of inpatient deaths. Separations are usually the preferred variable to measure hospital inpatient throughputs since they measure the number of completed cases, while admissions measure the number of cases that entered treatment. The number of admissions and separations were almost identical for most years between and , with differences normally less than two-tenths of one percent (Figure 4). Differences were greater in and subsequent years, possibly reflecting greater variability due to lower response rates. (000) 4,500 Figure 4 Hospital Separations and Admissions, Canada, to ,500 Separations Admissions 2,500 1, Year Sources: Canadian Institute for Health Information and Statistics Canada. Figure 5 compares the extrapolated series of separations from to from the CMDB with data from the HMDB publications. Separations from HMDB are not extrapolated but historically reporting to HMDB has been more complete than for the other hospital databases (the CMDB and the DAD). Data published in the HMDB reports cover facilities that provide acute care and exclude same day surgery, extended care facilities, psychiatric and chronic care hospitals. HMDB also excludes newborns born in the reporting facility from published series. Newborns represent approximately 10% of hospital separations and were added into the HMDB separation statistics for purposes of comparisons in Figure 5. The two series correspond in most years, indicating that trends in hospital separations are consistent between the two independent sources of data. 6

23 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS (000) 4,500 Figure 5 Hospital Separations in CMDB and HMDB, Canada, to CMDB HMDB 3,500 2,500 1, Year Sources: Canadian Institute for Health Information and Statistics Canada. 2.2 Average Length of Stay for Inpatients Average length of stay (ALOS) is a statistic that is measured by dividing the total days stay since admission for separated patients by the number of separations. There were data quality problems with the total days stay variable in the early years of the CMDB. Consequently, average inpatient days during the year per separation was considered to be a more reliable indicator of the overall tendency in average duration of an episode of inpatient care since there was a continuous series from to the present. The main difference between this statistic and average length of stay is in the calculation for patients whose stay in hospital extends over two fiscal years. In the ALOS statistic all days since admission are included for patient separations during the year (including days in the previous year); in the average inpatient days per separation statistic all inpatient days during the year are divided by total separations for that year. Average inpatient days per separation may slightly understate average time in hospital. On the other hand, patients who remain in hospital for more than one year are uncommon except in extended and long term care facilities, and could be considered outliers that would tend to skew estimates of norms for time spent in hospital before separation. While the conceptual differences above provide important context for analysts, the two series were very similar between and as shown in Table 2. Both variables followed the same trend through time (Figure 6). Both statistics showed that average inpatient days remained relatively constant during the 1980s, between 13.0 and 13.9 days per separation, and then began to decline in Average days per separation declined from 13.3 in 1989 to 10.1 in Variations in the trend in and may result from data variability in extrapolations from reported data (inpatient days, discharges and deaths were extrapolated separately and the average inpatient days statistic was calculated from the resulting estimates). 7

24 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS Table 2 Comparison of Statistics for Average Length of Stay, Canada, to Average Days Per Separation ALOS Mean Value Standard Deviation Sources: Canadian Institute for Health Information and Statistics Canada Figure 6 Average Inpatient Days, Canada, to Inpatient Days per Separation Average Length of Stay Year Sources: Canadian Institute for Health Information and Statistics Canada. S E C T I O N 3 : S U M M A R Y O F R E S U L T S ACUTE CARE HOSPITALS Trends in beds and utilization were not the same in all sectors of hospital care. Between and , the year in which beds actually staffed and in operation reached a peak, the number of beds in general hospitals 6 that offered only short term care fell while beds in hospitals 7 offering both short term and long term care grew (Figure 7). While a detailed analysis of this trend was not carried out, it seems reasonable to assume that a number of hospitals that were exclusively short term care in introduced long term care beds over the next ten years. Beds in teaching hospitals and hospitals 6. This category also includes public pediatric hospitals and private hospitals which account for a small portion of the entire category. Refer to Section 5 for further details. 7. Federal hospitals are also included in this category. 8

25 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS dedicated to short term psychiatric care, other specialties and rehab services also grew during this period. 8 The number of extended care hospital beds grew during the decade, but at lower rates than the other two categories in which growth occurred. 70,000 Figure 7 Hospital Beds Staffed and in Operation, Reporting Hospitals, Canada, Selected Years 50,000 30,000 10, p Year Public General With No Long Term Units; Pediatric and Private Hospitals Public General With Long Term Units and Federal Hospitals Teaching, Short Term Psychiatric, Other Specialty and Rehabilitation Hospitals Extended and Long Term Psychiatric Hospitals p = preliminary data Source: Statistics Canada. Between and , beds staffed and in operation fell in all categories of hospitals, with the greatest percentage reductions occurring in extended care hospitals (54%) and hospitals offering only short term care (34%). Reductions in beds staffed and in operation were greater than reductions in approved beds, especially during the 1990s (see discussion in the Methodology section). The reclassification of some hospitals from extended care hospitals to residential care facilities was an important factor in the reduction of extended care beds. Statistics Canada reports that approximately 14,000 approved beds were reclassified to residential care in Alberta and Quebec during the early and mid-1990s. 9 Numbers were not provided for beds staffed and in-operation that were reclassified. Statistical data for residential care facilities are contained in a separate database the Residential Care Facilities (RCF) database and when hospitals are reclassified their statistics are no longer recorded in the HS-1 and HS-2 surveys or the CMDB. Consequently, trend data that include extended care facilities prior to their transfer to the RCF database tend to overstate reductions in utilization during years when the transfer took place. In order to understand trends without this confounding factor, this section focuses on hospitals that offer primarily acute care. The definition of acute care hospitals 8. The category that includes teaching hospitals in Figure 7 had 44,442 beds in , 38,464 of which were beds in teaching hospitals. 9. Downsizing Canada s Hospitals, 1986/87 to 1994/95. Patricia Tully, Etienne Saint-Pierre. Health Reports, Spring 1997, Vol.8, No.4. 9

26 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS in this analysis is based on that of the OECD. 10 It includes hospital types found in the CMDB which are general hospitals, specialty hospitals except long term psychiatric hospitals, and rehabilitation hospitals. Extended care facilities and long term psychiatric hospitals, which were included in the previous section, were excluded in this section. Both the HS-1 and HS-2 and the CMDB classify hospitals according to type of service and size. Although the two classification systems were not identical, it was possible to combine hospitals into comparable groups. Hospitals included in the analysis had approximately 132,500 approved beds and 103,900 beds staffed and in operation in (Table 3). They had an average of 9.3 days stay per separation, while extended care and long term psychiatric care hospitals had an average of days. While hospitals included in this analysis are referred to as acute care, it is important to note that many of these hospitals may provide a mix of short term acute care and longer term care. The HS-1 and HS-2 data distinguished between short term and long term units in hospitals. In the CMDB series, short term and acute care are subsumed in the CMDB hospital types of general hospitals, specialty hospitals and rehabilitation hospitals and are not identified as separate categories. Table 3 Hospital Beds by Type of Hospital, Canada, Type of Hospital Approved Beds Beds Staffed and In Operation Inpatient Days per Separation (1993) Public general with no long term units* Public general with long term units** 24,470 18, ,458 51, Teaching 37,263 29, Short term psychiatric; other specialty and rehab 5,315 4, Sub-total acute care 132, , Extended care and long term psychiatric 24,041 16, Total 156, , * This category also includes public pediatric hospitals and private hospitals which account for a small portion of the entire category. ** Federal hospitals are also included in this category. Source: Statistics Canada. 10. OECD Health Data 2004, 3 rd Edition. 10

27 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS 3.1 Separations and Inpatient Days per 1,000 Population Hospital separations per 1,000 population decreased throughout the 27 years from to , 11 with the largest annual decreases in the years after There was little difference between all hospitals and acute care hospitals in the number of separations per 1,000 population or rates of change. There were marked differences in the number of inpatient days (Table 4, Figure 8), reflecting the relatively high average days stay in extended care hospitals. Rates of change in inpatient days were similar between the two hospital groups, with small increases between and , followed by decreases in subsequent years. The higher rate of decrease between and for all hospitals includes the effects of transferring beds and associated utilization from hospital to RCF status (Table 4). Table 4 Trends in Hospital Utilization per 1,000 Population, Canada, Select Years All Hospitals Acute Care Hospitals Separations Inpatient Days Separations Inpatient Days , , , , , , to to to Annual Rates of Change -0.9% 0.2% -1.0% 0.1% -1.6% -3.4% -1.6% -3.6% -3.9% -5.7% -3.8% -4.2% 11. Data in Section 1 show modest growth in admissions and separations until , but rates of growth in these statistics were less than the rate of growth in the population. 11

28 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS 2,500 Figure 8 Inpatient Days per 1,000 Population, Canada, Selected Years All Hospitals Acute Care Hospitals 2,000 1,500 1, Year Sources: Canadian Institute for Health Information and Statistics Canada. 3.2 Average Length of Stay for Inpatients Average inpatient days per separation increased between and in acute care hospitals (Figure 9). Average days decreased over the next 16 years, reaching 9.0 days in , a reduction of 15.9% from the 10.7 days recorded in Average days per separation reported here are higher than estimates in the HMDB due to additional exclusions in that database. Figure 9 Average Inpatient Days per Separation, Canada, Selected Years Year Sources: Canadian Institute for Health Information and Statistics Canada. 12

29 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS SECTION 4: VISITS TO AMBULATORY CARE UNITS Ambulatory care units include clinics, emergency departments and day surgery. Day surgery procedures are identified in CIHI s Discharge Abstract Database (excludes Quebec; Alberta since ; and Manitoba hospitals outside the Winnipeg area). The DAD reported 2.0 million day surgery procedures and 1.4 million day surgery visits in Visits to ambulatory care departments did not follow the same trend as separations. Visits increased in virtually all years, following a linear trend in which total visits in acute care hospitals almost doubled between (23 million) and (41 million). 12 If trends in the ten years ending in continued, the number of visits would exceed 50 million by (Figure 10). Trends in visits provide an important counterpoint to trends in inpatient services, demonstrating that a considerable amount of hospital care was transferred from inpatient to ambulatory services during the period when hospital beds were decreasing. (000) 50,000 Figure 10 Visits Ambulatory Care Units, Canada, to ,000 30,000 20,000 10,000 HS-1 and HS-2 Linear Trend (HS-1 and HS-2) Source: Statistics Canada. Year Visits under the HS-1 and HS-2 were reported for clinics, outpatient programs, emergency departments and day surgery. The term ambulatory care refers to ambulatory care units in the hospital but includes visits by both outpatients and inpatients for example those who are required to go to emergency departments for care not available in the inpatient service to which they were admitted. In the CMDB, visits were reported as either scheduled or unscheduled visits until April 2002, when they were replaced by visits face to face. The MIS Guidelines break down statistics into functional centres that include specialty clinics, emergency departments, surgical suite and other ambulatory care. As a 12. Visits in acute care hospitals represented 96.5% of all visits reported to HS-1 and HS-2 in

