Hospital Trends in Canada

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

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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... 1 1.1 Hospital Databases... 1 1.2 Size of the Hospital Sector... 2 1.3 Response Rates... 3 Section 2: Summary of Results All Hospitals... 5 2.1 Admissions and Separations... 5 2.2 Average Length of Stay for Inpatients... 7 Section 3: Summary of Results Acute Care Hospitals... 8 3.1 Separations and Inpatient Days per 1,000 Population... 11 3.2 Average Length of Stay for Inpatients... 12 Section 4: Visits to Ambulatory Care Units... 13 Section 5: Methodology... 15 5.1 Issues in Matching and Extrapolating Data... 15 5.2 Comprehensiveness... 16 5.3 Beds Staffed and In Operation... 16 5.4 Extrapolation of Totals... 17 5.5 Peer Groups... 19 5.6 Were Responding Hospitals Representative of all Operating Hospitals?... 19 Conclusions... 19 Part 2 Hospital Expenditures... 21 Introduction... 21 Section 6: Hospital Expenditure Trends... 22 Section 7: Hospital Expenditure by Functional Centre... 24 7.1 Functional Center Breakdown... 24 7.2 Functional Centre Distributions in the HS-1 and HS-2 and the CMDB... 26 7.3 Trends by Type of Expense from 1976 1977 to 2002 2003... 28 Section 8: Hospital Expenditure by Type of Expense... 32 8.1 Type of Expense Breakdown... 32 8.2 Expense Distributions in the HS-1 and HS-2 and the CMDB... 33 8.3 Trends by Type of Expense from 1976 1977 to 2002 2003... 34 Section 9: Hospital Expenditure by Functional Centre and Type of Expense... 37 9.1 Functional Center and Type of Expense Breakdown... 37 9.2 Trends by Functional Centre and Type of Expense... 38 Conclusions... 40

Hospital Trends in Canada Table of Contents (cont'd) Data Tables... 43 Table 1 Series Statistics... 45 Table 2 Series Expenditure... 57 Appendix A Statistical Variables and Data Matching... A 1 List of Figures Figure 1 Trends in Hospital Beds, Canada, 1976 to 2002... 3 Figure 2 Response Rates in HS-1 and HS-2 and CMDB, Canada, 1984 1985 to 2002 2003... 4 Figure 3 Hospital Admissions, Canada, 1976 1977 to 2002 2003... 5 Figure 4 Hospital Separations and Admissions, Canada, 1976 1977 to 2002 2003... 6 Figure 5 Hospital Separations and Admissions in CMDB and HMDB, Canada, 1995 1996 to 2002 2003... 7 Figure 6 Average Inpatient Days, Canada, 1976 1977 to 2002 2003... 8 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... 12 Figure 9 Average Days per Separation, Canada, Selected Years... 12 Figure 10 Visits Ambulatory Care Units, Canada, 1976 1977 to 2002 2003... 13 Figure 11 Distribution of Hospital Expenditure, Reporting Hospitals, Canada, Selected Years... 14 Figure 12 Alternative Measures of Hospital Beds, Canada, 1976 1977 to 2002 2003... 17 Figure 13 Figure 14 Hospital Expenditure Trends from the NHEX Database and from the Reporting Hospitals to CMDB, Canada, 1976 to 2002... 22 Distribution of Hospital Expenditure by Functional Centre, Reporting Hospitals, Canada, 1993 1994 and 1995 1996... 27

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, 1976 1977 to 2002 2003... 28 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 30 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 30 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 31 Share of Hospital Expenditure by Selected Functional Centre, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 32 Distribution of Hospital Expenditure by Type of Expense, Reporting Hospitals, Canada, 1993 1994 and 1995 1996... 34 Share of Hospital Expenditure by Selected Type of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 34 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 35 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 36 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003... 37 Distribution of Salaries and Benefits, Reporting Hospitals, Canada, 1992 1993 and 2002 2003... 39 Distribution of Ambulatory Care Expense, Reporting Hospitals, Canada, 1992 1993 and 2002 2003... 39 Distribution of Emergency Care Expense, Reporting Hospitals, Canada, 1992 1993 and 2002 2003... 40

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, 1976 1977 to 1992 1993... 8 Table 3 Hospital Beds by Type of Hospital, Canada, 1994 1995... 10 Table 4 Table 5 Table 6 Table 7 Table 8 Trends in Hospital Utilization per 1,000 Population, Canada, Selected Years... 11 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, 1995 1996 to 2002 2003... 18 Hospital Expenditure and the Percentage Distributions by Functional Centre, Canada, Selected Years... 27 Expenditure Weights and Annual Rates of Increase, Administrative and Support Services, Canada, 2002 2003... 29 Hospital Expenditures by Functional Centre and Type of Expenses, Canada, 2002 2003... 38 List of Data Tables Table 1 Series Statistics Table 1.1 Selected Statistics, All Hospital Types, Canada, 1976 1977 to 2002 2003... 47 Table 1.2 Table 1.3 Selected Statistics, General Public Hospitals Without Long Term Units, Pediatric Hospitals, and Private Hospitals, Canada, 1976 1977 to 2002 2003... 48 Selected Statistics, General Hospitals With Long Term Units and Federal Hospitals, Canada, 1976 1977 to 2002 2003... 49 Table 1.4 Selected Statistics, Teaching Hospitals, Canada, 1976 1977 to 2002 2003... 50 Table 1.5 Table 1.6 Selected Statistics, Short Term Psychiatric Hospitals, Canada, 1976 1977 to 2002 2003... 51 Selected Statistics, Long Term Psychiatric Hospitals, Canada, 1976 1977 to 2002 2003... 52

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, 1976 1977 to 2002 2003... 53 Table 1.8 Selected Statistics, Rehabilitation Hospitals, Canada, 1976 1977 to 2002 2003... 54 Table 1.9 Selected Statistics, Extended Care Hospitals, Canada, 1976 1977 to 2002 2003... 55 Table 1.10 Selected Statistics, Other Hospitals, Canada, 1976 1977 to 2002 2003... 56 Table 2 Series Expenditure Table 2.1 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1976 1977 Current Dollars... 59 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, 1977 1978 Current Dollars... 60 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1978 1979 Current Dollars... 61 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1979 1980 Current Dollars... 62 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1980 1981 Current Dollars... 63 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1981 1982 Current Dollars... 64 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1982 1983 Current Dollars... 65 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1983 1984 Current Dollars... 66 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1984 1985 Current Dollars... 67 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1985 1986 Current Dollars... 68

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, 1986 1987 Current Dollars... 69 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, 1987 1988 Current Dollars... 70 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1988 1989 Current Dollars... 71 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1989 1990 Current Dollars... 72 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1990 1991 Current Dollars... 73 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1991 1992 Current Dollars... 74 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1992 1993 Current Dollars... 75 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1993 1994 Current Dollars... 76 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1994 1995 Current Dollars... 77 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1995 1996 Current Dollars... 78 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1996 1997 Current Dollars... 79 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1997 1998 Current Dollars... 80 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1998 1999 Current Dollars... 81 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 1999 2000 Current Dollars... 82 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 2000 2001 Current Dollars... 83

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, 2001 2002 Current Dollars... 84 Table 2.27 Hospital Expenditure by Functional Centre and Type of Expense, Canada, 2002 2003 Current Dollars... 85

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 200 377 Dalhousie Street Ottawa, Ontario K1N 9N8 Tel.: (613) 241-7860 Fax: (613) 241-8120 Email: nhex@cihi.ca Web: www.cihi.ca i

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 1976 1977 to 1991 1992, 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 1985 1986. 3. 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 2002. 6. 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 2002 2003. 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 1976 1977 to 68% in 2002 2003. 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

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 1993 1994. 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 2002. 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 2. 1. 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 1999. CIHI, Ottawa, 2003. Available at <http://secure.cihi.ca>. v

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 1995 1996. 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 1993 1994. In 1994 1995 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

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: 2002 2003 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 1996. 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 1988 1989 at 179,256 (Figure 1). The number of beds declined slowly for the next three years but then increased in 1993 1994, 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 1993 1994 to 1996 1997, the number of beds 3. National Health Expenditure Trends, 1975 to 2004. Canadian Institute for Health Information, Ottawa. 2004. 2

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 1997. The number of beds continued to drop until 2000 2001, 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) 200 35 30 160 Expenditure (per calendar year) 25 Beds (per fiscal year) 120 20 15 80 10 40 5 0 0 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 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 1994 1995. Response rates (beds in reporting hospitals as a percentage of beds in all operating hospitals) were lower during the four years from 1995 1996 to 1999 2000, 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

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 1988 1989. By 1993 1994, the gap had increased to 9.8% and in 1994 1995 reached 22.8%. Bed counts shown in Figure 1 are approved beds until 1993 1994. Under the CMDB provinces/territories report only one set of bed counts. In 1995 1996 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 1986 1987 and 1994 1995 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. 100.0% Figure 2 Response Rates in HS-1 and HS-2 and CMDB, Canada, 1984 1985 to 2002 2003 90.0% 80.0% 70.0% 60.0% 1984 1985 1985-1986 1986 1987 1987 1988 1988 1989 1989 1990 1990 1991 1991 1992 1992 1993 1993 1994 1994 1995 1995 1996 1996 1997 1997 1998 1998 1999 1999 2000 2000 2001 2001 2002 2002 2003 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.33 39. 4

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 1995 1996 to 90.9% in 2000 2001 and then dropped back to 86.6% by 2002 2003. 5 Admissions tended to be fairly constant between 1976 1977 and 1991 1992 at approximately 4.0 to 4.2 million per year (Figure 3). Admissions began declining in 1992 1993, dropping from 4.2 million in 1991 1992 to 4.1 million in 1993 1994. During the following years the number of admissions continued to drop, leveling out at 3.3 million to 3.1 million between 1997 1998 and 2002 2003. (000) 4,500 Figure 3 Hospital Admissions, Canada, 1976 1977 to 2002 2003 3,500 Raw data Extrapolation 2,500 1,500 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 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

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 1987 1988 and 2002 2003, 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 1976 1977 and 2002 2003, with differences normally less than two-tenths of one percent (Figure 4). Differences were greater in 1995 1996 and subsequent years, possibly reflecting greater variability due to lower response rates. (000) 4,500 Figure 4 Hospital Separations and Admissions, Canada, 1976 1977 to 2002 2003 3,500 Separations Admissions 2,500 1,500 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Year 1996 1997 1998 1999 2000 2001 2002 2003 Sources: Canadian Institute for Health Information and Statistics Canada. Figure 5 compares the extrapolated series of separations from 1995 1996 to 2002 2003 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

HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS (000) 4,500 Figure 5 Hospital Separations in CMDB and HMDB, Canada, 1995 1996 to 2002 2003 CMDB HMDB 3,500 2,500 1,500 1995 1996 1996 1997 1997 1998 1998 1999 1999 2000 2000 2001 2001 2002 2002 2003 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 1976 1977 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 1976 1977 and 1992 1993 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 1990 1991. Average days per separation declined from 13.3 in 1989 to 10.1 in 2002 2003. Variations in the trend in 1996 1997 and 1997 1998 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

HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS Table 2 Comparison of Statistics for Average Length of Stay, Canada, 1976 1977 to 1992 1993 Average Days Per Separation ALOS Mean Value 13.0 13.4 Standard Deviation 0.58 0.47 Sources: Canadian Institute for Health Information and Statistics Canada. 15.0 Figure 6 Average Inpatient Days, Canada, 1976 1977 to 2002 2003 13.0 11.0 9.0 7.0 5.0 Inpatient Days per Separation Average Length of Stay 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 Year 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 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 1976 1977 and 1986 1987, 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 1976 1977 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

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 10,000 1976 1977 1986 1987 1994 1995 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 1986 1987 and 1994 1995, 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 1986 1987, 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

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 1994 1995 (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 123.7 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, 1994 1995 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 18,532 6.8 65,458 51,816 10.2 Teaching 37,263 29,340 9.2 Short term psychiatric; other specialty and rehab 5,315 4,186 19.7 Sub-total acute care 132,506 103,874 9.3 Extended care and long term psychiatric 24,041 16,909 123.7 Total 156,547 120,783 11.9 * 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

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 1976 1977 to 2002 2003, 11 with the largest annual decreases in the years after 1993 1994. 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 1976 1977 and 1986 1987, followed by decreases in subsequent years. The higher rate of decrease between 1993 1994 and 2002 2003 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 1976 1977 174.0 2,115.6 171.5 1,648.7 1986 1987 158.5 2,153.8 155.6 1,671.7 1993 1994 142.0 1,691.6 138.8 1,295.8 2002 2003 98.8 995.9 97.7 878.8 1976 1977 to 1986 1987 1986 1987 to 1993 1994 1993 1994 to 2002 2003 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 1989 1990, but rates of growth in these statistics were less than the rate of growth in the population. 11

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 1,000 500 1976 1977 1986 1987 1993 1994 2002 2003 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 1976 1977 and 1986 1987 in acute care hospitals (Figure 9). Average days decreased over the next 16 years, reaching 9.0 days in 2002 2003, a reduction of 15.9% from the 10.7 days recorded in 1986 1987. 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 12 10 9.6 10.7 9.3 9.0 8 6 4 2 1976 1977 1986 1987 1993 1994 2002 2003 Year Sources: Canadian Institute for Health Information and Statistics Canada. 12

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 1997 1998; and Manitoba hospitals outside the Winnipeg area). The DAD reported 2.0 million day surgery procedures and 1.4 million day surgery visits in 2001 2002. 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 1976 1977 (23 million) and 1993 1994 (41 million). 12 If trends in the ten years ending in 1993 1994 continued, the number of visits would exceed 50 million by 2002 2003 (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, 1976 1977 to 2002 2003 40,000 30,000 20,000 10,000 HS-1 and HS-2 Linear Trend (HS-1 and HS-2) 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 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 1993 1994. 13

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 1993 1994 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 1976 1977 and 2002 2003. Taken together, these functional centres accounted for 12.4% of hospital expenditure, or $4.1 billion, in 2002 2003, compared to 4.9% in 1976 1977. 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% 1976 1977 1986 1987 1993 1994 2002 2003 Year Sources: Canadian Institute for Health Information and Statistics Canada. 14

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 2002. 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

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 1989 1990. Between 1989 1990 and 1992 1993 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 1993 1994 the difference was equivalent to 10%. There were large decreases in both approved and operating beds in 1994 1995, 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 1995 1996 until 1998 1999, the number of beds reported on the provincial master lists remained above the number of beds reported to be in operation in 1994 1995. 16

HOSPITAL TRENDS IN CANADA P ART 1 HOSPITAL STATISTICS 190,000 180,000 170,000 160,000 150,000 140,000 130,000 120,000 110,000 1976 1977 Figure 12 Alternative Measures of Hospital Beds, Canada, 1976 1977 to 2002 2003 1978 1979 1980 1981 Rated Approved Staffed and In Operation CMDB 1982 1983 1984 1985 1986 1987 1988 1989 Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada. 1990 1991 1992 1993 1994 1995 p 1996 1997 1998 1999 2000 2001 2002 2003 5.4 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

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, 1995 1996 to 2002 2003 Year Admissions Inpatient Days Discharges Beds in Hospitals Reporting Any Statistics 1995 1996 97.0% 98.2% 98.3% 123,849 1996 1997 95.8% 98.5% 95.9% 114,000 1997 1998 98.0% 99.5% 96.9% 115,959 1998 1999 95.2% 98.0% 95.2% 113,042 1999 2000 95.1% 97.7% 94.2% 111,433 2000 2001 97.1% 97.0% 92.9% 109,443 2001 2002 95.6% 97.1% 94.2% 111,168 2002 2003 96.6% 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 55,500. 18

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 1994 1995 where available, however, the 1994 1995 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 1976 1977 to 1991 1992. 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

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 1993 1994 to 1995 1996. 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

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 1993 1994. 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 1995 1996 to 2002 2003. 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 1976 1977 to 2002 2003 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

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 $26.7 billion in 1993 (Figure 13). Hospital expenditures decreased during the next three years, then resumed growth in 1997. 15 The period of negative growth in hospital expenditures coincided with a period of fiscal restraint by provincial and territorial governments, which saw both health expenditures and other government expenditures decrease. Figure 13 Hospital Expenditure Trends from the NHEX Database and from the Reporting Hosptials to CMDB, Canada, ($ millions) 1976 to 2002 35,000 30,000 25,000 20,000 15,000 10,000 5,000 NHEX Reported 0 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 Year Sources: Canadian Institute for Health Information and Statistics Canada. Hospital survey estimates tend to be close to the NHEX estimates. From 1976 1977 to the end of the HS-1 and HS-2 series in 1994 1995, survey estimates were in the range of 87% to 96% of NHEX estimates in most years. With the transition to the CMDB in 1995 1996, estimates ranged from 86% to 96% of the NHEX estimates, with the closest match in 2002 2003. 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 1995 1996, with the response rate rising to 98% of beds in 2002 2003). 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

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 2002 2003, 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. 1996 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 2002 2003 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 1994 1995 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 1993 1994 and 16. Canadian MIS Database. Canadian Institute for Health Information. 23

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS 1995 1996 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

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

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 1993 1994 18 and the CMDB in 1995 1996 (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 1995 1996 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 1993 1994. Survey data for 1994 1995 were preliminary with the details by certain type of expenses but the data were not available by functional centre. 26

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) 1993 1994 1995 1996 2001 2002 2002 2003 Administrative Services 2,698.7 9.4 6.5 8.0 7.9 Support Services 5,650.8 21.8 21.4 16.8 16.4 Nursing Inpatient Services 10,322.0 31.5 29.9 29.9 30.0 Operating Room 2,014.4 5.2 6.5 5.8 5.9 Ambulatory Care Services 2,601.0 4.8 5.9 7.5 7.6 Emergency 1,669.6 3.0 3.3 4.8 4.9 Diagnostic and Therapeutic 6,865.8 21.8 20.0 19.8 20.0 Community and Social Services 699.5 0.1 0.0 1.9 2.0 Research and Education 822.7 2.5 2.8 2.5 2.4 All Other 1,030.7 n/a 3.7 3.1 3.0 Total 34,375.1 100.0 100.0 100.0 100.0 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, 1993 1994 and 1995 1996 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 1993 1994 1995 1996 All Other 27

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS 7.3 Trends by Functional Centre from 1976 1977 to 2002 2003 Administration and Support Services Administration has increased as a share of hospital expenditure. The trend from 1976 1977 to 1993 1994 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 1991 1992. 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 1995 1996 and 2002 2003 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 1976 1977 to 16% in 2002 2003 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 1999 2000 and 2002 2003. 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, 1976 1977 to 2002 2003 25.0% 20.0% 15.0% Administrative Services Support Services 10.0% 5.0% 0.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Year 1996 1997 1998 1999 2000 2001 2002 2003 Sources: Canadian Institute for Health Information and Statistics Canada. 28

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Table 7 Expenditure Weights and Annual Rates of Increase, Administrative and Support Services, Canada, 2002 2003 MIS Account Numbers and Name Expenditure 2002 2003 ($' millions) Annual Rate of Increase Since 1995 1996 Administrative Services 71110 General Administration 1,223 7.3% 71115 Finance 223-1.9% 71120 Human Resources 252 3.8% 71125 Systems Support 647 9.6% 71130 Communications 354 15.6% Total 2,699 7.1% Support Services 71135 Materiel Management 564 1.4% 71140 Volunteer Services 26 2.3% 71145 Housekeeping 979 1.3% 71150 Laundry and Linen 311-2.5% 71153, 55 Plant Administration 924 3.3% and Operation 71160 Plant Security 146 2.8% 71165 Plant Maintenance 731 0.6% 71175 Bio-Medical Engineering 101 3.3% 71180, 82 Registration 189-7.5% 71185 Patient Transport 212 6.0% 71190 Health Records 368-1.1% 71195 Patient Food Services 1,101-0.7% Total 5,651 0.5% All Hospital Expenditures (Calendar 2002) 34,375.1 4.4% 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 1980 1981 to 31.5% in 1993 1994 (Figure 16). Since 1995 1996, 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

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 16 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, 1976 1977 to 2002 2003 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Nursing Inpatient Services 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 Year 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 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 1976 1977 to 1993 1994). After dropping six tenths of a percentage point between 1995 1996 and 1999 2000, operating room expenditures have stabilized at about 5.9% (Figure 17). Figure 17 Share of Hospital Expenditure by Selected Functional Centres, Reporting Hospitals, Canada, 1976 1977 to 2002 2003 10.0% 8.0% Operating Room 6.0% 4.0% 2.0% 0.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year Sources: Canadian Institute for Health Information and Statistics Canada. 30

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 1995 1996 than in the earlier years of the analysis (Figure 18). Both functional centres increased their shares by one tenth of a percentage point in 2002 2003, 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, 1976 1977 to 2002 2003 Ambulatory Care Services Emergency 4.0% 2.0% 0.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 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 1976 1977 to 22% in 1993 1994 (Figure 19). The share dropped by 1.8 percentage points from 1993 1994 to 1995 1996 and has stabilized at about 20% since then. 31

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, 1976 1977 to 2002 2003 20.0% 15.0% 10.0% 5.0% Diagnostic and Therapeutic 0.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 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 1995 1996 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 2002 2003. Research and education has been quite stable, fluctuating in a narrow range around three percent of expenditures from 1976 1977 to 1993 1994, and between 2.4% to 2.8% since 1995 1996. 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

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 1993 1994 and the CMDB in 1995 1996 (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 1976 1977 to 2002 2003. 19. For example, salaries paid by contractors who provide security or housekeeping services would be recorded as purchased salaries. 33

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 20 Distribution of Hospital Expenditure by Type of Expense, Reporting Hospitals, Canada, 1993 1994 and 1995 1996 70.0% 60.0% 50.0% 40.0% 1993 1994 1995 1996 30.0% 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 1976 1977 to 2002 2003 Physician compensation represented 3.3% of hospital expenditures in 1976 1977 but dropped to 2.3% in 1979 1980 (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, 1976 1977 to 2002 2003 Physician Compensation 6.0% 4.0% 2.0% 0.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada. 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995p 1996 1997 1998 1999 2000 2001 2002 2003 34

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Staff salaries and benefits together accounted for 76.3% of hospital expenses in 1976 1977. The share for these expenses declined throughout the 1980s and 1990s (Figure 22). The combined share in 1994 1995 20 was 71.8% and in 2002 2003 it was 67.6%. Salaries have declined steadily, falling 4.4 percentage points to 57.4% between 1995 1996 and 2002 2003. While benefits experienced an initial increase after the transition to the CMDB, they have been virtually stable since that time. Prior to 1995 1996, benefits had been trending upward, accounting for 6.6% of hospital expenditures in 1976 1977 and 9.7% in 1994 1995. 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 2002 2003 was 5.7 to 1. 80.0% Figure 22 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003 60.0% 40.0% Benefits Salaries 20.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 p = preliminary data Year Sources: Canadian Institute for Health Information and Statistics Canada. 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995p 1996 1997 1998 1999 2000 2001 2002 2003 Drugs accounted for an increasing share of hospital expenditure from 1983 1984 to 1986 1987. From 1986 1987 to 1994 1995 the share of drugs remained between 3.1% and 3.4% (Figure 23). Drug expenditures have been increasing since 1995 1996, from 3.5% of hospital expenses to 4.5% in 2002 2003. 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 2002. 21 20. Data for the year 1994-1995 where available were preliminary and obtained from Hospital Statistics: Preliminary Annual Report, 1994/95, Statistics Canada, 1996. 21. See discussion in section titled Total Health Expenditure by Use of Funds in National Health Expenditure Trends, 1975 2004, CIHI, Dec. 2004, available at www.cihi.ca. 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

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS The share of expenses for medical supplies increased slowly from 1976 1977 to 1983 1984, from 2.9% to 3.6%. While it saw greater growth over the next four years, reaching 4.3% of total hospital expenditure, between 1987 1988 and 1993 1994 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 1995 1996 to 5.4% in 2002 2003. Figure 23 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Drugs Medical Supplies 1976 1977 1978 1979 1980 1981 1982 1983 Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada. 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995p 1996 1997 1998 1999 2000 2001 2002 2003 Supplies and sundries have followed a variable trend, peaking at 18.5% of hospital expenses in 1989 1990 (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 1998 1999 shows supplies and sundries decreasing, there have been large variations in the data. The category increased quite rapidly between 1995 1996 and 1998 1999 (from 15.5% in 1995 1996 to 18.7% in 1998-1999), before dropping 1.9 percentage points between 1998 1999 and 2002 2003. 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 1995 1996 to 13.3% in 1998 1999. 36

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 24 Share of Hospital Expenditure by Selected Types of Expense, Reporting Hospitals, Canada, 1976 1977 to 2002 2003 22.0% 20.0% 18.0% 16.0% 14.0% Other Supplies and Sundries 12.0% 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 Year p = preliminary data Sources: Canadian Institute for Health Information and Statistics Canada. 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995p 1996 1997 1998 1999 2000 2001 2002 2003 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

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 105.8 1,720.2 0.5 0.6 871.6 2,698.7 Support Services 6.7 3,490.5 7.9 31.5 2,114.3 5,650.8 Nursing Inpatient Services 492.2 8,721.0 446.6 328.1 334.0 10,322.0 Operating Room 36.2 924.6 91.1 844.3 118.1 2,014.4 Ambulatory Care Services 222.7 1,649.4 285.7 284.3 158.8 2,601.0 Emergency 213.3 1,239.3 83.4 76.6 56.9 1,669.6 Diagnostic and Therapeutic 740.2 4,205.1 344.0 285.4 1,291.1 6,865.8 Community and Social Services 26.6 362.7 117.4 10.9 182.0 699.5 Research and Education 64.1 500.4 0.1 0.7 257.3 822.7 All Other 19.4 432.0 175.1 7.6 396.5 1,030.7 Total 1,927.1 23,245.3 1,552.0 1,870.0 5,780.7 34,375.1 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 1995 1996. 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 1992 1993 and 2002 2003 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