30 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS result, the structure of the two reporting systems allows a match of statistics for visits to ambulatory care units, both in aggregate and in some detail regarding the type of unit in which the visit took place. After the transition from the HS-1 and HS-2 to the CMDB, the reporting of visits became somewhat erratic. This might have resulted from under-reporting in some jurisdictions or misinterpretation of how visits and other ambulatory services, such as lab procedures, should be reported. At an early stage during the matching process it was determined that the distinction between scheduled and unscheduled visits was unclear in data from a number of jurisdictions (for example, one might expect that most visits to emergency departments would be coded as unscheduled, but this was not the case). As a result of these findings, data on trends in the number of visits after were not included. Investigation of these issues is ongoing as part of the CMDB s quality control procedures and visit data is expected to be available in the future. Trends in hospital expenditures for ambulatory care units in the HS-1 and HS-2 and the CMDB confirm the shift of hospital care to ambulatory units. Hospital expenditures by functional centre show increasing shares of hospital budgets allocated to emergency departments, ambulatory care and operating room (Figure 11). The share of expenses allocated to emergency departments and ambulatory care more than doubled between and Taken together, these functional centres accounted for 12.4% of hospital expenditure, or $4.1 billion, in , compared to 4.9% in Operating rooms increased their share more modestly (4.7% to 5.9%). Operating room expenditures include both inpatient and day surgery cases. 8.0% 7.0% 6.0% Figure 11 Distribution of Hospital Expenditure, Reporting Hospitals, Canada, Selected Years Emergency Ambulatory Care Operating Room 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Year Sources: Canadian Institute for Health Information and Statistics Canada. 14

31 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS SECTION 5: METHODOLOGY 5.1 Issues in Matching and Extrapolating Data Reporting standards in the HS-1 and HS-2 and the CMDB databases are based on two different accounting systems (the CHAM and the MIS Guidelines respectively). Challenges in matching financial data reported under the two standards are discussed in some detail in the financial project documentation manual available on CIHI s web site. Both types of data can be matched at certain levels of detail, but the prospect for matching is limited as the levels of detail become finer. The Annual Hospital Surveys collected data at more aggregate levels than the CMDB. The MIS Guidelines used in the CMDB require more detailed data, which can be rolled up to aggregate levels for trend comparisons. Statistical data can be separated into two types of variables: 1. those that allow analysis of utilization trends (e.g. inpatient separations, inpatient days and ambulatory visits); 2. those that complement financial data in the analysis of hospital efficiency (e.g. hours worked in specific functional centres). The utilization data were defined in a similar way in both HS-1 and HS-2 and CMDB. The efficiency-related data tend to be consistent at certain levels, but tend at more detailed levels to have the same limitations on consistency as financial data. The financial data matching project was able to provide annual estimates of expenditure by type of expense and hospital functional centre. This two-way breakdown was achieved by first calculating percentage coefficients for each cell in a data matrix, based on HS-1 and HS-2 returns and data submission to CMDB, and then applying the coefficients to estimates of total hospital expenditure from NHEX. Part 2 of this report consists of updated financial estimates first presented in While financial breakdowns can all be seen as allocations within a hospital budget, statistical variables must be extrapolated independently. A two-way breakdown was not feasible for most variables. In some cases variables were naturally concentrated in certain functional centres or were mainly interesting at aggregate levels, e.g. hospital admissions. Statistical extrapolations based on sample data can normally be assigned a specific margin of error within a defined level of probability (95% is usually the level of probability at which differences within random samples are considered significant). This is possible when the samples from which data are drawn are random and reflect the characteristics of the sector from which they are drawn. A second assumption is that survey respondents provide accurate responses subject to random errors that will tend to cancel out. 15

32 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS 5.2 Comprehensiveness Both the Statistics Canada surveys and the provincial data collected for the CMDB cover all hospitals, not a random sample. The HS-1 and HS-2 surveys were compulsory under the Statistics Act and compliance appears to have been almost universal, except for a decline in the 1990s (see Figure 2). Response rates were lower in the early years of the CMDB, although this fact alone would not obstruct extrapolation of the data collected so long as the non-responses were random rather than systemic. There is no evidence of systemic non-response for the major utilization variables discussed in Section 1, although there were years in which fewer than half of hospitals in Newfoundland, Prince Edward Island, Nova Scotia, Saskatchewan and territories reported. A second concern with respect to response rates relates to whether all questions were answered. Both databases contain data elements that are broken down by operating department (e.g. admissions or visits). In the HS-1and HS-2 these data elements also have a total for all departments. The CMDB contains high-level accounts that could be used to record aggregate data in lieu of detail. In some cases only the variable total or high level account was reported. These situations limit the extent to which some data can be disaggregated, even after adopting strategies to distribute the high level accounts. In the matching project high level accounts were distributed to lower level accounts (see financial project documentation manual for details). 5.3 Beds Staffed and In Operation The data in Figure 12 are based on provincial master lists of hospitals and their bed capacity. Different definitions have been used to measure capacity. Rated beds (based on hospital technical capacity), approved beds (based on provincial budget allocations) and beds staffed and in operation were all reported to the HS-1 and HS-2. Bed counts were as of the last day of the fiscal year. Rated and approved beds followed similar trend lines with absolute differences of 4,000 to 5,000 beds until Between and there was very little difference between rated beds and approved beds (Figure 12). However, the number of approved beds and the number actually staffed and in operation tended to diverge. In the difference was equivalent to 10%. There were large decreases in both approved and operating beds in , and the gap between approved and operating beds increased to 23%. Part of this reduction can be explained by the transfer of a number of extended care hospitals to residential care facilities and the loss of their data to the hospital databases (see Table 3 and Section 1). Provincial/territorial ministries of health provide master lists of beds to the CMDB as of the beginning of the fiscal year. Provinces/Territories report either approved or operating beds, with a recent trend toward reporting operating beds. From until , the number of beds reported on the provincial master lists remained above the number of beds reported to be in operation in

33 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS 190, , , , , , , , , Figure 12 Alternative Measures of Hospital Beds, Canada, to Rated Approved Staffed and In Operation CMDB Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada p Extrapolation of Totals The method used to extrapolate the utilization variable was to divide the values of the variables by the number of beds in reporting hospitals and multiply the result by beds in all operating hospitals. This technique standardizes for hospital size and avoids potential distortions that could result from using the number of hospitals to project totals. Two sets of extrapolations were done. The first set extrapolated data for each variable separately for each province/territory and year. Provincial/territorial lists of beds were used to obtain bed counts in both stages of the estimation (calculating average per bed in reporting hospitals and multiplying by total beds), and therefore the lack of a consistent series of beds does not affect the annual extrapolations. In the second set of extrapolations hospitals were grouped into peer groups reflecting type of care (see Table 4 in Section 3). Extrapolations were carried out for each peer group and aggregated to obtain a series for acute care hospitals, then for all hospitals. In both cases Canada totals were obtained by summing the extrapolated provincial/territorial or peer group values. A variation of the methodology was tested in provincial/territorial extrapolations of the three utilization variables where all hospitals would be expected to have data to report. All hospitals with beds in operation would be expected to have admissions, separations and inpatient days, even though they might not have reported these variables in their survey responses. In the extrapolations for each jurisdiction, data reported were divided by beds in 17

34 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS hospitals that actually reported data for the utilization variable and multiplied by the number of beds in all operating hospitals. 13 The rates of completeness in reporting major utilization variables are shown in Table 5. Table 5 Beds in Hospitals Reporting Admissions, Inpatient Days, Discharges as a Percent of Beds in Hospitals Reporting Any Statistics, and Bed Counts in Hospitals Reporting Any Statistics, Canada, to Year Admissions Inpatient Days Discharges Beds in Hospitals Reporting Any Statistics % 98.2% 98.3% 123, % 98.5% 95.9% 114, % 99.5% 96.9% 115, % 98.0% 95.2% 113, % 97.7% 94.2% 111, % 97.0% 92.9% 109, % 97.1% 94.2% 111, % 97.1% 95.7% 112,612 The approach using beds in hospitals reporting each data variable tended to provide higher values in extrapolated data than the approach that used beds in hospitals reporting any statistical data, with the ratio of the different sets of estimates normally in the range of the percentages shown in Table 5. In addition, the greater detail in provincial series allowed analysts to pinpoint anomalous data in certain jurisdiction-year cells. As data are aggregated into higher levels (e.g. peer group for Canada), these data anomalies are not always apparent. In effect, the level of aggregation of the data may lead to different perspectives about consistency over time. The level of data aggregation affects extrapolation results, as demonstrated when provincial/territorial and peer group extrapolations were compared. In some cases errors in cells with few reporting beds were blown up in the provincial extrapolations into totals that would be several times higher than actual totals. 14 Consequently, more intervention by analysts is required when using the provincial data, necessitating judgments about data accuracy. In this report, extrapolated values shown in figures and data tables were taken from the series used in the peer group analysis. This was done in view of the importance of focusing on acute care hospitals and the need to provide a consistent methodology for 13. This approach is conceptually different from the main approach, which assumes that some hospitals would not have certain data to report (e.g. services to newborns) and that data from hospitals that provided any response to the survey would be representative, in aggregate, of all hospitals in terms of the patterns of care provided. 14. As an example, in one of the smaller provinces there was an apparent error of 50,000 in the number of discharges during a year when only 21% of beds reported. The error from extrapolation would have increased to 236,000. If the data were rolled up in Canada totals, the percent of beds reporting would have been 91% and the resulting error would be 55,

35 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS estimating totals in both Sections 3 and 4 where extrapolated values are used. In future work there would be merit in carrying out a more thorough examination of data by peer group and province/territory. 5.5 Peer Groups The analysis contains nine peer groups into which data were aggregated. Although a finer level of peer groups is available, it was decided to group hospitals into aggregations based on similar inpatient days per separation (e.g. pediatric hospitals and private general hospitals joined to the group primarily for public hospitals with no long term units), while retaining distinctions based on traditional groupings (e.g. public general, teaching, other specialties). Time series data for all nine peer groups are included in the Data Tables. These data are not extrapolated. They also include preliminary data for where available, however, the series have not been included in the Part 1 analysis except for trends in hospital beds. 5.6 Were Responding Hospitals Representative of all Operating Hospitals? The issue as to whether responding hospitals were representative of all hospitals is mainly relevant during the early years of the CMDB when response rates were below normal. In years where response rates (percentage of beds in responding hospitals) were in the midnineties, it is unlikely that differences between respondents and non-respondents would be sufficient to affect extrapolated values. CONCLUSIONS This project provides a complementary set of time series data that, together with the financial data in Part 2, have the potential to add to our understanding of trends in hospital utilization and the allocation of hospital resources. Extrapolated data provide the first comprehensive series of utilization statistics published for all hospitals. A second set of data focuses on hospitals that provide acute care. Notable trends include: Use of hospitals in Canada, in terms of total admissions and separations, remained relatively stable during the 15 years from to Admissions and separations grew by only 3% during that time, less than the growth in population, which was 19%. Average inpatient stays increased during the late 1970s but then remained stable during the 1980s. Hospital beds and inpatient utilization fell rapidly during the period of cost restraint and acute care reorganization of the 1990s. Recent data suggest these trends are leveling out. A considerable amount of hospital care has been shifted from inpatient settings to ambulatory clinics. This trend is confirmed both by statistical and financial data. The project provided insights about the ability to match data between the HS-1 and HS-2 surveys and the CMDB. These insights have the potential to inform ongoing development of hospital databases. 19

36 HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS The two databases can be matched at relatively high levels of aggregation. The reliability of the matching declines as details specific to level of care are investigated. A troubling example was the inability to create a reliable series on visits to emergency care departments. The decision to collect data from provincial/territorial ministries of health (in the CMDB) might have led to some discontinuities in data when compared to annual surveys completed by hospitals themselves. It is important to note that provincial/territorial ministries were subject to considerable change due to staff downsizing and reorganization during the period of transition from to The MIS Guidelines are structured to provide much greater functional centre detail than the CHAM-based data in the HS-1 and HS-2. If the data were reported to the level of detail that the MIS Guidelines permit, more accurate statistics could be tracked to support better decision-making in the Canadian health care system. 20

37 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Part 2 Hospital Expenditures INTRODUCTION Part 1 of this report details the results of matching several selected common statistical variables collected by Statistics Canada in their Annual Return of Health Care Facilities- Hospitals (HS-1 and HS-2) with those collected in CIHI s Canadian MIS Database (CMDB). The Statistics Canada survey is based on the Canadian Hospital Accounting Manual (CHAM). The time series that was collected using this tool extends from 1932 to The CMDB is based on the Guidelines for Management Information Systems in Canadian Health Service Organizations (MIS Guidelines) and is the successor dataset to the HS-1 and HS-2 and contains data from to The purpose for matching data between the two data sets is to create a historical series. Part 2 of this report provides an update of data originally published in the Analytical Focus section of the National Health Expenditure Trends report released in 2002 when CIHI and Statistics Canada carried out a project to develop a consistent historical series of detailed hospital expenditures from the mid-1970s to the late-1990s. In order to match the data as closely as possible, a matrix of functional centres and types of expense was created and mapped from each data set into cells of the matrix. The template for the matrix was based on the MIS Guidelines primary and secondary accounts, which provided a good fit for most of the CMDB data. Analysts were able to fit variables from the HS-1 and HS-2 data into most cells of the matrix but there were some cases where the higher levels of aggregation in HS-1 and HS-2 did not permit as fine a division of data as is the case with the CMDB. Nonetheless, CIHI and Statistics Canada decided to use greater levels of detail for CMDB data in the matrix where there seemed to be the potential for continuing analytical interest. Further details about the data-matching can be found in the documentation manual, which is available through the CIHI web site. This part of the report contains four sections. Section 6 provides a description of hospital expenditure trends during to and compares survey data to NHEX estimates. Section 7 discusses expenditures by functional centre and Section 8 discusses expenditures by type of expense. Section 9 presents a cross-classification of expenditures using the template developed for the data-matching project. 21

38 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS S E C T I O N 6 : H O S P I T A L EXPENDITURE TRENDS Hospital expenditures in Canada increased from $6.4 billion in 1976 to $26.7 billion in 1993 (Figure 13). Hospital expenditures decreased during the next three years, then resumed growth in The period of negative growth in hospital expenditures coincided with a period of fiscal restraint by provincial and territorial governments, which saw both health expenditures and other government expenditures decrease. Figure 13 Hospital Expenditure Trends from the NHEX Database and from the Reporting Hosptials to CMDB, Canada, ($ millions) 1976 to ,000 30,000 25,000 20,000 15,000 10,000 5,000 NHEX Reported Year Sources: Canadian Institute for Health Information and Statistics Canada. Hospital survey estimates tend to be close to the NHEX estimates. From to the end of the HS-1 and HS-2 series in , survey estimates were in the range of 87% to 96% of NHEX estimates in most years. With the transition to the CMDB in , estimates ranged from 86% to 96% of the NHEX estimates, with the closest match in Response rates were somewhat lower in the initial years of the CMDB than they were with the HS-1 and HS-2 surveys (reporting hospitals accounted for 84% of approved beds in , with the response rate rising to 98% of beds in ). A number of factors should be taken into account when comparing the data from the HS-1 and HS-2 and the CMDB to NHEX data. 15. All trend data reported in this analysis are based on current dollars. At present there is no specific price index for hospital expenditure. Inflation adjusted data based on the implicit price index for government consumption expenditure (the public sector price index used in NHEX) shows a flatter expenditure curve than Figure 13 but the trends before and after 1993 are the same. 22

39 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Hospitals included in the HS-1 and HS-2 surveys consisted of all hospitals controlled by provincial and territorial ministries of health. Federal and private hospitals are not included. Although some data from federal and private hospitals are collected in the CMDB, their data have been excluded from this analysis to maintain comparability with the HS-1 and HS-2. The NHEX database includes all hospitals. There were 746 hospitals with 115,120 beds in Canada in , of which six hospitals with 266 beds were federal and 12 hospitals with 814 beds were classified as proprietary. 16 Data in Figure 13 have not been extrapolated to estimate expenditure in non-reporting hospitals. NHEX data are for calendar years while survey data are for fiscal years (e.g is compared to the CMDB for the fiscal year April 1996 to March 1997). NHEX excludes capital from the hospital expenditure estimates and report capital expenditures as a separate category. Hospital expenditure from the HS-1 and HS-2 and the CMDB include all expenses except those that are capitalized. The data from these sources do include some expenses that are capital related, such as amortization and interest on long term debt. Capital-related expenses were not included in this analysis to avoid double counting (capital-related expenses reported in the CMDB for were $1.1 billion, equivalent to 3.2% of amounts reported). NHEX public sector estimates are compiled from public accounts (private sector estimates are taken from the HS-1 and HS-2 and the CMDB). In some cases long term care program expenditures could flow to hospitals with long term care units. Long term care expenditures in public accounts would normally be grouped with expenditure for other institutions (homes for special care) in NHEX, unless such expenditures were explicitly identified as going to hospitals (or to home care). The HS-1 and HS-2 preliminary survey in coincided with the reversal of the trend to annual increases in hospital expenditure. Expenditure for all hospitals declined by 2.1% in 1994, the first decrease in any of the years since the data series began. Hospital expenditure decreased by another 2.5% in 1995 and 1.2% in 1996, leading to a compound decrease of 5.8% in three years. Hospitals would have made a number of adjustments during this period to deal with reduced revenues. Some of these adjustments could have taken the form of an acceleration of trends that had begun earlier, such as reduced number of beds (see discussion in Part 1, Section 1.2). Provincial and regional financial restructuring during the 1990s led to closures or mergers of certain hospitals, which would have been a significant factor in the reduction of bed capacity. Another notable change that had been underway for a number of years included the conversion of certain procedures from inpatient to day surgery. Other adjustments would have involved internal expenditures in ways that are not well defined. Time series data from the HS-1 and HS-2 and the CMDB show the extent to which expenditures were reallocated between functional centres and types of expense. The introduction of a new reporting standard and new institutional responsibility creates uncertainties around the transition period. As a result changes between and 16. Canadian MIS Database. Canadian Institute for Health Information. 23

40 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS should be interpreted with caution. In this analysis we have attempted to identify real changes by examining trends before and after the transition years for consistency or changes in direction. A decrease/increase in the share of expenditure for a specific cell in the data matrix between transition years could be considered as reflecting actual changes in allocation if it was consistent with the trend for that item before and after the transition years. A stable or increasing/decreasing trend before the transition year followed by decreases/increases after the transition could be considered to be a reversal of trend if the direction of change persisted in years that followed the transition year. A simple reallocation of shares without supporting trend data would be considered as probably resulting from different data collection methodologies. SECTION 7: HOSPITAL EXPENDITURE BY F U N C T I O N A L C E N T R E 7.1 Functional Center Breakdown This section examines hospital expenditure by functional centre. The functional centre analysis is based on major categories of the MIS Guidelines primary accounts. The accounts define subdivisions within hospitals to record revenue, expenses and statistics, which pertain to the function or activity being carried out. Abridged definitions from the MIS Guidelines for the categories included in this analysis are shown below. 17 It is important to note that certain service areas, such as diagnostic and therapeutic, normally provide care to both inpatients and outpatients. Other service areas are predominantly inpatient or outpatient but provide care to both types of client as required (e.g. inpatients may receive services in the emergency department in the event of a mishap or for service needs that are not normally treated within the inpatient department to which they were admitted). As a result it is not possible to directly observe trends in the balance of inpatient care or outpatient care and day surgery from these financial data. Administrative Services Functional centres that generally support administering the health service organization. Examples include finance, human resources, systems support and telecommunications. Support Services Functional centres that generally support the other functional centres within the health service organization. Examples include material management and plant maintenance. Nursing Inpatient Services Nursing services provided to inpatients to meet their physical and psychosocial needs, including: Ambulatory care clients receiving services in nursing inpatient units if separate ambulatory care functional centres have not been established for these services. 17. Source: MIS Guidelines 2004 Glossary of Terms. CIHI Ottawa. 24

41 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Direct expense for physicians contracted by the health service organization to provide services within a specific nursing inpatient and resident functional centre. Operating Room is typically included under Nursing Inpatient Services in the MIS Guidelines. For this analysis it has been removed and is reported separately. Operating Room Units specifically designed, staffed and equipped for the provision of services to patients during surgical intervention. Includes data for surgical day/night patients who receive services in this unit. In the analytical framework used for this project operating room expenses consist of expenses reported for operating rooms and post-anaesthetic recovery rooms. Ambulatory Care Services Specialized diagnostic, consultative, treatment, and teaching services provided primarily for registered clients. These services are generally provided in a hospital setting and exclude the following: services provided to ambulatory care patients by personnel who are accountable to and charged to Nursing Inpatient or Diagnostic and Therapeutic Services; and primary care and supportive services (e.g. public health clinics, home care programs, health promotion/education) provided to clients of Community and Social Services. Emergency services are typically included under Ambulatory Care Services in the MIS Guidelines. For this analysis it has been removed and is reported separately. Emergency The unit provides assessment, diagnostic and treatment services to individuals with conditions requiring immediate attention. Includes data for services provided for registered scheduled outpatients/clients receiving care in Emergency. Diagnostic and Therapeutic Services Diagnostic services include professional and technical services which assist in the clinical investigation either to detect the presence of disease, disability, or injury or to assess the severity of known disease, disability, or injury. Therapeutic services include professional and technical services provided to inpatients, residents or clients which assist in the alleviation or cure of the causes, symptoms and/or sequelae of disease, disability or injury. Excludes professional and technical services provided by personnel who are accountable and charged to Nursing Inpatient Services in the functional centre framework. 25