HOSPITAL TRENDS IN CANADA P ART 2 HOSPITAL STATISTICS Figure 25 Distribution of Salaries and Benefits, Reporting Hospitals, Canada, 1992 1993 and 2002 2003 50.0% 40.0% 1992 1993 2002 2003 30.0% 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, 1992 1993 and 2002 2003 Physician Compensation Salaries and Benefits Drugs 1992 1993 2002 2003 Medical Supplies Other Supplies and Sundries Sources: Canadian Institute for Health Information and Statistics Canada. 39

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, 1992 1993 and 2002 2003 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Physician Compensation Salaries and Benefits 1992 1993 2002 2003 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

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

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

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

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, All Hospital Types, Canada, 1976 1977 to 2002 2003 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 1976 1977 4,080,462 49,536,238 3,976,230 102,848 23,229,869 161,212 162,234 164,296 165,318 1977 1978 4,045,953 50,345,092 3,931,060 105,385 24,046,221 162,152 163,131 165,139 166,088 1978 1979 4,023,023 51,062,646 3,923,891 102,569 25,472,709 163,729 164,619 166,262 167,149 1979 1980 4,004,374 51,467,203 3,887,030 106,609 26,042,318 163,503 164,362 165,671 166,527 1980 1981 3,996,630 51,962,017 3,885,140 107,816 26,315,096 165,019 165,588 167,305 167,862 1981 1982 4,009,534 53,521,202 3,898,604 109,514 27,522,957 168,925 170,272 171,984 173,333 1982 1983 4,042,903 53,668,139 3,936,344 114,124 28,366,397 167,617 171,473 171,256 175,085 1983 1984 4,078,438 55,208,418 3,963,897 112,876 29,351,174 171,902 173,520 174,620 176,205 1984 1985 4,093,111 55,656,886 3,970,461 116,874 30,759,412 172,513 174,565 174,982 177,006 1985 1986 4,107,329 55,538,591 3,990,948 120,762 32,663,556 171,936 174,463 174,957 177,461 1986 1987 4,129,059 55,662,554 4,000,814 119,635 34,305,893 172,422 174,978 175,641 178,137 1987 1988 4,138,951 55,568,242 4,022,522 124,411 35,918,848 172,138 174,710 176,374 178,905 1988 1989 4,091,734 54,794,498 3,943,699 123,481 37,073,306 170,786 173,838 176,170 179,256 1989 1990 4,075,113 53,795,244 3,929,252 125,012 37,599,189 168,851 172,811 174,740 179,156 1990 1991 4,042,218 50,616,604 3,905,379 120,401 38,491,022 159,575 165,741 167,153 173,617 1991 1992 4,110,079 49,764,928 3,978,288 124,126 39,524,969 156,210 161,620 166,494 171,904 1992 1993 3,903,555 46,616,740 3,784,128 121,131 39,095,204 147,879 156,466 160,792 169,379 1993 1994 3,831,749 45,725,059 3,720,640 122,602 39,398,204 144,200 155,266 161,156 172,222 1994 1995 p 3,228,604 36,893,446 3,140,659 103,491 --- --- 120,783 136,041 156,547 1995 1996 3,266,843 36,669,964 3,252,075 89,586 35,755,461 124,788 146,701 124,788 146,701 1996 1997 2,824,589 33,751,433 2,845,950 88,592 32,224,926 114,000 135,959 114,000 135,959 1997 1998 2,969,540 34,402,270 2,885,477 107,798 34,541,538 118,063 137,018 118,063 137,018 1998 1999 3,047,792 33,246,284 3,105,248 104,078 36,318,960 113,131 131,823 113,131 131,823 1999 2000 3,154,326 34,151,239 3,120,040 110,484 37,944,490 111,300 119,199 111,300 119,199 2000 2001 3,133,806 32,739,815 2,950,956 110,625 38,770,350 110,968 115,222 110,968 115,222 2001 2002 3,067,059 30,970,666 2,963,686 143,555 40,281,093 111,555 115,079 111,555 115,079 2002 2003 3,058,901 30,725,675 2,951,466 109,989 39,811,037 113,167 115,120 113,167 115,120 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978-0.8 1.6-1.1 2.5 3.5 0.6 0.6 0.5 0.5 1978 1979-0.6 1.4-0.2-2.7 5.9 1.0 0.9 0.7 0.6 1979 1980-0.5 0.8-0.9 3.9 2.2-0.1-0.2-0.4-0.4 1980 1981-0.2 1.0 0.0 1.1 1.0 0.9 0.7 1.0 0.8 1981 1982 0.3 3.0 0.3 1.6 4.6 2.4 2.8 2.8 3.3 1982 1983 0.8 0.3 1.0 4.2 3.1-0.8 0.7-0.4 1.0 1983 1984 0.9 2.9 0.7-1.1 3.5 2.6 1.2 2.0 0.6 1984 1985 0.4 0.8 0.2 3.5 4.8 0.4 0.6 0.2 0.5 1985 1986 0.3-0.2 0.5 3.3 6.2-0.3-0.1 0.0 0.3 1986 1987 0.5 0.2 0.2-0.9 5.0 0.3 0.3 0.4 0.4 1987 1988 0.2-0.2 0.5 4.0 4.7-0.2-0.2 0.4 0.4 1988 1989-1.1-1.4-2.0-0.7 3.2-0.8-0.5-0.1 0.2 1989 1990-0.4-1.8-0.4 1.2 1.4-1.1-0.6-0.8-0.1 1990 1991-0.8-5.9-0.6-3.7 2.4-5.5-4.1-4.3-3.1 1991 1992 1.7-1.7 1.9 3.1 2.7-2.1-2.5-0.4-1.0 1992 1993-5.0-6.3-4.9-2.4-1.1-5.3-3.2-3.4-1.5 1993 1994-1.8-1.9-1.7 1.2 0.8-2.5-0.8 0.2 1.7 1994 1995-15.7-19.3-15.6-15.6 --- --- -22.2-15.6-9.1 1995 1996 1.2-0.6 3.5-13.4 --- --- 21.5-8.3-6.3 1996 1997-13.5-8.0-12.5-1.1-9.9-8.6-7.3-8.6-7.3 1997 1998 5.1 1.9 1.4 21.7 7.2 3.6 0.8 3.6 0.8 1998 1999 2.6-3.4 7.6-3.5 5.1-4.2-3.8-4.2-3.8 1999 2000 3.5 2.7 0.5 6.2 4.5-1.6-9.6-1.6-9.6 2000 2001-0.7-4.1-5.4 0.1 2.2-0.3-3.3-0.3-3.3 2001 2002-2.1-5.4 0.4 29.8 3.9 0.5-0.1 0.5-0.1 2002 2003-0.3-0.8-0.4-23.4-1.2 1.4 0.0 1.4 0.0 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 47

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, 1976 1977 to 2002 2003 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 1976 1977 1,686,466 13,129,947 1,652,826 33,559 8,888,789 45,999 46,027 46,222 46,250 1977 1978 1,546,756 12,074,140 1,512,753 30,916 8,353,009 41,924 42,434 42,153 42,668 1978 1979 1,491,898 11,672,120 1,464,074 29,284 8,558,767 40,781 40,853 41,027 41,099 1979 1980 1,354,354 10,537,283 1,324,608 26,803 8,136,993 37,011 37,061 37,217 37,267 1980 1981 1,328,410 10,367,878 1,301,405 26,850 8,193,036 36,534 36,574 36,782 36,822 1981 1982 1,291,603 10,144,103 1,265,248 26,166 8,148,069 36,048 36,088 36,426 36,466 1982 1983 1,251,906 9,770,130 1,228,132 26,567 8,066,367 34,164 34,239 34,894 34,969 1983 1984 1,168,920 9,205,137 1,143,666 24,666 7,872,695 32,159 32,205 32,658 32,704 1984 1985 1,129,290 8,925,798 1,104,200 23,993 7,970,293 30,947 31,012 31,465 31,530 1985 1986 1,071,781 8,457,452 1,049,496 23,678 7,996,471 29,498 29,575 30,233 30,317 1986 1987 1,011,724 7,966,123 988,200 21,828 7,914,968 27,617 27,862 28,253 28,474 1987 1988 995,521 7,874,224 974,791 22,612 8,186,401 27,361 27,372 28,112 28,120 1988 1989 957,344 7,432,902 935,296 22,033 8,022,285 26,533 26,620 27,521 27,609 1989 1990 891,229 6,882,120 870,464 21,614 7,771,330 24,749 24,970 25,751 25,972 1990 1991 942,688 7,044,010 922,466 21,998 8,481,784 25,988 26,344 27,285 27,641 1991 1992 975,101 7,049,502 950,639 22,751 8,824,861 25,768 26,013 27,679 27,924 1992 1993 910,540 6,436,504 889,379 21,610 8,578,196 23,899 24,422 26,068 26,591 1993 1994 887,024 6,056,269 867,677 22,239 8,762,801 22,218 22,682 25,551 26,015 1994 1995 p 713,995 4,906,313 698,697 23,023 --- --- 18,532 21,315 24,470 1995 1996 700,357 5,216,867 663,992 18,246 7,242,484 18,247 21,754 18,247 21,754 1996 1997 540,857 3,817,167 539,473 14,748 5,863,983 14,762 19,171 14,762 19,171 1997 1998 610,290 4,459,468 607,914 18,060 6,906,569 17,301 19,741 17,301 19,741 1998 1999 609,394 4,422,108 676,740 20,100 7,070,091 15,773 17,899 15,773 17,899 1999 2000 529,705 3,929,095 538,470 18,878 6,480,229 14,296 15,300 14,296 15,300 2000 2001 502,124 3,443,610 477,483 16,670 6,259,924 13,842 14,334 13,842 14,334 2001 2002 476,835 3,251,842 454,338 14,228 6,307,665 12,642 13,192 12,642 13,192 2002 2003 451,402 3,160,362 439,729 13,909 5,804,646 12,562 12,734 12,562 12,734 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978-8.3-8.0-8.5-7.9-6.0-8.9-7.8-8.8-7.7 1978 1979-3.5-3.3-3.2-5.3 2.5-2.7-3.7-2.7-3.7 1979 1980-9.2-9.7-9.5-8.5-4.9-9.2-9.3-9.3-9.3 1980 1981-1.9-1.6-1.8 0.2 0.7-1.3-1.3-1.2-1.2 1981 1982-2.8-2.2-2.8-2.5-0.5-1.3-1.3-1.0-1.0 1982 1983-3.1-3.7-2.9 1.5-1.0-5.2-5.1-4.2-4.1 1983 1984-6.6-5.8-6.9-7.2-2.4-5.9-5.9-6.4-6.5 1984 1985-3.4-3.0-3.5-2.7 1.2-3.8-3.7-3.7-3.6 1985 1986-5.1-5.2-5.0-1.3 0.3-4.7-4.6-3.9-3.8 1986 1987-5.6-5.8-5.8-7.8-1.0-6.4-5.8-6.5-6.1 1987 1988-1.6-1.2-1.4 3.6 3.4-0.9-1.8-0.5-1.2 1988 1989-3.8-5.6-4.1-2.6-2.0-3.0-2.7-2.1-1.8 1989 1990-6.9-7.4-6.9-1.9-3.1-6.7-6.2-6.4-5.9 1990 1991 5.8 2.4 6.0 1.8 9.1 5.0 5.5 6.0 6.4 1991 1992 3.4 0.1 3.1 3.4 4.0-0.8-1.3 1.4 1.0 1992 1993-6.6-8.7-6.4-5.0-2.8-7.3-6.1-5.8-4.8 1993 1994-2.6-5.9-2.4 2.9 2.2-7.0-7.1-2.0-2.2 1994 1995-19.5-19.0-19.5 3.5 --- --- -18.3-16.6-5.9 1995 1996-1.9 6.3-5.0-20.8 --- --- 17.4-14.4-11.1 1996 1997-22.8-26.8-18.8-19.2-19.0-19.1-11.9-19.1-11.9 1997 1998 12.8 16.8 12.7 22.5 17.8 17.2 3.0 17.2 3.0 1998 1999-0.1-0.8 11.3 11.3 2.4-8.8-9.3-8.8-9.3 1999 2000-13.1-11.1-20.4-6.1-8.3-9.4-14.5-9.4-14.5 2000 2001-5.2-12.4-11.3-11.7-3.4-3.2-6.3-3.2-6.3 2001 2002-5.0-5.6-4.8-14.6 0.8-8.7-8.0-8.7-8.0 2002 2003-5.3-2.8-3.2-2.2-8.0-0.6-3.5-0.6-3.5 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 48