42 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Community and Social Services Health and social services provided by the hospital on an ambulatory or out-reach basis to individuals, groups and/or communities. (e.g. primary care, prevention, wellness, etc.). Services provided by regional health authorities independent of hospitals are not included. Research and Education Research Overall management and operational support of formally organized research undertaken by the health service organization. Education In-service education programs to health service organization personnel, as well as formal education programs to undergraduate and post-graduate technical, professional and medical students/trainees. All Other Includes undistributed expenses in the MIS Guidelines. Most of these expenses cannot be associated directly with patient care and include items such as non-patient food services, ancillary operations, transportation, and capital fund. Unallocated administrative expenses such as taxes, depreciation and amortization are also included in this category. All capitalrelated expenses are excluded from this analysis. There are no expenses allocated to the all other category in the HS-1 and HS-2 data. 7.2 Functional Centre Distributions in the HS-1 and HS-2 and the CMDB Distributions of expenditures by functional centre were quite similar under the HS-1 and HS-2 in and the CMDB in (Table 6, Figure 14). One important difference was the addition of the All Other category in the CMDB, which accounted for approximately four percent of hospital expenditures. In the HS-1 and HS-2 many of these expenditures are believed to have been allocated to the Administrative Services category. It is also worth noting that the convention of excluding capital related expenses in this analysis reduces the weight of All Other expenditures, since capital related expenses tend to be the largest expense item in the All Other category. Operating room, ambulatory care services, emergency, and research and education increased in the CMDB in relative to the HS-1 and HS-2 two years earlier. These functional centres were receiving an increasing share of expenditures in prior years, however, and continued to receive higher shares in subsequent years. Increases in these categories between the two sources appear for the most part to reflect a trend in restructuring of the ways in which care is delivered. There might also be an effect arising from the existence of more detailed categories in the MIS Guidelines. Trends in category allocations are discussed in greater detail in the sections that follow. 18. The last year of the HS-1 and HS-2 survey with complete data was Survey data for were preliminary with the details by certain type of expenses but the data were not available by functional centre. 26

43 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Table 6 Hospital Expenditure and the Percentage Distributions by Functional Centre, Canada, Selected Years Functional Centres Expenditure Percentage Distributions (%) 2002 ($' millions) Administrative Services 2, Support Services 5, Nursing Inpatient Services 10, Operating Room 2, Ambulatory Care Services 2, Emergency 1, Diagnostic and Therapeutic 6, Community and Social Services Research and Education All Other 1,030.7 n/a Total 34, Sources: Canadian Institute for Health Information and Statistics Canada. 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Administrative Services Figure 14 Distribution of Hospital Expenditure by Functional Centre, Reporting Hospitals, Canada, and Support Services Nursing Inpatient Services Operating Room Ambulatory Care Services Emergency Diagnostic and Therapeutic Community and Social Services Sources: Canadian Institute for Health Information and Statistics Canada. Research and Education All Other 27

44 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS 7.3 Trends by Functional Centre from to Administration and Support Services Administration has increased as a share of hospital expenditure. The trend from to shows a gradual increase with variations upward and downward from year to year (Figure 15). Administration s share in the HS-1 and HS-2 survey peaked at 9.8% in The transition to the CMDB resulted in a one-time drop of 2.9 percentage points, which is believed to be due largely to the reclassification of certain expenses under the MIS Guidelines. Between and administration expenditures increased at an average rate of 7.1%, with the largest increases in the areas of communications, systems support and general administration (Table 7). These data provide a highly aggregate overview, but they suggest that the trend to hospital mergers and closures associated with financial restructuring may have contributed to above average increases in administrative expense during the latter half of the 1990s. The share of hospital expenditure allocated to support services has declined during the last 27 years, dropping from 26% in to 16% in the largest decline in share of any category. The decline was been steeper than normal during the initial years of the CMDB, dropping 4.5 percentage points in four years. Since then the decline has slowed, dropping by half of a percentage point between and A closer examination of the data shows that while overall hospital expenditures increased at an average annual rate of 4.4%, support services experienced only moderate growth of 0.5%. Though most subcategories within support services experienced some growth, they were balanced by declines in registration, laundry and linen, health records, and patient food services. 30.0% Figure 15 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to % 20.0% 15.0% Administrative Services Support Services 10.0% 5.0% 0.0% Year Sources: Canadian Institute for Health Information and Statistics Canada. 28

45 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Table 7 Expenditure Weights and Annual Rates of Increase, Administrative and Support Services, Canada, MIS Account Numbers and Name Expenditure ($' millions) Annual Rate of Increase Since Administrative Services General Administration 1, % Finance % Human Resources % Systems Support % Communications % Total 2, % Support Services Materiel Management % Volunteer Services % Housekeeping % Laundry and Linen % 71153, 55 Plant Administration % and Operation Plant Security % Plant Maintenance % Bio-Medical Engineering % 71180, 82 Registration % Patient Transport % Health Records % Patient Food Services 1, % Total 5, % All Hospital Expenditures (Calendar 2002) 34, % Source: Canadian Institute for Health Information. Nursing Inpatient Services Nursing inpatient services is the largest broad functional center grouping. Its share of total expenditures trended downward from a high of 33.8% in to 31.5% in (Figure 16). Since , the share of nursing inpatient services has been relatively stable at approximately 30%. Nursing inpatient services are broken down in the CMDB into more discrete functional centres such as medical, surgical, obstetrics, pediatrics, psychiatry, and long term care, rehabilitation and intensive care. This analysis does not delve further into the specific functional centres but the database provides an opportunity to study trends for these types of care. The range of functional centres included demonstrates that there is a wide range of expenditures within the nursing inpatient services functional centre including other occupational groups and other related expenses. 29

46 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 16 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to % 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Nursing Inpatient Services Year Sources: Canadian Institute for Health Information and Statistics Canada. Operating Room Operating room expenditures increased as a share of hospital expenditure modestly in the HS-1 and HS-2 surveys (from 4.7% to 5.2% during to ). After dropping six tenths of a percentage point between and , operating room expenditures have stabilized at about 5.9% (Figure 17). Figure 17 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to % 8.0% Operating Room 6.0% 4.0% 2.0% 0.0% Year Sources: Canadian Institute for Health Information and Statistics Canada. 30

47 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Ambulatory Care Services and Emergency Ambulatory care services and emergency have increased their shares of hospital expenditure, with steeper trend curves since than in the earlier years of the analysis (Figure 18). Both functional centres increased their shares by one tenth of a percentage point in , accounting for 7.6% and 4.9% respectively. 10.0% 8.0% 6.0% Figure 18 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, to Ambulatory Care Services Emergency 4.0% 2.0% 0.0% Year Sources: Canadian Institute for Health Information and Statistics Canada. Diagnostic and Therapeutic Services Diagnostic and therapeutic services increased modestly from 18% of hospital expenditures in to 22% in (Figure 19). The share dropped by 1.8 percentage points from to and has stabilized at about 20% since then. 31

48 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS 30.0% 25.0% Figure 19 Share of Hospital Expenditure by Selected Functional Centre, Reporting Hospitals, Canada, to % 15.0% 10.0% 5.0% Diagnostic and Therapeutic 0.0% Year Sources: Canadian Institute for Health Information and Statistics Canada. Community and Social Services, Research and Education Community and social services has accounted for a very small share of hospital expenditure historically. Prior to the only expenditure in this category was for community-based home care. Hospitals have been providing a broader range of community-based services in recent years and the share of this category is growing, accounting for 2.0% of hospital expenditure in Research and education has been quite stable, fluctuating in a narrow range around three percent of expenditures from to , and between 2.4% to 2.8% since SECTION 8: HOSPITAL EXPENDITURE BY TYPE OF EXPENSE 8.1 Type of Expense Breakdown The second view of hospital expenditures is the most traditional expenditures by type of expense. Categories used in this analysis include: Physicians services reimbursed directly by hospitals. This category includes physicians employed or contracted by the hospital. It is important to note that most physicians services are paid directly by provincial governments and would not be included in hospital expenditures even though the service took place in a hospital (e.g. most surgery). Gross salaries for hospital staff other than physicians. This would include medical professionals such as nurses; staff providing hotel services such as food service and cleaning; and administrative staff. 32

49 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Benefits, including government programs such as Canada Pension, employment insurance, workers compensation; life and health insurance; termination benefits and perquisites. Drugs purchased by the hospital. Medical supplies used in treating patients, such as medical instruments and sutures. Non-medical supplies such as food and general supplies used to maintain the hospital premises. Sundries, which include non-medical professional services (e.g. legal and accounting), rent and data processing. Expenses for amortization and interest on long term debt are not included for purposes of this analysis as they are considered to be capital-related expenses that would usually be counted under the broad category of Capital in the National Health Expenditures database. Services contracted out to private providers are recorded differently in the CMDB and HS-1 and HS-2 databases. The CMDB includes an account for purchased salaries or fees, which includes services contracted out. 19 In the HS-1 and HS-2 contracted services would normally have been recorded in the account Other supplies and expenses. 8.2 Expense Distributions in the HS-1 and HS-2 and the CMDB The distribution of most expense categories was quite similar under the HS-1 and HS-2 in and the CMDB in (Figure 20). Physicians services expenditure was higher under the CMDB. Two differences in recording expenditure for physician services would have been partially responsible for the increase in physicians share of expenditure: (1) the CMDB includes salaries of residents, interns and medical students as physician expenditure while these expenses would be allocated to other staff salaries in the HS-1 and HS-2; and (2) most physician expenditure is recorded as purchased services in the CMDB. It is possible that some physician payments by hospitals (e.g. fee-for-service or sessional fees) could have been recorded as other supplies and sundries in the HS-1 and HS-2. The accounts for other supplies and sundries in the HS-1 and HS-2 included some amounts that are distributed to other functional centres in the CMDB. Other supplies and sundries were not separate categories in the HS-1 and HS-2 and efforts to separate specific components during the data-matching project were unsuccessful. For purposes of this analysis, two categories in the CMDB were combined for time series analysis from to For example, salaries paid by contractors who provide security or housekeeping services would be recorded as purchased salaries. 33

50 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 20 Distribution of Hospital Expenditure by Type of Expense, Reporting Hospitals, Canada, and % 60.0% 50.0% 40.0% % 20.0% 10.0% 0.0% Physician Compensation Salaries Benefits Drugs Medical Supplies Other Supplies and Sundries Sources: Canadian Institute for Health Information and Statistics Canada. 8.3 Trends by Type of Expense from to Physician compensation represented 3.3% of hospital expenditures in but dropped to 2.3% in (Figure 21). The share increased slowly during the 1980s, stabilizing at 2.7%, but has been more variable in the CMDB, ranging from 3.6% to 5.6%. 10.0% 8.0% Figure 21 Share of Hospital Expenditure by Selected Type of Expense, Reporting Hospitals, Canada, to Physician Compensation 6.0% 4.0% 2.0% 0.0% Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada p

51 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Staff salaries and benefits together accounted for 76.3% of hospital expenses in The share for these expenses declined throughout the 1980s and 1990s (Figure 22). The combined share in was 71.8% and in it was 67.6%. Salaries have declined steadily, falling 4.4 percentage points to 57.4% between and While benefits experienced an initial increase after the transition to the CMDB, they have been virtually stable since that time. Prior to , benefits had been trending upward, accounting for 6.6% of hospital expenditures in and 9.7% in The share of staff salaries in the CMDB has continued the downward trend found in the HS-1 and HS-2 surveys. The ratio of salaries to benefits in was 5.7 to % Figure 22 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, to % 40.0% Benefits Salaries 20.0% p = preliminary data Year Sources: Canadian Institute for Health Information and Statistics Canada p Drugs accounted for an increasing share of hospital expenditure from to From to the share of drugs remained between 3.1% and 3.4% (Figure 23). Drug expenditures have been increasing since , from 3.5% of hospital expenses to 4.5% in Despite the increase in recent years, drug expenditures by hospitals have not followed the same strong trend for drugs purchased outside of the institutional setting, which increased from 8.5% of health expenditures in 1976 to 15.7% in Data for the year where available were preliminary and obtained from Hospital Statistics: Preliminary Annual Report, 1994/95, Statistics Canada, See discussion in section titled Total Health Expenditure by Use of Funds in National Health Expenditure Trends, , CIHI, Dec. 2004, available at In the NHEX total expenditure series, the Drugs category does not include products supplied to institutional inpatients. Instead, all expenses of institutions are classified as Hospital or Other Institutions expenditure. 35

52 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS The share of expenses for medical supplies increased slowly from to , from 2.9% to 3.6%. While it saw greater growth over the next four years, reaching 4.3% of total hospital expenditure, between and its share fell by half of a percentage point. The share of medical supplies is higher under the CMDB (presumably some expenses have moved from supplies and sundries to medical supplies under the MIS Guidelines). Medical supplies have increased from 4.3% of expenditures in to 5.4% in Figure 23 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, to % 8.0% 6.0% 4.0% 2.0% 0.0% Drugs Medical Supplies Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada p Supplies and sundries have followed a variable trend, peaking at 18.5% of hospital expenses in (Figure 24). There was a break in the series between the surveys, as some expenses were assigned to different categories under the MIS Guidelines. While the trend since shows supplies and sundries decreasing, there have been large variations in the data. The category increased quite rapidly between and (from 15.5% in to 18.7% in ), before dropping 1.9 percentage points between and Most of the increase in the share of the combined categories is accounted for by other supplies, which increased in share from 10.8% in to 13.3% in

53 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 24 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, to % 20.0% 18.0% 16.0% 14.0% Other Supplies and Sundries 12.0% Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada p SECTION 9: HOSPITAL EXPENDITURE BY FUNCTIONAL CENTRE AND TYPE OF EXPENSE 9.1 Functional Center and Type of Expense Breakdown Table 8 provides a cross-classification of hospital expenditure in 2002, showing how expenses for each functional centre are allocated to each of the different types of expense. Physician compensation is concentrated in diagnostic and therapeutic functional centres reflecting the fact that many physicians in the specialties such as pathology receive remuneration from hospitals. Other staff salaries and benefits are the largest item of expenditure in all functional centres. Other staff salaries are concentrated in nursing inpatient, diagnostic and therapeutic and support services. Approximately half of drugs expenditures are found in nursing inpatient and diagnostic and therapeutic functional centres. Medical supplies expenditures are concentrated in operating room and nursing inpatient functional centres. Other supplies and sundries expenditures are concentrated in support, diagnostic and therapeutic and administrative functional centres. 37

54 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Table 8 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 2002 ($millions) Functional Centre Physician Compensation Salaries and Benefits Drugs Medical Supplies Other Supplies and Sundries Total Administrative Services , ,698.7 Support Services 6.7 3, , ,650.8 Nursing Inpatient Services , ,322.0 Operating Room ,014.4 Ambulatory Care Services , ,601.0 Emergency , ,669.6 Diagnostic and Therapeutic , , ,865.8 Community and Social Services Research and Education All Other ,030.7 Total 1, , , , , ,375.1 Source: Canadian Institute for Health Information. 9.2 Trends by Functional Centre and Type of Expense It is possible to track trends by functional centre and type of expense with CMDB data. In the HS-1 and HS-2 data, staff benefits, medical supplies and drugs were not reported by functional centre. In order to estimate total expenses by functional centre for this study, the distribution of these three types of expense were estimated using their distribution in the CMDB in Physician expenses reported in HS-1 and HS-2 could be mapped to most functional categories but not to nursing inpatient or operating room functional centres. These survey differences limit the scope for comparing trends in expenditures within specific functional centres and expense types. In the discussion that follows, the analysis has been limited to the ambulatory care and emergency functional centres and a combined salary and benefits expense category. The estimated distributions of salaries and benefits are shown for and in Figure 25. The percent of salaries and benefits accounted for by administration and support and nursing inpatient declined over the ten year period while the percent accounted for by ambulatory care and emergency increased. 38

55 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 25 Distribution of Salaries and Benefits, Reporting Hospitals, Canada, and % 40.0% % 20.0% 10.0% 0.0% Admin. and Support Nursing Inpatient Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Other Sources: Canadian Institute for Health Information and Statistics Canada. Within the ambulatory care functional centre, expenditures for physicians services increased as a share of the total during the ten year period while expenditures for drugs and salaries and benefits for other staff as a share of the total decreased (Figure 26). This trend suggests that physician remuneration through hospital resources is now more predominant than ten years ago. 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Figure 26 Distribution of Ambulatory Care Expense, Reporting Hospitals, Canada, and Physician Compensation Salaries and Benefits Drugs Medical Supplies Other Supplies and Sundries Sources: Canadian Institute for Health Information and Statistics Canada. 39

56 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS In emergency departments, physicians services increased from 2.9% to 12.8% of expenditure during the ten year period, perhaps reflecting the increasing tendency for emergency physicians to be remunerated through hospital budgets rather than paid directly by the ministry on a fee-for-service basis. 22 The share of other staff salaries and benefits decreased by 9.8 percentage points while the remaining categories remained approximately the same (Figure 27). Figure 27 Distribution of Emergency Care Expense, Reporting Hospitals, Canada, and % 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Physician Compensation Salaries and Benefits Drugs Medical Supplies Other Supplies and Sundries Sources: Canadian Institute for Health Information and Statistics Canada. CONCLUSIONS The joint project by CIHI and Statistics Canada to match historical data from the HS-1 and HS-2 and the CMDB has resulted in a consistent time series of financial data for Canadian hospitals. During the 27 years covered by this analysis there were clear trends in the distribution of hospital expenditures across functional centres and types of expense. These trends were consistent for hospitals irrespective of number of beds, or status as pediatric or teaching hospitals. There has been a substantial reduction in the shares of expenditure accounted for by support services and nursing inpatient services. The share of budgets allocated to administration has increased during the period of financial restructuring in the late 1990s. The share of expenditure for ambulatory care and emergency has increased steadily since the early 1980s. Expenditures for operating rooms and diagnostic and therapeutic services have maintained a fairly steady share of hospital budgets. 22. Although alternatives to fee-for-service remuneration have grown in emergency medicine in most jurisdictions, there are a variety of administrative arrangements. The extent to which payments flow through hospital budgets (versus direct provincial or health region payments) is not clear. 40

57 HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS In the expense categories, salaries and benefits have declined in aggregate as a share of hospital budgets, although benefits have increased; salary and benefits together account for over two-thirds of total hospital expenditure. Drugs and medical supplies have increased their shares of hospital expenditure although rates of increase in the share of drugs have been considerably less in hospitals than in total health spending. 41

58

59 HOSPITAL TRENDS IN CANADA D ATA TABLES Data Tables Table 1 Series Statistical Table 2 Series Expenditure 43

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61 HOSPITAL TRENDS IN CANADA D ATA TABLES Table 1 Series Statistics 45

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63 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, All Hospital Types, Canada, to Table 1.1 Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year ,080,462 49,536,238 3,976, ,848 23,229, , , , , ,045,953 50,345,092 3,931, ,385 24,046, , , , , ,023,023 51,062,646 3,923, ,569 25,472, , , , , ,004,374 51,467,203 3,887, ,609 26,042, , , , , ,996,630 51,962,017 3,885, ,816 26,315, , , , , ,009,534 53,521,202 3,898, ,514 27,522, , , , , ,042,903 53,668,139 3,936, ,124 28,366, , , , , ,078,438 55,208,418 3,963, ,876 29,351, , , , , ,093,111 55,656,886 3,970, ,874 30,759, , , , , ,107,329 55,538,591 3,990, ,762 32,663, , , , , ,129,059 55,662,554 4,000, ,635 34,305, , , , , ,138,951 55,568,242 4,022, ,411 35,918, , , , , ,091,734 54,794,498 3,943, ,481 37,073, , , , , ,075,113 53,795,244 3,929, ,012 37,599, , , , , ,042,218 50,616,604 3,905, ,401 38,491, , , , , ,110,079 49,764,928 3,978, ,126 39,524, , , , , ,903,555 46,616,740 3,784, ,131 39,095, , , , , ,831,749 45,725,059 3,720, ,602 39,398, , , , , p 3,228,604 36,893,446 3,140, , , , , ,266,843 36,669,964 3,252,075 89,586 35,755, , , , , ,824,589 33,751,433 2,845,950 88,592 32,224, , , , , ,969,540 34,402,270 2,885, ,798 34,541, , , , , ,047,792 33,246,284 3,105, ,078 36,318, , , , , ,154,326 34,151,239 3,120, ,484 37,944, , , , , ,133,806 32,739,815 2,950, ,625 38,770, , , , , ,067,059 30,970,666 2,963, ,555 40,281, , , , , ,058,901 30,725,675 2,951, ,989 39,811, , , , ,120 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