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, 1976 1977 to 2002 2003 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 1976 1977 1,252,434 13,818,099 1,219,310 32,309 6,587,745 45,620 45,805 46,828 47,013 1977 1978 1,363,301 14,960,566 1,324,544 35,862 7,572,510 48,530 48,530 49,307 49,307 1978 1979 1,405,857 15,755,503 1,370,375 36,449 8,265,708 50,736 50,932 51,625 51,813 1979 1980 1,515,867 16,876,492 1,470,739 41,063 9,285,367 53,635 53,818 54,144 54,319 1980 1981 1,511,132 17,419,101 1,467,110 42,006 9,323,953 54,746 54,814 55,373 55,440 1981 1982 1,558,324 18,240,247 1,512,680 44,702 10,112,776 57,217 57,243 57,865 57,890 1982 1983 1,559,977 18,084,177 1,516,127 46,534 10,058,526 56,324 56,384 57,260 57,320 1983 1984 1,675,567 19,240,977 1,626,322 48,468 10,922,301 59,785 59,811 60,671 60,696 1984 1985 1,690,468 19,768,494 1,636,656 51,020 11,508,478 61,152 61,178 62,003 62,028 1985 1986 1,733,312 20,609,847 1,680,514 53,961 12,539,426 63,876 64,032 64,516 64,671 1986 1987 1,781,047 21,091,858 1,722,158 54,408 13,409,192 65,645 65,645 66,389 66,389 1987 1988 1,816,635 21,182,987 1,762,027 57,243 14,203,166 65,724 66,024 66,733 67,033 1988 1989 1,814,896 21,184,603 1,756,024 58,223 14,872,053 66,152 66,442 67,542 67,842 1989 1990 1,931,441 21,670,116 1,871,949 60,922 15,908,054 68,103 69,290 69,775 71,398 1990 1991 1,782,652 19,300,316 1,729,469 56,237 15,429,198 60,394 63,039 62,753 65,672 1991 1992 1,830,038 19,288,920 1,768,348 58,386 15,837,160 60,086 62,286 63,561 65,761 1992 1993 1,783,765 18,670,725 1,725,419 58,521 16,025,965 59,112 60,939 63,890 65,717 1993 1994 1,741,375 17,752,154 1,686,737 58,713 15,899,441 56,118 59,636 62,240 65,758 1994 1995 p 1,483,051 15,967,311 1,440,973 47,483 --- --- 51,816 57,594 65,458 1995 1996 1,614,131 17,573,234 1,635,386 44,365 15,411,386 58,189 60,241 58,189 60,241 1996 1997 1,427,701 16,853,243 1,451,899 43,506 14,273,749 54,425 58,739 54,425 58,739 1997 1998 1,416,251 16,301,006 1,395,421 52,644 14,673,313 52,747 56,604 52,747 56,604 1998 1999 1,456,524 15,644,214 1,452,922 48,661 15,137,756 50,843 57,638 50,843 57,638 1999 2000 1,538,451 16,107,331 1,590,289 56,451 16,509,488 51,166 53,787 51,166 53,787 2000 2001 1,548,686 15,338,429 1,542,993 59,655 17,561,300 50,057 50,435 50,057 50,435 2001 2002 1,551,475 13,916,854 1,522,970 58,337 17,352,818 52,519 52,932 52,519 52,932 2002 2003 1,524,162 13,603,362 1,497,071 60,265 17,465,791 52,842 53,921 52,842 53,921 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 8.9 8.3 8.6 11.0 14.9 6.4 5.9 5.3 4.9 1978 1979 3.1 5.3 3.5 1.6 9.2 4.5 4.9 4.7 5.1 1979 1980 7.8 7.1 7.3 12.7 12.3 5.7 5.7 4.9 4.8 1980 1981-0.3 3.2-0.2 2.3 0.4 2.1 1.9 2.3 2.1 1981 1982 3.1 4.7 3.1 6.4 8.5 4.5 4.4 4.5 4.4 1982 1983 0.1-0.9 0.2 4.1-0.5-1.6-1.5-1.0-1.0 1983 1984 7.4 6.4 7.3 4.2 8.6 6.1 6.1 6.0 5.9 1984 1985 0.9 2.7 0.6 5.3 5.4 2.3 2.3 2.2 2.2 1985 1986 2.5 4.3 2.7 5.8 9.0 4.5 4.7 4.1 4.3 1986 1987 2.8 2.3 2.5 0.8 6.9 2.8 2.5 2.9 2.7 1987 1988 2.0 0.4 2.3 5.2 5.9 0.1 0.6 0.5 1.0 1988 1989-0.1 0.0-0.3 1.7 4.7 0.7 0.6 1.2 1.2 1989 1990 6.4 2.3 6.6 4.6 7.0 2.9 4.3 3.3 5.2 1990 1991-7.7-10.9-7.6-7.7-3.0-11.3-9.0-10.1-8.0 1991 1992 2.7-0.1 2.2 3.8 2.6-0.5-1.2 1.3 0.1 1992 1993-2.5-3.2-2.4 0.2 1.2-1.6-2.2 0.5-0.1 1993 1994-2.4-4.9-2.2 0.3-0.8-5.1-2.1-2.6 0.1 1994 1995-14.8-10.1-14.6-19.1 --- --- -13.1-7.5-0.5 1995 1996 8.8 10.1 13.5-6.6 --- --- 16.3 1.0-8.0 1996 1997-11.5-4.1-11.2-1.9-7.4-6.5-2.5-6.5-2.5 1997 1998-0.8-3.3-3.9 21.0 2.8-3.1-3.6-3.1-3.6 1998 1999 2.8-4.0 4.1-7.6 3.2-3.6 1.8-3.6 1.8 1999 2000 5.6 3.0 9.5 16.0 9.1 0.6-6.7 0.6-6.7 2000 2001 0.7-4.8-3.0 5.7 6.4-2.2-6.2-2.2-6.2 2001 2002 0.2-9.3-1.3-2.2-1.2 4.9 5.0 4.9 5.0 2002 2003-1.8-2.3-1.7 3.3 0.7 0.6 1.9 0.6 1.9 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 49

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.4 Selected Statistics, Teaching Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 1,029,084 10,631,505 1,001,265 27,525 6,972,231 34,175 34,175 35,253 35,253 1977 1978 1,021,591 11,060,088 989,188 29,085 7,283,469 35,449 35,449 36,606 36,606 1978 1979 1,005,686 11,029,341 979,003 28,060 7,670,417 34,951 34,951 36,027 36,027 1979 1980 1,012,948 11,131,643 979,967 29,773 7,617,079 34,871 34,871 35,828 35,828 1980 1981 1,037,173 11,299,933 1,005,551 30,703 7,875,832 35,606 35,606 36,527 36,527 1981 1982 1,027,930 11,304,583 997,574 30,626 8,043,395 34,862 34,862 36,044 36,044 1982 1983 1,092,659 12,007,512 1,062,080 32,760 8,928,741 36,629 36,629 37,978 37,978 1983 1984 1,086,554 12,086,235 1,054,542 31,874 9,168,326 36,871 36,871 37,957 37,957 1984 1985 1,129,319 12,452,712 1,093,692 33,756 9,888,126 37,673 37,673 38,655 38,655 1985 1986 1,160,832 12,543,500 1,127,566 34,739 10,596,235 37,857 37,857 39,183 39,183 1986 1987 1,192,078 12,755,290 1,154,686 35,145 11,251,478 38,464 38,464 39,787 39,787 1987 1988 1,181,805 12,753,780 1,149,113 35,655 11,703,638 38,913 38,913 40,834 40,834 1988 1989 1,121,790 12,061,017 1,064,011 33,450 11,764,211 36,775 36,775 38,711 38,711 1989 1990 1,114,890 11,881,343 1,057,753 33,807 11,816,642 36,634 36,634 38,789 38,789 1990 1991 1,176,889 12,073,892 1,120,784 34,236 12,428,908 37,032 37,032 40,069 40,069 1991 1992 1,166,655 11,622,064 1,128,815 35,128 12,550,053 35,573 35,573 38,861 38,861 1992 1993 1,079,046 10,429,228 1,046,522 33,050 12,221,148 32,164 34,574 36,498 38,908 1993 1994 1,060,811 9,839,249 1,031,273 32,954 12,401,884 30,298 33,869 34,813 38,384 1994 1995 p 929,808 9,240,983 901,897 29,719 --- --- 29,340 34,493 37,263 1995 1996 835,994 8,309,486 824,700 23,482 11,754,241 29,448 38,408 29,448 38,408 1996 1997 787,991 7,762,692 792,504 26,496 11,108,118 27,645 34,396 27,645 34,396 1997 1998 858,841 8,651,679 812,537 31,100 11,915,041 31,602 37,005 31,602 37,005 1998 1999 888,747 8,599,212 883,432 30,924 12,962,628 31,085 33,027 31,085 33,027 1999 2000 993,611 8,941,894 894,275 31,391 13,253,209 28,600 29,690 28,600 29,690 2000 2001 954,832 8,971,712 805,422 29,300 12,947,093 30,635 30,842 30,635 30,842 2001 2002 913,863 9,262,697 867,977 66,649 14,523,802 29,782 29,553 29,782 29,553 2002 2003 948,114 8,883,178 887,094 31,428 14,455,615 29,356 29,237 29,356 29,237 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978-0.7 4.0-1.2 5.7 4.5 3.7 3.7 3.8 3.8 1978 1979-1.6-0.3-1.0-3.5 5.3-1.4-1.4-1.6-1.6 1979 1980 0.7 0.9 0.1 6.1-0.7-0.2-0.2-0.6-0.6 1980 1981 2.4 1.5 2.6 3.1 3.4 2.1 2.1 2.0 2.0 1981 1982-0.9 0.0-0.8-0.3 2.1-2.1-2.1-1.3-1.3 1982 1983 6.3 6.2 6.5 7.0 11.0 5.1 5.1 5.4 5.4 1983 1984-0.6 0.7-0.7-2.7 2.7 0.7 0.7-0.1-0.1 1984 1985 3.9 3.0 3.7 5.9 7.9 2.2 2.2 1.8 1.8 1985 1986 2.8 0.7 3.1 2.9 7.2 0.5 0.5 1.4 1.4 1986 1987 2.7 1.7 2.4 1.2 6.2 1.6 1.6 1.5 1.5 1987 1988-0.9 0.0-0.5 1.5 4.0 1.2 1.2 2.6 2.6 1988 1989-5.1-5.4-7.4-6.2 0.5-5.5-5.5-5.2-5.2 1989 1990-0.6-1.5-0.6 1.1 0.4-0.4-0.4 0.2 0.2 1990 1991 5.6 1.6 6.0 1.3 5.2 1.1 1.1 3.3 3.3 1991 1992-0.9-3.7 0.7 2.6 1.0-3.9-3.9-3.0-3.0 1992 1993-7.5-10.3-7.3-5.9-2.6-9.6-2.8-6.1 0.1 1993 1994-1.7-5.7-1.5-0.3 1.5-5.8-2.0-4.6-1.3 1994 1995-12.3-6.1-12.5-9.8 --- --- -13.4-0.9-2.9 1995 1996-10.1-10.1-8.6-21.0 --- --- 30.9-14.6 3.1 1996 1997-5.7-6.6-3.9 12.8-5.5-6.1-10.4-6.1-10.4 1997 1998 9.0 11.5 2.5 17.4 7.3 14.3 7.6 14.3 7.6 1998 1999 3.5-0.6 8.7-0.6 8.8-1.6-10.7-1.6-10.7 1999 2000 11.8 4.0 1.2 1.5 2.2-8.0-10.1-8.0-10.1 2000 2001-3.9 0.3-9.9-6.7-2.3 7.1 3.9 7.1 3.9 2001 2002-4.3 3.2 7.8 127.5 12.2-2.8-4.2-2.8-4.2 2002 2003 3.7-4.1 2.2-52.8-0.5-1.4-1.1-1.4-1.1 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 50

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, Short Term Psychiatric Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 --- --- --- --- --- --- --- --- --- 1978 1979 --- --- --- --- --- --- --- --- --- 1979 1980 --- --- --- --- --- --- --- --- --- 1980 1981 --- --- --- --- --- --- --- --- --- 1981 1982 10,433 403,079 10,351 35 194,967 1,259 1,279 1,274 1,294 1982 1983 8,860 392,931 8,845 16 205,431 1,166 1,287 1,184 1,305 1983 1984 10,039 557,740 10,011 40 242,044 1,612 1,696 1,658 1,742 1984 1985 8,456 396,767 8,405 17 141,144 1,187 1,296 1,182 1,291 1985 1986 8,463 398,358 8,430 20 150,388 1,218 1,283 1,212 1,277 1986 1987 11,846 629,585 11,799 30 376,814 1,923 1,988 1,939 2,004 1987 1988 11,352 627,355 11,337 39 378,435 1,916 1,968 1,931 1,983 1988 1989 11,639 628,898 11,629 36 396,267 1,836 1,928 1,871 1,963 1989 1990 9,511 548,321 9,526 28 223,161 1,663 1,907 1,695 1,937 1990 1991 9,132 533,090 9,160 29 223,737 1,650 1,889 1,681 1,921 1991 1992 10,633 576,034 10,654 20 521,637 1,719 1,812 1,815 1,908 1992 1993 9,044 456,994 9,026 14 440,130 1,382 1,771 1,475 1,864 1993 1994 11,287 529,653 11,393 19 469,393 1,629 1,706 1,728 1,805 1994 1995 p 9,295 413,675 8,942 295 --- --- 1,244 1,380 1,429 1995 1996 12,399 528,479 44,725 9 179,079 1,524 1,776 1,524 1,776 1996 1997 5,847 392,556 5,604 15 124,687 1,212 1,640 1,212 1,640 1997 1998 5,906 301,961 5,887 42 138,588 881 1,553 881 1,553 1998 1999 5,367 399,287 8,133 48 146,684 1,198 1,558 1,198 1,558 1999 2000 7,760 403,314 15,836 11 135,412 1,169 1,511 1,169 1,511 2000 2001 8,291 501,636 8,285 15 123,989 1,319 1,477 1,319 1,477 2001 2002 7,552 454,376 7,624 25 167,992 1,229 1,319 1,229 1,319 2002 2003 7,495 434,998 7,616 23 167,858 1,184 1,315 1,184 1,315 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 --- --- --- --- --- --- --- --- --- 1978 1979 --- --- --- --- --- --- --- --- --- 1979 1980 --- --- --- --- --- --- --- --- --- 1980 1981 --- --- --- --- --- --- --- --- --- 1981 1982 --- --- --- --- --- --- --- --- --- 1982 1983-15.1-2.5-14.5-54.3 5.4-7.4 0.6-7.1 0.9 1983 1984 13.3 41.9 13.2 150.0 17.8 38.3 31.8 40.0 33.5 1984 1985-15.8-28.9-16.0-57.5-41.7-26.4-23.6-28.7-25.9 1985 1986 0.1 0.4 0.3 17.6 6.5 2.6-1.0 2.5-1.1 1986 1987 40.0 58.0 40.0 50.0 150.6 57.9 54.9 60.0 56.9 1987 1988-4.2-0.4-3.9 30.0 0.4-0.4-1.0-0.4-1.0 1988 1989 2.5 0.2 2.6-7.7 4.7-4.2-2.0-3.1-1.0 1989 1990-18.3-12.8-18.1-22.2-43.7-9.4-1.1-9.4-1.3 1990 1991-4.0-2.8-3.8 3.6 0.3-0.8-0.9-0.8-0.8 1991 1992 16.4 8.1 16.3-31.0 133.1 4.2-4.1 8.0-0.7 1992 1993-14.9-20.7-15.3-30.0-15.6-19.6-2.3-18.7-2.3 1993 1994 24.8 15.9 26.2 35.7 6.6 17.9-3.7 17.2-3.2 1994 1995-17.6-21.9-21.5 1450.9 --- --- -27.1-20.1-20.8 1995 1996 33.4 27.8 400.1-96.9 --- --- 42.8 10.4 24.3 1996 1997-52.8-25.7-87.5 66.7-30.4-20.5-7.7-20.5-7.7 1997 1998 1.0-23.1 5.0 180.0 11.1-27.3-5.3-27.3-5.3 1998 1999-9.1 32.2 38.2 14.3 5.8 36.0 0.3 36.0 0.3 1999 2000 44.6 1.0 94.7-77.1-7.7-2.4-3.0-2.4-3.0 2000 2001 6.8 24.4-47.7 36.4-8.4 12.8-2.3 12.8-2.3 2001 2002-8.9-9.4-8.0 66.7 35.5-6.8-10.7-6.8-10.7 2002 2003-0.8-4.3-0.1-8.0-0.1-3.7-0.3-3.7-0.3 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 51

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.6 Selected Statistics, Long Term Psychiatric Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 --- --- --- --- --- --- --- --- --- 1978 1979 --- --- --- --- --- --- --- --- --- 1979 1980 --- --- --- --- --- --- --- --- --- 1980 1981 --- --- --- --- --- --- --- --- --- 1981 1982 3,880 715,178 3,865 122 4,160 2,126 2,755 2,566 3,195 1982 1983 2,575 515,234 2,544 45 10,107 1,542 4,535 1,584 4,577 1983 1984 8,258 1,097,631 8,279 139 36,098 3,308 4,362 3,278 4,332 1984 1985 6,900 1,090,514 6,821 139 46,517 3,394 4,856 3,394 4,856 1985 1986 5,539 837,068 5,408 115 35,612 2,611 4,356 2,624 4,369 1986 1987 19,166 4,051,100 18,716 727 423,371 11,982 13,727 12,301 14,038 1987 1988 19,558 3,945,295 19,243 711 447,190 11,511 13,164 11,904 13,549 1988 1989 19,025 3,744,112 18,704 715 475,795 10,999 12,937 11,511 13,474 1989 1990 18,850 3,672,342 18,308 690 505,560 10,968 12,761 11,479 13,294 1990 1991 18,331 3,532,119 18,057 600 486,194 10,597 12,607 10,905 12,937 1991 1992 16,866 3,219,122 16,633 582 444,323 9,654 11,451 10,372 12,169 1992 1993 14,837 2,908,969 14,689 605 470,784 8,640 10,529 9,290 11,179 1993 1994 24,383 4,019,231 24,249 848 686,050 11,894 13,376 13,746 15,228 1994 1995 p 20,357 2,871,235 20,232 667 --- --- 8,876 9,828 12,625 1995 1996 8,106 1,334,388 7,145 366 366,390 6,053 11,024 6,053 11,024 1996 1997 14,606 1,932,203 12,875 592 298,477 6,374 9,916 6,374 9,916 1997 1998 15,222 1,665,268 12,098 1,720 179,667 5,682 9,949 5,682 9,949 1998 1999 8,886 1,144,929 9,468 412 132,496 4,071 9,606 4,071 9,606 1999 2000 19,193 1,929,182 17,770 392 791,722 7,885 9,194 7,885 9,194 2000 2001 15,743 1,580,364 12,802 366 615,863 5,920 7,845 5,920 7,845 2001 2002 13,022 1,321,623 12,989 311 698,897 5,187 7,683 5,187 7,683 2002 2003 19,888 2,029,173 18,001 430 557,206 6,907 7,293 6,907 7,293 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 --- --- --- --- --- --- --- --- --- 1978 1979 --- --- --- --- --- --- --- --- --- 1979 1980 --- --- --- --- --- --- --- --- --- 1980 1981 --- --- --- --- --- --- --- --- --- 1981 1982 --- --- --- --- --- --- --- --- --- 1982 1983-33.6-28.0-34.2-63.1 143.0-27.5 64.6-38.3 43.3 1983 1984 220.7 113.0 225.4 208.9 257.2 114.5-3.8 106.9-5.4 1984 1985-16.4-0.6-17.6 0.0 28.9 2.6 11.3 3.5 12.1 1985 1986-19.7-23.2-20.7-17.3-23.4-23.1-10.3-22.7-10.0 1986 1987 246.0 384.0 246.1 532.2 1088.8 358.9 215.1 368.8 221.3 1987 1988 2.0-2.6 2.8-2.2 5.6-3.9-4.1-3.2-3.5 1988 1989-2.7-5.1-2.8 0.6 6.4-4.4-1.7-3.3-0.6 1989 1990-0.9-1.9-2.1-3.5 6.3-0.3-1.4-0.3-1.3 1990 1991-2.8-3.8-1.4-13.0-3.8-3.4-1.2-5.0-2.7 1991 1992-8.0-8.9-7.9-3.0-8.6-8.9-9.2-4.9-5.9 1992 1993-12.0-9.6-11.7 4.0 6.0-10.5-8.1-10.4-8.1 1993 1994 64.3 38.2 65.1 40.2 45.7 37.7 27.0 48.0 36.2 1994 1995-16.5-28.6-16.6-21.4 --- --- -33.6-28.5-17.1 1995 1996-60.2-53.5-64.7-45.1 --- --- 24.2-38.4-12.7 1996 1997 80.2 44.8 80.2 61.7-18.5 5.3-10.1 5.3-10.1 1997 1998 4.2-13.8-6.0 190.5-39.8-10.9 0.3-10.9 0.3 1998 1999-41.6-31.2-21.7-76.0-26.3-28.4-3.4-28.4-3.4 1999 2000 116.0 68.5 87.7-4.9 497.5 93.7-4.3 93.7-4.3 2000 2001-18.0-18.1-28.0-6.6-22.2-24.9-14.7-24.9-14.7 2001 2002-17.3-16.4 1.5-15.0 13.5-12.4-2.1-12.4-2.1 2002 2003 52.7 53.5 38.6 38.3-20.3 33.2-5.1 33.2-5.1 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 52

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, Other Specialty Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 46,322 417,209 45,490 793 243,647 1,258 1,258 1,245 1,245 1977 1978 49,290 476,284 48,250 904 254,381 1,481 1,481 1,463 1,463 1978 1979 51,425 626,852 50,423 1,088 313,384 1,883 1,912 1,924 1,953 1979 1980 53,778 844,790 52,590 995 407,312 2,593 2,593 2,606 2,606 1980 1981 54,351 860,317 53,371 970 388,115 2,564 2,564 2,586 2,586 1981 1982 55,339 841,526 54,317 1,025 452,687 2,532 2,532 2,572 2,572 1982 1983 59,936 853,892 59,041 1,033 470,101 2,571 2,571 2,581 2,581 1983 1984 62,281 853,887 61,272 1,048 495,526 2,581 2,581 2,613 2,613 1984 1985 62,280 860,080 61,195 1,074 523,099 2,583 2,583 2,623 2,623 1985 1986 63,128 851,166 62,167 1,087 557,780 2,580 2,580 2,603 2,603 1986 1987 61,124 435,047 59,920 1,125 433,728 1,329 1,329 1,328 1,328 1987 1988 61,314 432,878 60,279 1,095 433,409 1,315 1,327 1,338 1,350 1988 1989 58,282 424,720 57,248 1,048 442,005 1,268 1,268 1,334 1,334 1989 1990 55,958 398,419 54,997 1,012 467,729 1,274 1,274 1,328 1,328 1990 1991 57,846 395,499 56,886 1,088 456,542 1,250 1,250 1,328 1,328 1991 1992 55,649 381,170 54,515 1,028 547,251 1,184 1,184 1,346 1,346 1992 1993 54,335 366,287 53,307 1,020 554,151 1,127 1,127 1,330 1,330 1993 1994 54,704 341,767 53,811 973 580,176 1,039 1,039 1,253 1,253 1994 1995 p 41,313 243,849 40,002 1,318 --- --- 899 1,147 1,271 1995 1996 62,779 249,811 46,905 539 400,226 1,011 1,235 1,011 1,235 1996 1997 19,313 168,050 18,808 623 287,423 694 1,095 694 1,095 1997 1998 19,152 169,339 18,575 612 315,670 655 979 655 979 1998 1999 46,910 259,881 46,446 425 403,701 1,017 1,055 1,017 1,055 1999 2000 39,794 193,240 40,197 295 273,274 742 951 742 951 2000 2001 77,424 477,174 77,802 1,363 871,600 1,693 1,731 1,693 1,731 2001 2002 73,578 448,909 73,529 1,019 771,817 1,716 1,754 1,716 1,754 2002 2003 76,016 457,442 74,746 1,071 909,291 1,665 1,703 1,665 1,703 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 6.4 14.2 6.1 14.0 4.4 17.7 17.7 17.5 17.5 1978 1979 4.3 31.6 4.5 20.4 23.2 27.1 29.1 31.5 33.5 1979 1980 4.6 34.8 4.3-8.5 30.0 37.7 35.6 35.4 33.4 1980 1981 1.1 1.8 1.5-2.5-4.7-1.1-1.1-0.8-0.8 1981 1982 1.8-2.2 1.8 5.7 16.6-1.2-1.2-0.5-0.5 1982 1983 8.3 1.5 8.7 0.8 3.8 1.5 1.5 0.3 0.3 1983 1984 3.9 0.0 3.8 1.5 5.4 0.4 0.4 1.2 1.2 1984 1985 0.0 0.7-0.1 2.5 5.6 0.1 0.1 0.4 0.4 1985 1986 1.4-1.0 1.6 1.2 6.6-0.1-0.1-0.8-0.8 1986 1987-3.2-48.9-3.6 3.5-22.2-48.5-48.5-49.0-49.0 1987 1988 0.3-0.5 0.6-2.7-0.1-1.1-0.2 0.8 1.7 1988 1989-4.9-1.9-5.0-4.3 2.0-3.6-4.4-0.3-1.2 1989 1990-4.0-6.2-3.9-3.4 5.8 0.5 0.5-0.4-0.4 1990 1991 3.4-0.7 3.4 7.5-2.4-1.9-1.9 0.0 0.0 1991 1992-3.8-3.6-4.2-5.5 19.9-5.3-5.3 1.4 1.4 1992 1993-2.4-3.9-2.2-0.8 1.3-4.8-4.8-1.2-1.2 1993 1994 0.7-6.7 0.9-4.6 4.7-7.8-7.8-5.8-5.8 1994 1995-24.5-28.7-25.7 35.5 --- --- -13.5-8.5 1.4 1995 1996 52.0 2.4 17.3-59.1 --- --- 37.4-11.9-2.8 1996 1997-69.2-32.7-59.9 15.6-28.2-31.4-11.3-31.4-11.3 1997 1998-0.8 0.8-1.2-1.8 9.8-5.6-10.6-5.6-10.6 1998 1999 144.9 53.5 150.0-30.6 27.9 55.3 7.8 55.3 7.8 1999 2000-15.2-25.6-13.5-30.6-32.3-27.0-9.9-27.0-9.9 2000 2001 94.6 146.9 93.6 362.0 218.9 128.2 82.0 128.2 82.0 2001 2002-5.0-5.9-5.5-25.2-11.4 1.4 1.3 1.4 1.3 2002 2003 3.3 1.9 1.7 5.1 17.8-3.0-2.9-3.0-2.9 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 53