64 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.2 Selected Statistics, General Public Hospitals Without Long Term Units, Pediatric Hospitals and Private Hospitals, Canada, to Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year ,686,466 13,129,947 1,652,826 33,559 8,888,789 45,999 46,027 46,222 46, ,546,756 12,074,140 1,512,753 30,916 8,353,009 41,924 42,434 42,153 42, ,491,898 11,672,120 1,464,074 29,284 8,558,767 40,781 40,853 41,027 41, ,354,354 10,537,283 1,324,608 26,803 8,136,993 37,011 37,061 37,217 37, ,328,410 10,367,878 1,301,405 26,850 8,193,036 36,534 36,574 36,782 36, ,291,603 10,144,103 1,265,248 26,166 8,148,069 36,048 36,088 36,426 36, ,251,906 9,770,130 1,228,132 26,567 8,066,367 34,164 34,239 34,894 34, ,168,920 9,205,137 1,143,666 24,666 7,872,695 32,159 32,205 32,658 32, ,129,290 8,925,798 1,104,200 23,993 7,970,293 30,947 31,012 31,465 31, ,071,781 8,457,452 1,049,496 23,678 7,996,471 29,498 29,575 30,233 30, ,011,724 7,966, ,200 21,828 7,914,968 27,617 27,862 28,253 28, ,521 7,874, ,791 22,612 8,186,401 27,361 27,372 28,112 28, ,344 7,432, ,296 22,033 8,022,285 26,533 26,620 27,521 27, ,229 6,882, ,464 21,614 7,771,330 24,749 24,970 25,751 25, ,688 7,044, ,466 21,998 8,481,784 25,988 26,344 27,285 27, ,101 7,049, ,639 22,751 8,824,861 25,768 26,013 27,679 27, ,540 6,436, ,379 21,610 8,578,196 23,899 24,422 26,068 26, ,024 6,056, ,677 22,239 8,762,801 22,218 22,682 25,551 26, p 713,995 4,906, ,697 23, ,532 21,315 24, ,357 5,216, ,992 18,246 7,242,484 18,247 21,754 18,247 21, ,857 3,817, ,473 14,748 5,863,983 14,762 19,171 14,762 19, ,290 4,459, ,914 18,060 6,906,569 17,301 19,741 17,301 19, ,394 4,422, ,740 20,100 7,070,091 15,773 17,899 15,773 17, ,705 3,929, ,470 18,878 6,480,229 14,296 15,300 14,296 15, ,124 3,443, ,483 16,670 6,259,924 13,842 14,334 13,842 14, ,835 3,251, ,338 14,228 6,307,665 12,642 13,192 12,642 13, ,402 3,160, ,729 13,909 5,804,646 12,562 12,734 12,562 12,734 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

65 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, General Hospitals With Long Term Units and Federal Hospitals, Canada, to Table 1.3 Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year ,252,434 13,818,099 1,219,310 32,309 6,587,745 45,620 45,805 46,828 47, ,363,301 14,960,566 1,324,544 35,862 7,572,510 48,530 48,530 49,307 49, ,405,857 15,755,503 1,370,375 36,449 8,265,708 50,736 50,932 51,625 51, ,515,867 16,876,492 1,470,739 41,063 9,285,367 53,635 53,818 54,144 54, ,511,132 17,419,101 1,467,110 42,006 9,323,953 54,746 54,814 55,373 55, ,558,324 18,240,247 1,512,680 44,702 10,112,776 57,217 57,243 57,865 57, ,559,977 18,084,177 1,516,127 46,534 10,058,526 56,324 56,384 57,260 57, ,675,567 19,240,977 1,626,322 48,468 10,922,301 59,785 59,811 60,671 60, ,690,468 19,768,494 1,636,656 51,020 11,508,478 61,152 61,178 62,003 62, ,733,312 20,609,847 1,680,514 53,961 12,539,426 63,876 64,032 64,516 64, ,781,047 21,091,858 1,722,158 54,408 13,409,192 65,645 65,645 66,389 66, ,816,635 21,182,987 1,762,027 57,243 14,203,166 65,724 66,024 66,733 67, ,814,896 21,184,603 1,756,024 58,223 14,872,053 66,152 66,442 67,542 67, ,931,441 21,670,116 1,871,949 60,922 15,908,054 68,103 69,290 69,775 71, ,782,652 19,300,316 1,729,469 56,237 15,429,198 60,394 63,039 62,753 65, ,830,038 19,288,920 1,768,348 58,386 15,837,160 60,086 62,286 63,561 65, ,783,765 18,670,725 1,725,419 58,521 16,025,965 59,112 60,939 63,890 65, ,741,375 17,752,154 1,686,737 58,713 15,899,441 56,118 59,636 62,240 65, p 1,483,051 15,967,311 1,440,973 47, ,816 57,594 65, ,614,131 17,573,234 1,635,386 44,365 15,411,386 58,189 60,241 58,189 60, ,427,701 16,853,243 1,451,899 43,506 14,273,749 54,425 58,739 54,425 58, ,416,251 16,301,006 1,395,421 52,644 14,673,313 52,747 56,604 52,747 56, ,456,524 15,644,214 1,452,922 48,661 15,137,756 50,843 57,638 50,843 57, ,538,451 16,107,331 1,590,289 56,451 16,509,488 51,166 53,787 51,166 53, ,548,686 15,338,429 1,542,993 59,655 17,561,300 50,057 50,435 50,057 50, ,551,475 13,916,854 1,522,970 58,337 17,352,818 52,519 52,932 52,519 52, ,524,162 13,603,362 1,497,071 60,265 17,465,791 52,842 53,921 52,842 53,921 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

66 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.4 Selected Statistics, Teaching Hospitals, Canada, to Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year ,029,084 10,631,505 1,001,265 27,525 6,972,231 34,175 34,175 35,253 35, ,021,591 11,060, ,188 29,085 7,283,469 35,449 35,449 36,606 36, ,005,686 11,029, ,003 28,060 7,670,417 34,951 34,951 36,027 36, ,012,948 11,131, ,967 29,773 7,617,079 34,871 34,871 35,828 35, ,037,173 11,299,933 1,005,551 30,703 7,875,832 35,606 35,606 36,527 36, ,027,930 11,304, ,574 30,626 8,043,395 34,862 34,862 36,044 36, ,092,659 12,007,512 1,062,080 32,760 8,928,741 36,629 36,629 37,978 37, ,086,554 12,086,235 1,054,542 31,874 9,168,326 36,871 36,871 37,957 37, ,129,319 12,452,712 1,093,692 33,756 9,888,126 37,673 37,673 38,655 38, ,160,832 12,543,500 1,127,566 34,739 10,596,235 37,857 37,857 39,183 39, ,192,078 12,755,290 1,154,686 35,145 11,251,478 38,464 38,464 39,787 39, ,181,805 12,753,780 1,149,113 35,655 11,703,638 38,913 38,913 40,834 40, ,121,790 12,061,017 1,064,011 33,450 11,764,211 36,775 36,775 38,711 38, ,114,890 11,881,343 1,057,753 33,807 11,816,642 36,634 36,634 38,789 38, ,176,889 12,073,892 1,120,784 34,236 12,428,908 37,032 37,032 40,069 40, ,166,655 11,622,064 1,128,815 35,128 12,550,053 35,573 35,573 38,861 38, ,079,046 10,429,228 1,046,522 33,050 12,221,148 32,164 34,574 36,498 38, ,060,811 9,839,249 1,031,273 32,954 12,401,884 30,298 33,869 34,813 38, p 929,808 9,240, ,897 29, ,340 34,493 37, ,994 8,309, ,700 23,482 11,754,241 29,448 38,408 29,448 38, ,991 7,762, ,504 26,496 11,108,118 27,645 34,396 27,645 34, ,841 8,651, ,537 31,100 11,915,041 31,602 37,005 31,602 37, ,747 8,599, ,432 30,924 12,962,628 31,085 33,027 31,085 33, ,611 8,941, ,275 31,391 13,253,209 28,600 29,690 28,600 29, ,832 8,971, ,422 29,300 12,947,093 30,635 30,842 30,635 30, ,863 9,262, ,977 66,649 14,523,802 29,782 29,553 29,782 29, ,114 8,883, ,094 31,428 14,455,615 29,356 29,237 29,356 29,237 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

67 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, Short Term Psychiatric Hospitals, Canada, to Table 1.5 Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year , ,079 10, ,967 1,259 1,279 1,274 1, , ,931 8, ,431 1,166 1,287 1,184 1, , ,740 10, ,044 1,612 1,696 1,658 1, , ,767 8, ,144 1,187 1,296 1,182 1, , ,358 8, ,388 1,218 1,283 1,212 1, , ,585 11, ,814 1,923 1,988 1,939 2, , ,355 11, ,435 1,916 1,968 1,931 1, , ,898 11, ,267 1,836 1,928 1,871 1, , ,321 9, ,161 1,663 1,907 1,695 1, , ,090 9, ,737 1,650 1,889 1,681 1, , ,034 10, ,637 1,719 1,812 1,815 1, , ,994 9, ,130 1,382 1,771 1,475 1, , ,653 11, ,393 1,629 1,706 1,728 1, p 9, ,675 8, ,244 1,380 1, , ,479 44, ,079 1,524 1,776 1,524 1, , ,556 5, ,687 1,212 1,640 1,212 1, , ,961 5, , , , , ,287 8, ,684 1,198 1,558 1,198 1, , ,314 15, ,412 1,169 1,511 1,169 1, , ,636 8, ,989 1,319 1,477 1,319 1, , ,376 7, ,992 1,229 1,319 1,229 1, , ,998 7, ,858 1,184 1,315 1,184 1,315 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

68 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.6 Selected Statistics, Long Term Psychiatric Hospitals, Canada, to Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year , ,178 3, ,160 2,126 2,755 2,566 3, , ,234 2, ,107 1,542 4,535 1,584 4, ,258 1,097,631 8, ,098 3,308 4,362 3,278 4, ,900 1,090,514 6, ,517 3,394 4,856 3,394 4, , ,068 5, ,612 2,611 4,356 2,624 4, ,166 4,051,100 18, ,371 11,982 13,727 12,301 14, ,558 3,945,295 19, ,190 11,511 13,164 11,904 13, ,025 3,744,112 18, ,795 10,999 12,937 11,511 13, ,850 3,672,342 18, ,560 10,968 12,761 11,479 13, ,331 3,532,119 18, ,194 10,597 12,607 10,905 12, ,866 3,219,122 16, ,323 9,654 11,451 10,372 12, ,837 2,908,969 14, ,784 8,640 10,529 9,290 11, ,383 4,019,231 24, ,050 11,894 13,376 13,746 15, p 20,357 2,871,235 20, ,876 9,828 12, ,106 1,334,388 7, ,390 6,053 11,024 6,053 11, ,606 1,932,203 12, ,477 6,374 9,916 6,374 9, ,222 1,665,268 12,098 1, ,667 5,682 9,949 5,682 9, ,886 1,144,929 9, ,496 4,071 9,606 4,071 9, ,193 1,929,182 17, ,722 7,885 9,194 7,885 9, ,743 1,580,364 12, ,863 5,920 7,845 5,920 7, ,022 1,321,623 12, ,897 5,187 7,683 5,187 7, ,888 2,029,173 18, ,206 6,907 7,293 6,907 7,293 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

69 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, Other Specialty Hospitals, Canada, to Table 1.7 Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year , ,209 45, ,647 1,258 1,258 1,245 1, , ,284 48, ,381 1,481 1,481 1,463 1, , ,852 50,423 1, ,384 1,883 1,912 1,924 1, , ,790 52, ,312 2,593 2,593 2,606 2, , ,317 53, ,115 2,564 2,564 2,586 2, , ,526 54,317 1, ,687 2,532 2,532 2,572 2, , ,892 59,041 1, ,101 2,571 2,571 2,581 2, , ,887 61,272 1, ,526 2,581 2,581 2,613 2, , ,080 61,195 1, ,099 2,583 2,583 2,623 2, , ,166 62,167 1, ,780 2,580 2,580 2,603 2, , ,047 59,920 1, ,728 1,329 1,329 1,328 1, , ,878 60,279 1, ,409 1,315 1,327 1,338 1, , ,720 57,248 1, ,005 1,268 1,268 1,334 1, , ,419 54,997 1, ,729 1,274 1,274 1,328 1, , ,499 56,886 1, ,542 1,250 1,250 1,328 1, , ,170 54,515 1, ,251 1,184 1,184 1,346 1, , ,287 53,307 1, ,151 1,127 1,127 1,330 1, , ,767 53, ,176 1,039 1,039 1,253 1, p 41, ,849 40,002 1, ,147 1, , ,811 46, ,226 1,011 1,235 1,011 1, , ,050 18, , , , , ,339 18, , , ,881 46, ,701 1,017 1,055 1,017 1, , ,240 40, , , ,174 77,802 1, ,600 1,693 1,731 1,693 1, , ,909 73,529 1, ,817 1,716 1,754 1,716 1, , ,442 74,746 1, ,291 1,665 1,703 1,665 1,703 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

70 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.8 Selected Statistics, Rehabilitation Hospitals, Canada, to Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year , ,172 16, ,369 2,514 2,514 2,691 2, , ,449 14, ,383 2,464 2,464 2,650 2, , ,135 14, ,974 2,507 2,507 2,569 2, , ,736 14, ,043 2,323 2,323 2,346 2, , ,179 14, ,904 2,371 2,371 2,409 2, , ,110 15, ,789 2,638 2,638 2,677 2, , ,712 15, ,631 2,563 2,563 2,627 2, , ,988 15, ,410 2,711 2,711 2,747 2, , ,344 15, ,094 2,710 2,710 2,746 2, , ,955 15, ,150 2,660 2,660 2,696 2, , ,326 15, ,671 2,661 2,661 2,696 2, , ,961 15, ,134 2,675 2,675 2,721 2, , ,944 15, ,829 2,949 2,949 3,044 3, , ,241 16, ,125 2,779 2,779 2,845 2, , ,787 16, ,990 2,691 2,809 2,765 2, , ,418 15, ,483 2,430 2,548 2,539 2, , ,755 15, ,770 2,436 2,554 2,508 2, , ,903 15, ,352 2,191 2,428 2,332 2, p 13, ,144 12, ,043 2,314 2, , ,322 14, ,294 2,653 2,719 2,653 2, , ,626 13, ,299 2,496 2,583 2,496 2, , ,352 16, ,409 2,964 2,964 2,964 2, , ,316 16, ,385 2,861 3,461 2,861 3, , ,797 13, ,970 1,970 2,381 1,970 2, , ,377 16, ,444 2,042 2,101 2,042 2, , ,987 14, ,995 2,134 2,134 2,134 2, , ,703 16, ,909 2,237 2,237 2,237 2,237 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

71 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, Extended Care Hospitals, Canada, to Table 1.9 Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year ,673 10,755,922 27,290 8, ,485 31,122 31,579 31,535 31, ,913 11,015,355 29,673 8, ,076 31,779 31,840 32,434 32, ,666 11,231,867 33,005 7, ,036 32,378 32,554 32,598 32, ,838 11,367,203 32,964 7, ,528 32,685 32,861 33,123 33, ,000 11,304,787 31,529 6, ,773 32,741 32,763 33,171 33, ,556 11,091,555 27,617 6, ,695 31,792 31,988 32,110 32, ,813 11,229,955 29,641 6, ,244 32,297 32,319 32,788 32, ,179 11,333,039 30,624 6, ,479 32,422 32,444 32,588 32, ,591 11,312,472 31,068 6, ,047 32,426 32,426 32,474 32, ,504 10,987,033 28,905 6, ,236 31,234 31,310 31,488 31, ,106 7,890,147 16,780 6, ,683 22,474 22,512 22,621 22, ,460 7,918,369 17,802 6, ,359 22,464 22,480 22,541 22, ,519 8,368,760 74,211 7, ,338 24,043 24,171 24,405 24, ,101 7,866,596 17,338 6, ,183 22,416 22,438 22,813 22, ,811 6,887,538 20,846 5, ,632 19,728 20,019 20,121 20, ,095 6,851,074 21,099 5, ,243 19,551 19,987 20,075 20, ,129 6,580,651 19,139 6, ,018 18,918 19,838 19,531 20, ,057 6,474,179 20,445 6, ,997 18,626 19,826 19,305 20, p 17,589 2,591,936 17, ,964 7,970 11, ,652 2,729,222 14,186 2, ,520 7,658 9,527 7,658 9, ,171 2,144,753 10,778 2, ,143 6,387 8,402 6,387 8, ,878 2,019,197 16,604 3, ,281 6,231 8,214 6,231 8, ,401 1,975,337 11,903 3, ,219 6,283 7,579 6,283 7, ,070 2,038,386 9,989 2, ,186 5,472 6,385 5,472 6, ,951 1,761,513 10,119 3, ,137 5,460 6,457 5,460 6, ,483 1,638,378 10,167 2, ,107 6,346 6,512 6,346 6, ,923 1,468,457 10,993 2, ,721 6,414 6,680 6,414 6,680 (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

72 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.10 Selected Statistics, Other Hospitals, Canada, to Admissions Inpatient Days Discharges Deaths Ambulatory Care Visits Beds Staffed and in Operation in Reporting Hospitals* Beds Staffed and in Operation in Operating Hospitals* Approved Beds in Reporting Hospitals* Approved Beds in Operating Hospitals* Year ,474 45,384 13, , ,162 42,210 12, , ,683 36,828 12, , ,134 34,056 12, , ,798 36,822 11, , ,901 35,821 11, , ,677 49,596 14, , ,310 37,784 13, , ,527 35,705 12, , ,488 33,212 12, , ,961 33,078 12, , ,340 36,393 12, , ,965 34,542 10, , ,127 31,746 12, , ,282 30,353 11, , ,286 31,624 12, , ,842 29,627 10, , ,562 27,654 9, , p , , (annual percentage change) p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, , Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for and afterward. CIHI

73 HOSPITAL TRENDS IN CANADA D ATA TABLES Table 2 Series Expenditure 57

74

75 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Table 2.1 Administration Support ,445.8 Inpatient Nursing 0.0 1, ,871.8 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total , ,503.9 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Drugs ($ 000,000) (annual percentage change) (percentage distribution of Type of Expense by Functional Centre) (percentage distribution of Functional Centre by Type of Expense) (percentage distribution of Total) 1 Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

76 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.2 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration Support ,605.6 Inpatient Nursing 0.0 1, ,059.0 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic ,116.9 Community Services Research and Education Total , ,104.2 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

77 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.3 Administration Support 0.0 1, ,790.2 Inpatient Nursing 0.0 1, ,266.9 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic ,247.2 Community Services Research and Education Total , , ,787.8 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Drugs (percentage distribution of Total) Medical Supplies Other Supplies and Sundries 1 Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

78 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.4 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration Support 0.0 1, ,951.1 Inpatient Nursing 0.0 2, ,522.8 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic ,337.7 Community Services Research and Education Total , , ,476.0 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

79 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.5 Administration Support 0.0 1, ,270.4 Inpatient Nursing 0.0 2, ,971.1 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic ,601.6 Community Services Research and Education Total , , ,785.1 (annual percentage change) Medical Supplies Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Other Supplies and Sundries 1 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Drugs (percentage distribution of Total) Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

80 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.6 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration Support 0.0 1, , ,704.1 Inpatient Nursing 0.0 3, ,548.9 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,913.4 Community Services Research and Education Total , , ,539.7 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

81 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Table 2.7 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Administration ,113.7 Support 0.0 1, , ,022.8 Inpatient Nursing 0.0 3, ,036.0 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,174.5 Community Services Research and Education Total , , ,963.1 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Drugs ($ 000,000) (annual percentage change) (percentage distribution of Type of Expense by Functional Centre) (percentage distribution of Functional Centre by Type of Expense) (percentage distribution of Total) 1 Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

82 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.8 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration ,177.8 Support 0.0 1, , ,329.2 Inpatient Nursing 0.0 3, ,448.2 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,409.0 Community Services Research and Education Total , , , ,143.0 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

83 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.9 Administration ,230.1 Support 0.0 1, , ,517.8 Inpatient Nursing 0.0 4, ,736.3 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,594.8 Community Services Research and Education Total , , , ,010.8 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Drugs (percentage distribution of Total) Medical Supplies Other Supplies and Sundries 1 Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

84 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.10 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration ,357.6 Support 0.0 1, , ,699.9 Inpatient Nursing 0.0 4, ,977.7 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,792.1 Community Services Research and Education Total , , , ,914.0 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

85 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.11 Administration ,489.9 Support 0.0 2, , ,872.2 Inpatient Nursing 0.0 4, ,273.7 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,043.7 Community Services Research and Education Total , , , ,930.7 (annual percentage change) Medical Supplies Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Other Supplies and Sundries 1 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Drugs (percentage distribution of Total) Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

86 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.12 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration ,617.4 Support 0.0 2, , ,100.8 Inpatient Nursing 0.0 4, ,683.5 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,354.6 Community Services Research and Education Total , , , ,221.9 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

87 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Table 2.13 Administration , ,781.9 Support 0.0 2, , ,363.0 Inpatient Nursing 0.0 5, ,058.3 Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic , ,631.3 Community Services Research and Education Total , , , ,523.8 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education d'activité 2 Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education d'activité 2 Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Drugs ($ 000,000) (annual percentage change) (percentage distribution of Type of Expense by Functional Centre) (percentage distribution of Functional Centre by Type of Expense) (percentage distribution of Total) 1 Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