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.8 Selected Statistics, Rehabilitation Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 17,009 738,172 16,600 426 45,369 2,514 2,514 2,691 2,691 1977 1978 14,940 716,449 14,513 338 66,383 2,464 2,464 2,650 2,650 1978 1979 14,808 710,135 14,430 387 74,974 2,507 2,507 2,569 2,569 1979 1980 14,455 675,736 14,038 418 57,043 2,323 2,323 2,346 2,346 1980 1981 14,766 673,179 14,413 286 91,904 2,371 2,371 2,409 2,409 1981 1982 15,568 745,110 15,093 314 88,789 2,638 2,638 2,677 2,677 1982 1983 15,500 764,712 15,268 331 94,631 2,563 2,563 2,627 2,627 1983 1984 16,330 795,988 15,881 346 74,410 2,711 2,711 2,747 2,747 1984 1985 16,280 814,344 15,911 360 94,094 2,710 2,710 2,746 2,746 1985 1986 16,282 820,955 15,955 314 80,150 2,660 2,660 2,696 2,696 1986 1987 16,007 810,326 15,663 286 75,671 2,661 2,661 2,696 2,696 1987 1988 15,966 796,961 15,783 299 76,134 2,675 2,675 2,721 2,721 1988 1989 16,274 914,944 15,796 452 96,829 2,949 2,949 3,044 3,044 1989 1990 17,006 844,241 16,767 269 369,125 2,779 2,779 2,845 2,845 1990 1991 16,587 819,787 16,387 243 327,990 2,691 2,809 2,765 2,883 1991 1992 15,756 745,418 15,410 290 123,483 2,430 2,548 2,539 2,657 1992 1993 16,017 737,755 15,829 205 123,770 2,436 2,554 2,508 2,626 1993 1994 15,546 684,903 15,520 204 113,352 2,191 2,428 2,332 2,569 1994 1995 p 13,196 658,144 12,839 423 --- --- 2,043 2,314 2,615 1995 1996 14,299 728,322 14,909 67 152,294 2,653 2,719 2,653 2,719 1996 1997 13,977 680,626 13,882 84 67,299 2,496 2,583 2,496 2,583 1997 1998 21,000 834,352 16,440 415 137,409 2,964 2,964 2,964 2,964 1998 1999 15,563 801,316 16,204 100 203,385 2,861 3,461 2,861 3,461 1999 2000 13,742 608,797 13,214 75 307,970 1,970 2,381 1,970 2,381 2000 2001 13,755 665,377 16,050 76 204,444 2,042 2,101 2,042 2,101 2001 2002 16,251 675,987 14,092 83 194,995 2,134 2,134 2,134 2,134 2002 2003 15,901 688,703 16,216 89 213,909 2,237 2,237 2,237 2,237 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978-12.2-2.9-12.6-20.7 46.3-2.0-2.0-1.5-1.5 1978 1979-0.9-0.9-0.6 14.5 12.9 1.7 1.7-3.1-3.1 1979 1980-2.4-4.8-2.7 8.0-23.9-7.3-7.3-8.7-8.7 1980 1981 2.2-0.4 2.7-31.6 61.1 2.1 2.1 2.7 2.7 1981 1982 5.4 10.7 4.7 9.8-3.4 11.3 11.3 11.1 11.1 1982 1983-0.4 2.6 1.2 5.4 6.6-2.8-2.8-1.9-1.9 1983 1984 5.4 4.1 4.0 4.5-21.4 5.8 5.8 4.6 4.6 1984 1985-0.3 2.3 0.2 4.0 26.5 0.0 0.0 0.0 0.0 1985 1986 0.0 0.8 0.3-12.8-14.8-1.8-1.8-1.8-1.8 1986 1987-1.7-1.3-1.8-8.9-5.6 0.0 0.0 0.0 0.0 1987 1988-0.3-1.6 0.8 4.5 0.6 0.5 0.5 0.9 0.9 1988 1989 1.9 14.8 0.1 51.2 27.2 10.2 10.2 11.9 11.9 1989 1990 4.5-7.7 6.1-40.5 281.2-5.8-5.8-6.5-6.5 1990 1991-2.5-2.9-2.3-9.7-11.1-3.2 1.1-2.8 1.3 1991 1992-5.0-9.1-6.0 19.3-62.4-9.7-9.3-8.2-7.8 1992 1993 1.7-1.0 2.7-29.3 0.2 0.2 0.2-1.2-1.2 1993 1994-2.9-7.2-2.0-0.5-8.4-10.1-4.9-7.0-2.2 1994 1995-15.1-3.9-17.3 107.4 --- --- -15.9-0.8 1.8 1995 1996 8.4 10.7 16.1-84.2 --- --- 33.1 14.6 4.0 1996 1997-2.3-6.5-6.9 25.4-55.8-5.9-5.0-5.9-5.0 1997 1998 50.2 22.6 18.4 394.0 104.2 18.8 14.8 18.8 14.8 1998 1999-25.9-4.0-1.4-75.9 48.0-3.5 16.8-3.5 16.8 1999 2000-11.7-24.0-18.5-25.0 51.4-31.1-31.2-31.1-31.2 2000 2001 0.1 9.3 21.5 1.3-33.6 3.7-11.8 3.7-11.8 2001 2002 18.1 1.6-12.2 9.2-4.6 4.5 1.6 4.5 1.6 2002 2003-2.2 1.9 15.1 7.2 9.7 4.8 4.8 4.8 4.8 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 54

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Selected Statistics, Extended Care Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 35,673 10,755,922 27,290 8,209 376,485 31,122 31,579 31,535 31,992 1977 1978 37,913 11,015,355 29,673 8,249 442,076 31,779 31,840 32,434 32,486 1978 1979 40,666 11,231,867 33,005 7,268 517,036 32,378 32,554 32,598 32,790 1979 1980 40,838 11,367,203 32,964 7,542 476,528 32,685 32,861 33,123 33,315 1980 1981 39,000 11,304,787 31,529 6,986 379,773 32,741 32,763 33,171 33,193 1981 1982 34,556 11,091,555 27,617 6,498 412,695 31,792 31,988 32,110 32,320 1982 1983 36,813 11,229,955 29,641 6,807 446,244 32,297 32,319 32,788 32,810 1983 1984 37,179 11,333,039 30,624 6,265 458,479 32,422 32,444 32,588 32,610 1984 1985 37,591 11,312,472 31,068 6,499 512,047 32,426 32,426 32,474 32,474 1985 1986 35,504 10,987,033 28,905 6,833 641,236 31,234 31,310 31,488 31,564 1986 1987 23,106 7,890,147 16,780 6,076 350,683 22,474 22,512 22,621 22,659 1987 1988 24,460 7,918,369 17,802 6,558 416,359 22,464 22,480 22,541 22,557 1988 1989 81,519 8,368,760 74,211 7,344 927,338 24,043 24,171 24,405 24,533 1989 1990 24,101 7,866,596 17,338 6,662 464,183 22,416 22,438 22,813 22,835 1990 1991 26,811 6,887,538 20,846 5,955 588,632 19,728 20,019 20,121 20,412 1991 1992 27,095 6,851,074 21,099 5,919 604,243 19,551 19,987 20,075 20,511 1992 1993 25,129 6,580,651 19,139 6,083 613,018 18,918 19,838 19,531 20,451 1993 1994 27,057 6,474,179 20,445 6,603 414,997 18,626 19,826 19,305 20,505 1994 1995 p 17,589 2,591,936 17,077 563 --- --- 7,964 7,970 11,416 1995 1996 18,652 2,729,222 14,186 2,512 246,520 7,658 9,527 7,658 9,527 1996 1997 14,171 2,144,753 10,778 2,527 198,143 6,387 8,402 6,387 8,402 1997 1998 22,878 2,019,197 16,604 3,205 275,281 6,231 8,214 6,231 8,214 1998 1999 16,401 1,975,337 11,903 3,408 262,219 6,283 7,579 6,283 7,579 1999 2000 12,070 2,038,386 9,989 2,991 193,186 5,472 6,385 5,472 6,385 2000 2001 12,951 1,761,513 10,119 3,180 186,137 5,460 6,457 5,460 6,457 2001 2002 14,483 1,638,378 10,167 2,903 263,107 6,346 6,512 6,346 6,512 2002 2003 15,923 1,468,457 10,993 2,774 236,721 6,414 6,680 6,414 6,680 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978 6.3 2.4 8.7 0.5 17.4 2.1 0.8 2.9 1.5 1978 1979 7.3 2.0 11.2-11.9 17.0 1.9 2.2 0.5 0.9 1979 1980 0.4 1.2-0.1 3.8-7.8 0.9 0.9 1.6 1.6 1980 1981-4.5-0.5-4.4-7.4-20.3 0.2-0.3 0.1-0.4 1981 1982-11.4-1.9-12.4-7.0 8.7-2.9-2.4-3.2-2.6 1982 1983 6.5 1.2 7.3 4.8 8.1 1.6 1.0 2.1 1.5 1983 1984 1.0 0.9 3.3-8.0 2.7 0.4 0.4-0.6-0.6 1984 1985 1.1-0.2 1.4 3.7 11.7 0.0-0.1-0.3-0.4 1985 1986-5.6-2.9-7.0 5.1 25.2-3.7-3.4-3.0-2.8 1986 1987-34.9-28.2-41.9-11.1-45.3-28.0-28.1-28.2-28.2 1987 1988 5.9 0.4 6.1 7.9 18.7 0.0-0.1-0.4-0.5 1988 1989 233.3 5.7 316.9 12.0 122.7 7.0 7.5 8.3 8.8 1989 1990-70.4-6.0-76.6-9.3-49.9-6.8-7.2-6.5-6.9 1990 1991 11.2-12.4 20.2-10.6 26.8-12.0-10.8-11.8-10.6 1991 1992 1.1-0.5 1.2-0.6 2.7-0.9-0.2-0.2 0.5 1992 1993-7.3-3.9-9.3 2.8 1.5-3.2-0.7-2.7-0.3 1993 1994 7.7-1.6 6.8 8.5-32.3-1.5-0.1-1.2 0.3 1994 1995-35.0-60.0-16.5-91.5 --- --- -59.8-58.7-44.3 1995 1996 6.0 5.3-16.9 346.4 --- --- 19.6-3.9-16.5 1996 1997-24.0-21.4-24.0 0.6-19.6-16.6-11.8-16.6-11.8 1997 1998 61.4-5.9 54.1 26.8 38.9-2.4-2.2-2.4-2.2 1998 1999-28.3-2.2-28.3 6.3-4.7 0.8-7.7 0.8-7.7 1999 2000-26.4 3.2-16.1-12.2-26.3-12.9-15.8-12.9-15.8 2000 2001 7.3-13.6 1.3 6.3-3.6-0.2 1.1-0.2 1.1 2001 2002 11.8-7.0 0.5-8.7 41.4 16.2 0.9 16.2 0.9 2002 2003 9.9-10.4 8.1-4.4-10.0 1.1 2.6 1.1 2.6 p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 55

HOSPITAL TRENDS IN CANADA D A T A T A B L E S Table 1.10 Selected Statistics, Other Hospitals, Canada, 1976 1977 to 2002 2003 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 1976 1977 13,474 45,384 13,449 27 115,603 524 876 522 874 1977 1978 12,162 42,210 12,139 31 74,393 525 933 526 908 1978 1979 12,683 36,828 12,581 33 72,423 493 910 492 898 1979 1980 12,134 34,056 12,124 15 61,996 385 835 407 846 1980 1981 11,798 36,822 11,761 15 62,483 457 896 457 885 1981 1982 11,901 35,821 11,859 26 65,419 451 887 450 875 1982 1983 14,677 49,596 14,666 31 86,249 361 946 360 918 1983 1984 13,310 37,784 13,300 30 81,295 453 839 450 804 1984 1985 12,527 35,705 12,513 16 75,614 441 831 440 803 1985 1986 12,488 33,212 12,507 15 66,258 402 810 402 781 1986 1987 12,961 33,078 12,892 10 69,988 327 790 327 762 1987 1988 12,340 36,393 12,147 199 74,116 259 787 260 758 1988 1989 10,965 34,542 10,780 180 76,523 231 748 231 746 1989 1990 12,127 31,746 12,150 8 73,405 265 758 265 758 1990 1991 11,282 30,353 11,324 15 68,037 245 752 246 754 1991 1992 12,286 31,624 12,175 22 71,958 245 766 246 767 1992 1993 10,842 29,627 10,818 23 68,042 201 712 202 713 1993 1994 9,562 27,654 9,535 49 70,110 187 704 188 705 1994 1995 p 0 0 0 0 --- --- 69 0 0 1995 1996 126 155 127 --- 2,841 5 17 5 17 1996 1997 126 143 127 1 3,047 5 17 5 17 1997 1998 0 0 0 0 0 0 9 0 9 1998 1999 0 0 0 0 0 0 0 0 0 1999 2000 0 0 0 0 0 0 0 0 0 2000 2001 0 0 0 0 0 0 0 0 0 2001 2002 0 0 0 0 0 0 0 0 0 2002 2003 0 0 0 0 0 0 0 0 0 (annual percentage change) 1976 1977 --- --- --- --- --- --- --- --- --- 1977 1978-9.7-7.0-9.7 14.8-35.6 0.2 6.5 0.8 3.9 1978 1979 4.3-12.8 3.6 6.5-2.6-6.1-2.5-6.5-1.1 1979 1980-4.3-7.5-3.6-54.5-14.4-21.9-8.2-17.3-5.8 1980 1981-2.8 8.1-3.0 0.0 0.8 18.7 7.3 12.3 4.6 1981 1982 0.9-2.7 0.8 73.3 4.7-1.3-1.0-1.5-1.1 1982 1983 23.3 38.5 23.7 19.2 31.8-20.0 6.7-20.0 4.9 1983 1984-9.3-23.8-9.3-3.2-5.7 25.5-11.3 25.0-12.4 1984 1985-5.9-5.5-5.9-46.7-7.0-2.6-1.0-2.2-0.1 1985 1986-0.3-7.0 0.0-6.3-12.4-8.8-2.5-8.6-2.7 1986 1987 3.8-0.4 3.1-33.3 5.6-18.7-2.5-18.7-2.4 1987 1988-4.8 10.0-5.8 1890.0 5.9-20.8-0.4-20.5-0.5 1988 1989-11.1-5.1-11.3-9.5 3.2-10.8-5.0-11.2-1.6 1989 1990 10.6-8.1 12.7-95.6-4.1 14.7 1.3 14.7 1.6 1990 1991-7.0-4.4-6.8 87.5-7.3-7.5-0.8-7.2-0.5 1991 1992 8.9 4.2 7.5 46.7 5.8 0.0 1.9 0.0 1.7 1992 1993-11.8-6.3-11.1 4.5-5.4-18.0-7.0-17.9-7.0 1993 1994-11.8-6.7-11.9 113.0 3.0-7.0-1.1-6.9-1.1 1994 1995-100.0-100.0-100.0-100.0 --- --- -90.2-100.0-100.0 1995 1996 --- --- --- --- --- --- -75.4 --- --- 1996 1997 0.0-7.7 0.0 --- 7.3 0.0 0.0 0.0 0.0 1997 1998 --- --- --- --- --- -100.0 --- -100.0-47.1 1998 1999 --- --- --- --- --- --- --- --- --- 1999 2000 --- --- --- --- --- --- --- --- --- 2000 2001 --- --- --- --- --- --- --- --- --- 2001 2002 --- --- --- --- --- --- --- --- --- 2002 2003 --- --- --- --- --- --- --- --- --- p = preliminary data. Preliminary data where available were obtained from the Hospital Statistics Preliminary Report, 1994 1995, Statistics Canada. * Bed counts are a mix of beds staffed and in operation, approved beds and rated bed capacity for 1995 1996 and afterward. CIHI 2005. 56

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

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, 1976 1977 Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Table 2.1 Administration 4.1 302.5 21.7 0.1 0.2 132.3 460.9 Support 0.0 855.5 77.8 1.0 3.9 507.6 1,445.8 Inpatient Nursing 0.0 1,638.1 135.4 45.6 36.7 16.0 1,871.8 Operating Room 0.0 150.8 21.0 11.4 74.1 3.6 260.9 Ambulatory Care 5.6 90.6 20.0 23.8 19.3 8.2 167.5 Emergency 1.3 72.6 13.8 5.8 7.2 0.6 101.3 Diagnostic and Therapeutic 150.7 569.1 65.7 35.7 18.6 150.3 990.2 Community Services 0.1 3.9 0.0 0.0 0.0 1.8 5.8 Research and Education 19.4 151.6 8.6 0.0 0.1 19.9 199.7 Total 181.2 3,834.7 364.1 123.4 160.2 840.3 5,503.9 Administration --- --- --- --- --- --- --- Support --- --- --- --- --- --- --- Inpatient Nursing --- --- --- --- --- --- --- Operating Room --- --- --- --- --- --- --- Ambulatory Care --- --- --- --- --- --- --- Emergency --- --- --- --- --- --- --- Diagnostic and Therapeutic --- --- --- --- --- --- --- Community Services --- --- --- --- --- --- --- Research and Education --- --- --- --- --- --- --- Total --- --- --- --- --- --- --- Administration 0.9 65.6 4.7 0.0 0.0 28.7 100.0 Support 0.0 59.2 5.4 0.1 0.3 35.1 100.0 Inpatient Nursing 0.0 87.5 7.2 2.4 2.0 0.9 100.0 Operating Room 0.0 57.8 8.0 4.4 28.4 1.4 100.0 Ambulatory Care 3.3 54.1 12.0 14.2 11.5 4.9 100.0 Emergency 1.3 71.7 13.6 5.7 7.1 0.6 100.0 Diagnostic and Therapeutic 15.2 57.5 6.6 3.6 1.9 15.2 100.0 Community Services 1.5 67.2 0.0 0.0 0.0 31.3 100.0 Research and Education 9.7 75.9 4.3 0.0 0.0 10.0 100.0 Total 3.3 69.7 6.6 2.2 2.9 15.3 100.0 Administration 2.3 7.9 6.0 0.1 0.1 15.7 8.4 Support 0.0 22.3 21.4 0.8 2.4 60.4 26.3 Inpatient Nursing 0.0 42.7 37.2 36.9 22.9 1.9 34.0 Operating Room 0.0 3.9 5.8 9.2 46.3 0.4 4.7 Ambulatory Care 3.1 2.4 5.5 19.3 12.1 1.0 3.0 Emergency 0.7 1.9 3.8 4.7 4.5 0.1 1.8 Diagnostic and Therapeutic 83.2 14.8 18.1 28.9 11.6 17.9 18.0 Community Services 0.0 0.1 0.0 0.0 0.0 0.2 0.1 Research and Education 10.7 4.0 2.4 0.0 0.1 2.4 3.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.1 5.5 0.4 0.0 0.0 2.4 8.4 Support 0.0 15.5 1.4 0.0 0.1 9.2 26.3 Inpatient Nursing 0.0 29.8 2.5 0.8 0.7 0.3 34.0 Operating Room 0.0 2.7 0.4 0.2 1.3 0.1 4.7 Ambulatory Care 0.1 1.6 0.4 0.4 0.4 0.1 3.0 Emergency 0.0 1.3 0.3 0.1 0.1 0.0 1.8 Diagnostic and Therapeutic 2.7 10.3 1.2 0.6 0.3 2.7 18.0 Community Services 0.0 0.1 0.0 0.0 0.0 0.0 0.1 Research and Education 0.4 2.8 0.2 0.0 0.0 0.4 3.6 Total 3.3 69.7 6.6 2.2 2.9 15.3 100.0 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 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. Total 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 59

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, 1977 1978 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 4.2 323.0 24.9 0.1 0.2 142.5 494.9 Support 0.0 923.7 83.5 1.2 4.5 592.6 1,605.6 Inpatient Nursing 0.0 1,799.7 148.0 51.6 43.1 16.5 2,059.0 Operating Room 0.0 166.7 22.1 12.9 86.9 4.1 292.8 Ambulatory Care 6.5 102.0 21.7 26.9 22.6 9.9 189.8 Emergency 1.5 90.5 14.9 6.6 8.5 0.8 122.8 Diagnostic and Therapeutic 157.9 645.9 71.6 40.5 21.9 179.1 1,116.9 Community Services 0.1 6.9 0.0 0.0 0.0 3.2 10.2 Research and Education 21.3 159.8 8.9 0.1 0.1 22.1 212.3 Total 191.5 4,218.3 395.8 139.9 187.8 970.9 6,104.2 (annual percentage change) Administration 0.6 6.8 14.7 14.7 18.1 7.8 7.4 Support --- 8.0 7.3 13.3 17.2 16.8 11.0 Inpatient Nursing --- 9.9 9.3 13.4 17.3 3.1 10.0 Operating Room --- 10.5 5.7 13.2 17.2 13.3 12.2 Ambulatory Care 17.8 12.6 8.5 13.0 17.2 21.4 13.3 Emergency 16.7 24.8 7.8 13.2 17.2 39.0 21.2 Diagnostic and Therapeutic 4.7 13.5 8.9 13.5 17.3 19.2 12.8 Community Services 38.5 78.0 9.2 --- --- 74.2 76.2 Research and Education 10.0 5.4 3.8 12.7 17.2 10.9 6.3 Total 5.7 10.0 8.7 13.3 17.2 15.5 10.9 (percentage distribution of Type of Expense by Functional Centre) Administration 0.8 65.3 5.0 0.0 0.0 28.8 100.0 Support 0.0 57.5 5.2 0.1 0.3 36.9 100.0 Inpatient Nursing 0.0 87.4 7.2 2.5 2.1 0.8 100.0 Operating Room 0.0 56.9 7.6 4.4 29.7 1.4 100.0 Ambulatory Care 3.5 53.7 11.5 14.2 11.9 5.2 100.0 Emergency 1.2 73.7 12.1 5.4 6.9 0.7 100.0 Diagnostic and Therapeutic 14.1 57.8 6.4 3.6 2.0 16.0 100.0 Community Services 1.2 67.9 0.0 0.0 0.0 31.0 100.0 Research and Education 10.0 75.3 4.2 0.0 0.0 10.4 100.0 Total 3.1 69.1 6.5 2.3 3.1 15.9 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 2.2 7.7 6.3 0.1 0.1 14.7 8.1 Support 0.0 21.9 21.1 0.8 2.4 61.0 26.3 Inpatient Nursing 0.0 42.7 37.4 36.9 22.9 1.7 33.7 Operating Room 0.0 4.0 5.6 9.2 46.3 0.4 4.8 Ambulatory Care 3.4 2.4 5.5 19.2 12.1 1.0 3.1 Emergency 0.8 2.1 3.8 4.7 4.5 0.1 2.0 Diagnostic and Therapeutic 82.4 15.3 18.1 29.0 11.6 18.4 18.3 Community Services 0.1 0.2 0.0 0.0 0.0 0.3 0.2 Research and Education 11.1 3.8 2.3 0.0 0.1 2.3 3.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.1 5.3 0.4 0.0 0.0 2.3 8.1 Support 0.0 15.1 1.4 0.0 0.1 9.7 26.3 Inpatient Nursing 0.0 29.5 2.4 0.8 0.7 0.3 33.7 Operating Room 0.0 2.7 0.4 0.2 1.4 0.1 4.8 Ambulatory Care 0.1 1.7 0.4 0.4 0.4 0.2 3.1 Emergency 0.0 1.5 0.2 0.1 0.1 0.0 2.0 Diagnostic and Therapeutic 2.6 10.6 1.2 0.7 0.4 2.9 18.3 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.2 Research and Education 0.3 2.6 0.1 0.0 0.0 0.4 3.5 Total 3.1 69.1 6.5 2.3 3.1 15.9 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 60

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, 1978 1979 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.3 Administration 7.8 362.8 27.2 0.1 0.2 164.1 562.3 Support 0.0 1,013.9 91.7 1.3 5.3 678.0 1,790.2 Inpatient Nursing 0.0 1,976.9 162.3 58.2 49.6 20.0 2,266.9 Operating Room 0.0 180.0 24.3 14.5 100.3 5.4 324.5 Ambulatory Care 9.3 114.7 23.8 30.2 26.0 9.9 213.9 Emergency 2.0 106.0 16.3 7.4 9.8 1.2 142.7 Diagnostic and Therapeutic 170.4 721.9 78.5 45.5 25.3 205.6 1,247.2 Community Services 0.1 10.1 0.0 0.0 0.0 5.7 15.9 Research and Education 20.5 170.3 9.8 0.1 0.1 23.4 224.2 Total 210.1 4,656.6 433.9 157.3 216.6 1,113.2 6,787.8 (annual percentage change) Administration 88.3 12.3 9.3 12.6 18.6 15.1 13.6 Support --- 9.8 9.8 12.8 15.6 14.4 11.5 Inpatient Nursing --- 9.8 9.6 12.6 15.1 20.9 10.1 Operating Room --- 8.0 9.7 12.3 15.4 31.5 10.8 Ambulatory Care 41.7 12.4 9.6 12.3 15.0-0.6 12.7 Emergency 34.2 17.1 9.6 12.4 15.3 43.7 16.2 Diagnostic and Therapeutic 7.9 11.8 9.6 12.3 15.7 14.8 11.7 Community Services -9.5 46.1 5.6 --- --- 80.3 56.0 Research and Education -3.6 6.6 9.8 12.4 14.4 6.0 5.6 Total 9.7 10.4 9.6 12.4 15.3 14.7 11.2 (percentage distribution of Type of Expense by Functional Centre) Administration 1.4 64.5 4.8 0.0 0.0 29.2 100.0 Support 0.0 56.6 5.1 0.1 0.3 37.9 100.0 Inpatient Nursing 0.0 87.2 7.2 2.6 2.2 0.9 100.0 Operating Room 0.0 55.5 7.5 4.5 30.9 1.7 100.0 Ambulatory Care 4.3 53.6 11.1 14.1 12.2 4.6 100.0 Emergency 1.4 74.3 11.4 5.2 6.8 0.8 100.0 Diagnostic and Therapeutic 13.7 57.9 6.3 3.7 2.0 16.5 100.0 Community Services 0.7 63.5 0.0 0.0 0.0 35.8 100.0 Research and Education 9.2 75.9 4.4 0.0 0.1 10.4 100.0 Total 3.1 68.6 6.4 2.3 3.2 16.4 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 3.7 7.8 6.3 0.1 0.1 14.7 8.3 Support 0.0 21.8 21.1 0.8 2.4 60.9 26.4 Inpatient Nursing 0.0 42.5 37.4 37.0 22.9 1.8 33.4 Operating Room 0.0 3.9 5.6 9.2 46.3 0.5 4.8 Ambulatory Care 4.4 2.5 5.5 19.2 12.0 0.9 3.2 Emergency 1.0 2.3 3.8 4.7 4.5 0.1 2.1 Diagnostic and Therapeutic 81.1 15.5 18.1 28.9 11.7 18.5 18.4 Community Services 0.1 0.2 0.0 0.0 0.0 0.5 0.2 Research and Education 9.8 3.7 2.3 0.0 0.1 2.1 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.1 5.3 0.4 0.0 0.0 2.4 8.3 Support 0.0 14.9 1.4 0.0 0.1 10.0 26.4 Inpatient Nursing 0.0 29.1 2.4 0.9 0.7 0.3 33.4 Operating Room 0.0 2.7 0.4 0.2 1.5 0.1 4.8 Ambulatory Care 0.1 1.7 0.4 0.4 0.4 0.1 3.2 Emergency 0.0 1.6 0.2 0.1 0.1 0.0 2.1 Diagnostic and Therapeutic 2.5 10.6 1.2 0.7 0.4 3.0 18.4 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.2 Research and Education 0.3 2.5 0.1 0.0 0.0 0.3 3.3 Total 3.1 68.6 6.4 2.3 3.2 16.4 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. 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 1976 1977 to 1994 1995. CIHI 2005. 61