88 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.14 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration , ,951.3 Support 0.0 2, , ,706.8 Inpatient Nursing 0.0 5, ,550.9 Operating Room ,019.5 Ambulatory Care Emergency Diagnostic and Therapeutic , ,036.7 Community Services Research and Education Total , , , ,200.2 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

89 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Table 2.15 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Administration , ,113.1 Support 0.0 2, , ,953.6 Inpatient Nursing 0.0 5, ,956.1 Operating Room ,106.3 Ambulatory Care Emergency Diagnostic and Therapeutic , ,423.6 Community Services Research and Education Total , , , ,710.0 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Drugs (percentage distribution of Total) Medical Supplies Other Supplies and Sundries 1 Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

90 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.16 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration , ,291.2 Support 0.0 2, , ,247.4 Inpatient Nursing 0.0 6, ,484.6 Operating Room ,203.2 Ambulatory Care ,011.6 Emergency Diagnostic and Therapeutic , , ,931.9 Community Services Research and Education Total , , , ,463.9 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

91 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Table 2.17 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Administration , ,271.6 Support 0.0 2, , ,148.6 Inpatient Nursing 0.0 6, ,497.2 Operating Room ,228.0 Ambulatory Care ,080.7 Emergency Diagnostic and Therapeutic , , ,022.6 Community Services Research and Education Total , , , ,613.3 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. Drugs ($ 000,000) (annual percentage change) (percentage distribution of Type of Expense by Functional Centre) (percentage distribution of Functional Centre by Type of Expense) (percentage distribution of Total) Total 2 There are no expenses allocated to All Other Functional Centre from to CIHI

92 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.18 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration , ,220.3 Support 0.0 2, , ,153.8 Inpatient Nursing 0.0 5, ,444.6 Operating Room ,223.6 Ambulatory Care ,128.4 Emergency Diagnostic and Therapeutic , , ,144.4 Community Services Research and Education Total , , , ,645.2 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to CIHI

93 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Table 2.19 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total , , , ,284.5 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Administration Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total Other Supplies and Sundries are combined from to Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from to Drugs ($ 000,000) (annual percentage change) (percentage distribution of Type of Expense by Functional Centre) (percentage distribution of Functional Centre by Type of Expense) (percentage distribution of Total) Total 3 Hospital Statistics Preliminary Annual Report, , Statistics Canada (available by total expenses only). CIHI

94 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.20 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies Sundries Total ($ 000,000) Administration ,445.7 Support 4.7 2, , ,735.0 Inpatient Nursing , ,629.1 Operating Room ,432.5 Ambulatory Care ,304.3 Emergency Diagnostic and Therapeutic , ,433.2 Community Services Research and Education All Other Total , , , , ,143.6 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total CIHI

95 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.21 Administration ,472.7 Support 5.5 2, , ,379.9 Inpatient Nursing , ,423.8 Operating Room ,359.1 Ambulatory Care ,353.3 Emergency Diagnostic and Therapeutic , ,307.5 Community Services Research and Education All Other Total , , , , ,637.4 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total Drugs Medical Supplies Other Supplies Sundries Total CIHI

96 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.22 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Medical Drugs Supplies Other Supplies Sundries Total ($ 000,000) Administration ,595.5 Support 5.9 2, , ,555.1 Inpatient Nursing , ,827.2 Operating Room ,521.1 Ambulatory Care ,545.3 Emergency Diagnostic and Therapeutic , ,495.6 Community Services Research and Education All Other Total , , , , , ,860.2 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total CIHI

97 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Table 2.23 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Drugs Supplies ($ 000,000) Administration ,740.5 Support 4.0 2, , ,470.2 Inpatient Nursing , ,705.8 Operating Room ,601.7 Ambulatory Care ,699.2 Emergency Diagnostic and Therapeutic , ,745.5 Community Services Research and Education All Other ,196.1 Total 1, , , , , , ,344.8 (annual percentage change) Other Supplies Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total Sundries Total CIHI

98 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.24 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Type of Expense Functional Centre Physician Compensation Salaries Benefits Drugs Medical Supplies Other Supplies Sundries Total ($ 000,000) Administration , ,182.5 Support 2.9 2, , ,411.3 Inpatient Nursing , ,983.8 Operating Room ,526.3 Ambulatory Care ,702.2 Emergency ,120.6 Diagnostic and Therapeutic , ,066.3 Community Services Research and Education All Other ,053.3 Total , , , , , , ,079.7 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total CIHI

99 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.25 Administration , ,316.8 Support 3.1 2, , ,767.5 Inpatient Nursing , , ,530.4 Operating Room ,634.5 Ambulatory Care , ,915.1 Emergency ,286.0 Diagnostic and Therapeutic , ,573.7 Community Services Research and Education All Other Total 1, , , , , , , ,105.7 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total Drugs Medical Supplies Other Supplies Sundries Total CIHI

100 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 2.26 Functional Centre Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies Sundries Total ($ 000,000) Administration , ,454.8 Support 3.6 2, , ,174.0 Inpatient Nursing , , ,212.9 Operating Room ,802.7 Ambulatory Care , ,302.9 Emergency ,471.6 Diagnostic and Therapeutic , ,114.8 Community Services Research and Education All Other Total 1, , , , , , , ,822.9 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total CIHI

101 HOSPITAL TRENDS IN CANADA D A T A T A B L E S Functional Centre Table 2.27 Hospital Expenditure by Functional Centre and Type of Expense, Canada, Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Drugs Supplies ($ 000,000) Other Supplies Administration , ,598.4 Support 6.4 2, , ,440.7 Inpatient Nursing , , ,938.2 Operating Room ,939.5 Ambulatory Care , ,504.3 Emergency , ,607.5 Diagnostic and Therapeutic , ,610.5 Community Services Research and Education All Other Total 1, , , , , , , ,097.0 (annual percentage change) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Type of Expense by Functional Centre) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Functional Centre by Type of Expense) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total (percentage distribution of Total) Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education All Other Total Sundries Total CIHI

102

103 Appendix A Statistical Variables and Data Matching

104

105 HOSPITAL TRENDS IN CANADA A PPENDIX A Appendix A: Statistical Variables and Data Matching DATA CURRENCY Both financial and statistical data were provided by Statistics Canada for to and extracted from the CMDB for onward. Financial data from to included in the Data Tables were originally published in National Health Expenditure Trends, 1975 to 2004 and extracted in the Fall of Financial data for and statistical data from to were extracted at the end of January 2005 before the CMDB had completely closed data collection for Consequently, data for may differ slightly from what are used in the CMDB Annual Report, Canadian MIS Database (CMDB), Hospital Financial Performance Indicators, to Further, any revisions or improvements in the CMDB for prior years would not be reflected in this analysis. Table A.1 lists the statistical variables considered in the matching project and decisions made about the levels at which the data could be matched from the HS-1 and HS-2 to the CMDB. Tables A.2 and A.3 show how HS-1 and HS-2 variables were matched to the CMDB variables. The functional centre dimension is included to show the full potential of matching variables even though functional centre breakdowns were not used in the statistical data analysis for this project. A 1

106 HOSPITAL TRENDS IN CANADA A PPENDIX A Table A.1 MIS Statistical Accounts and Decisions for Matching Project Variable MIS Secondary Account Admissions 401 Discharges 410 Deaths 411 Inpatient Days 403 Decision Report aggregate data by peer group. Extrapolate to universe based on provincial and peer group aggregations. Approved Beds 862 Beds Staffed and in Operation 825 Approved Bassinets 863 Bassinets Staffed and in Operation 826 Use Ministry of Health master lists. Use Ministry of Health data. These variables are not normally included with bed counts. Scheduled Visits 416 Unscheduled Visits 418 Face-to-face Visits 450 Combine as one variable. 416 and 418 were replaced in by 450. Earned Hours Management and Operational Support Personnel 310 Unit-Producing Personnel 350 Medical Personnel 390 Not used in time series. Indicators by functional centre reported in CMDB Annual Reports. Units of Service Diagnostic 115 Units of Service Therapeutic 116 Procedures Diagnostic 458 Procedures Therapeutic 459 Not used in time series. Matching schedule available from CIHI. Total Days Stay 861 Referred-Out Exams Diagnostic and 460 Therapeutic Referred-Out Procedures Diagnostic 461 These variables excluded due to data quality problems. Attendance Days 483 Other MIS statistical accounts could not be matched due to the absence of equivalent variables in the HS-1 and HS-2. A 2

107 HOSPITAL TRENDS IN CANADA A PPENDIX A Table A.2 Matching Schedule Between MIS Secondary Statistical Accounts and HS-1 and HS-2 Variables Functional Centre Matching Between MIS Accounts and HS-1 and HS-2 Variables and S and 418 and and 459 Administrative Services P P Support Services P P Less P P Operating Room P Nursing Inpatient Services P Less P P P P P P P P P Emergency P P Less P Specialty Day and Night Care P P P P Specialty Clinics P P P Laboratory P P Diagnostic and Therapeutic P P P P Less P P P P P P P P P P P P Community Services P Research and Education P P A 3

108 HOSPITAL TRENDS IN CANADA A PPENDIX A HS-1 and HS-2 Code Table A.3 Brief Description of HS-1 and HS-2 Variables Description P Patient days, adults and children P Patient days, newborns P Admissions, adults and children P Admissions, newborns P Discharges, adults and children P Discharges, newborns P Deaths, adults and children P Deaths, newborns P Total units for laboratory P Examinations, procedures and units, to P Examinations, procedures and units for outpatients, to P Examinations for both inpatients and outpatients for inpatients, to P Units for diagnostic radiology P Time units for physiotherapy services P Time units for occupational therapy P Treatments and diagnostic procedures (under respiratory technology) P Number of visits, ambulatory care units, outpatients P Number of visits, ambulatory care units, inpatients P Number of visits, day and night care programs, outpatients P Number of visits, surgical day care in Emergency unit P Number of visits, emergency unit P Number of visits, all surgical day care program units P Paid hours, surgical suite P Paid hours, nursing inpatient services excluding emergency P Paid hours, emergency P Paid hours, general and special clinics P Total paid hours, surgical day care P Total paid hours, all other ambulatory care P Paid hours, laboratory P Paid hours, hospital-based home care P Paid hours, ambulance (excluding motor transportation) P Paid hours, chief of medical staff and heads of services P Total accumulated paid hours, diagnostic and therapeutic, emergency and chief of medical staff and heads of services P Paid hours, hospital administration P Paid hours, staff education program P Total paid hours, administrative and support services P Approved beds P Approved newborn bassinets P Beds staffed and in operation P Newborn bassinets staffed and in operation A 4

109 Taking health information further Á l avant-garde de l information sur la santé