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, 1979 1980 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 8.2 425.4 28.9 0.1 0.3 211.1 674.0 Support 0.0 1,087.3 88.9 1.5 6.2 767.2 1,951.1 Inpatient Nursing 0.0 2,216.7 161.3 68.0 58.3 18.5 2,522.8 Operating Room 0.0 199.0 23.0 16.9 117.8 5.3 362.0 Ambulatory Care 10.7 100.2 23.6 35.4 30.5 11.5 211.9 Emergency 2.0 137.0 15.9 8.7 11.5 1.3 176.3 Diagnostic and Therapeutic 131.7 812.1 77.6 53.4 29.7 233.2 1,337.7 Community Services 0.1 13.3 0.0 0.0 0.0 4.8 18.2 Research and Education 21.5 167.0 9.1 0.1 0.1 24.2 221.9 Total 174.3 5,158.0 428.2 184.1 254.4 1,277.0 7,476.0 (annual percentage change) Administration 4.9 17.3 6.3 16.4 18.2 28.6 19.9 Support --- 7.2-3.1 16.8 17.3 13.2 9.0 Inpatient Nursing --- 12.1-0.6 16.9 17.4-7.6 11.3 Operating Room --- 10.5-5.5 16.9 17.5-3.1 11.5 Ambulatory Care 15.7-12.6-1.1 17.1 17.2 16.5-1.0 Emergency 2.0 29.3-2.6 17.0 17.6 6.9 23.6 Diagnostic and Therapeutic -22.7 12.5-1.1 17.3 17.6 13.4 7.3 Community Services 1.2 32.0 8.0 --- --- -15.8 14.7 Research and Education 4.5-1.9-7.9 17.1 16.9 3.5-1.0 Total -17.1 10.8-1.3 17.0 17.5 14.7 10.1 (percentage distribution of Type of Expense by Functional Centre) Administration 1.2 63.1 4.3 0.0 0.0 31.3 100.0 Support 0.0 55.7 4.6 0.1 0.3 39.3 100.0 Inpatient Nursing 0.0 87.9 6.4 2.7 2.3 0.7 100.0 Operating Room 0.0 55.0 6.3 4.7 32.6 1.5 100.0 Ambulatory Care 5.1 47.3 11.1 16.7 14.4 5.4 100.0 Emergency 1.2 77.7 9.0 4.9 6.5 0.7 100.0 Diagnostic and Therapeutic 9.8 60.7 5.8 4.0 2.2 17.4 100.0 Community Services 0.6 73.1 0.0 0.0 0.0 26.3 100.0 Research and Education 9.7 75.2 4.1 0.0 0.1 10.9 100.0 Total 2.3 69.0 5.7 2.5 3.4 17.1 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 4.7 8.2 6.8 0.1 0.1 16.5 9.0 Support 0.0 21.1 20.7 0.8 2.4 60.1 26.1 Inpatient Nursing 0.0 43.0 37.7 36.9 22.9 1.4 33.7 Operating Room 0.0 3.9 5.4 9.2 46.3 0.4 4.8 Ambulatory Care 6.2 1.9 5.5 19.2 12.0 0.9 2.8 Emergency 1.2 2.7 3.7 4.7 4.5 0.1 2.4 Diagnostic and Therapeutic 75.6 15.7 18.1 29.0 11.7 18.3 17.9 Community Services 0.1 0.3 0.0 0.0 0.0 0.4 0.2 Research and Education 12.3 3.2 2.1 0.0 0.1 1.9 3.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.1 5.7 0.4 0.0 0.0 2.8 9.0 Support 0.0 14.5 1.2 0.0 0.1 10.3 26.1 Inpatient Nursing 0.0 29.7 2.2 0.9 0.8 0.2 33.7 Operating Room 0.0 2.7 0.3 0.2 1.6 0.1 4.8 Ambulatory Care 0.1 1.3 0.3 0.5 0.4 0.2 2.8 Emergency 0.0 1.8 0.2 0.1 0.2 0.0 2.4 Diagnostic and Therapeutic 1.8 10.9 1.0 0.7 0.4 3.1 17.9 Community Services 0.0 0.2 0.0 0.0 0.0 0.1 0.2 Research and Education 0.3 2.2 0.1 0.0 0.0 0.3 3.0 Total 2.3 69.0 5.7 2.5 3.4 17.1 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 62

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, 1980 1981 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.5 Administration 11.0 484.8 34.4 0.2 0.3 249.3 780.0 Support 0.0 1,263.2 117.9 1.7 7.4 880.1 2,270.4 Inpatient Nursing 0.0 2,593.3 207.5 78.3 69.7 22.2 2,971.1 Operating Room 0.0 226.2 31.0 19.5 140.3 6.4 423.5 Ambulatory Care 13.2 121.0 30.2 40.7 36.3 14.4 255.8 Emergency 2.6 160.3 20.7 10.0 13.7 1.7 208.9 Diagnostic and Therapeutic 151.9 957.3 100.0 61.8 35.4 295.0 1,601.6 Community Services 0.1 15.5 0.0 0.0 0.0 5.2 20.8 Research and Education 23.3 193.1 12.5 0.1 0.2 24.0 253.1 Total 202.1 6,014.8 554.3 212.3 303.3 1,498.3 8,785.1 (annual percentage change) Medical Supplies Administration 33.9 14.0 18.7 15.8 21.9 18.1 15.7 Support --- 16.2 32.7 15.1 19.8 14.7 16.4 Inpatient Nursing --- 17.0 28.6 15.2 19.6 20.4 17.8 Operating Room --- 13.7 35.0 15.1 19.1 22.6 17.0 Ambulatory Care 22.8 20.8 28.0 15.1 19.1 25.3 20.7 Emergency 25.4 17.0 30.6 15.2 19.3 28.8 18.5 Diagnostic and Therapeutic 15.4 17.9 28.8 15.8 19.1 26.5 19.7 Community Services 29.4 16.0 18.0 --- --- 8.2 14.0 Research and Education 8.4 15.6 38.3 14.9 18.6-1.1 14.0 Total 16.0 16.6 29.4 15.3 19.2 17.3 17.5 (percentage distribution of Type of Expense by Functional Centre) Administration 1.4 62.2 4.4 0.0 0.0 32.0 100.0 Support 0.0 55.6 5.2 0.1 0.3 38.8 100.0 Inpatient Nursing 0.0 87.3 7.0 2.6 2.3 0.7 100.0 Operating Room 0.0 53.4 7.3 4.6 33.1 1.5 100.0 Ambulatory Care 5.2 47.3 11.8 15.9 14.2 5.6 100.0 Emergency 1.2 76.7 9.9 4.8 6.5 0.8 100.0 Diagnostic and Therapeutic 9.5 59.8 6.2 3.9 2.2 18.4 100.0 Community Services 0.7 74.4 0.0 0.0 0.0 24.9 100.0 Research and Education 9.2 76.3 4.9 0.0 0.1 9.5 100.0 Total 2.3 68.5 6.3 2.4 3.5 17.1 100.0 (percentage distribution of Functional Centre by Type of Expense) Other Supplies and Sundries 1 Administration 5.4 8.1 6.2 0.1 0.1 16.6 8.9 Support 0.0 21.0 21.3 0.8 2.4 58.7 25.8 Inpatient Nursing 0.0 43.1 37.4 36.9 23.0 1.5 33.8 Operating Room 0.0 3.8 5.6 9.2 46.3 0.4 4.8 Ambulatory Care 6.5 2.0 5.4 19.2 12.0 1.0 2.9 Emergency 1.3 2.7 3.7 4.7 4.5 0.1 2.4 Diagnostic and Therapeutic 75.2 15.9 18.0 29.1 11.7 19.7 18.2 Community Services 0.1 0.3 0.0 0.0 0.0 0.3 0.2 Research and Education 11.5 3.2 2.3 0.0 0.1 1.6 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.1 5.5 0.4 0.0 0.0 2.8 8.9 Support 0.0 14.4 1.3 0.0 0.1 10.0 25.8 Inpatient Nursing 0.0 29.5 2.4 0.9 0.8 0.3 33.8 Operating Room 0.0 2.6 0.4 0.2 1.6 0.1 4.8 Ambulatory Care 0.2 1.4 0.3 0.5 0.4 0.2 2.9 Emergency 0.0 1.8 0.2 0.1 0.2 0.0 2.4 Diagnostic and Therapeutic 1.7 10.9 1.1 0.7 0.4 3.4 18.2 Community Services 0.0 0.2 0.0 0.0 0.0 0.1 0.2 Research and Education 0.3 2.2 0.1 0.0 0.0 0.3 2.9 Total 2.3 68.5 6.3 2.4 3.5 17.1 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. 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 1976 1977 to 1994 1995. CIHI 2005. 63

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, 1981 1982 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 16.3 573.9 43.0 0.2 0.4 332.1 965.9 Support 0.0 1,481.8 158.0 2.1 9.0 1,053.3 2,704.1 Inpatient Nursing 0.0 3,069.1 273.9 92.7 84.6 28.6 3,548.9 Operating Room 0.0 262.2 42.0 23.1 170.4 7.7 505.3 Ambulatory Care 15.6 168.3 40.0 48.3 44.1 15.7 332.0 Emergency 4.2 173.0 27.6 11.8 16.6 2.2 235.3 Diagnostic and Therapeutic 186.1 1,139.2 132.4 73.9 43.0 338.8 1,913.4 Community Services 0.4 20.9 0.0 0.0 0.0 8.0 29.2 Research and Education 28.6 233.2 17.3 0.1 0.2 26.1 305.5 Total 251.1 7,121.6 734.1 252.1 368.3 1,812.5 10,539.7 (annual percentage change) Administration 48.0 18.4 25.3 18.9 22.9 33.2 23.8 Support --- 17.3 34.0 18.5 21.7 19.7 19.1 Inpatient Nursing --- 18.3 32.0 18.3 21.4 28.7 19.4 Operating Room --- 15.9 35.2 18.5 21.4 19.7 19.3 Ambulatory Care 17.9 39.1 32.5 18.6 21.4 9.1 29.8 Emergency 64.4 7.9 32.9 18.4 21.4 30.8 12.6 Diagnostic and Therapeutic 22.5 19.0 32.4 19.5 21.4 14.8 19.5 Community Services 148.6 35.0 33.3 --- --- 53.7 40.5 Research and Education 22.9 20.8 37.7 18.3 21.2 8.9 20.7 Total 24.2 18.4 32.4 18.7 21.4 21.0 20.0 (percentage distribution of Type of Expense by Functional Centre) Administration 1.7 59.4 4.5 0.0 0.0 34.4 100.0 Support 0.0 54.8 5.8 0.1 0.3 39.0 100.0 Inpatient Nursing 0.0 86.5 7.7 2.6 2.4 0.8 100.0 Operating Room 0.0 51.9 8.3 4.6 33.7 1.5 100.0 Ambulatory Care 4.7 50.7 12.0 14.6 13.3 4.7 100.0 Emergency 1.8 73.5 11.7 5.0 7.1 0.9 100.0 Diagnostic and Therapeutic 9.7 59.5 6.9 3.9 2.2 17.7 100.0 Community Services 1.2 71.5 0.0 0.0 0.0 27.3 100.0 Research and Education 9.4 76.4 5.6 0.0 0.1 8.5 100.0 Total 2.4 67.6 7.0 2.4 3.5 17.2 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 6.5 8.1 5.9 0.1 0.1 18.3 9.2 Support 0.0 20.8 21.5 0.8 2.4 58.1 25.7 Inpatient Nursing 0.0 43.1 37.3 36.8 23.0 1.6 33.7 Operating Room 0.0 3.7 5.7 9.1 46.3 0.4 4.8 Ambulatory Care 6.2 2.4 5.4 19.2 12.0 0.9 3.1 Emergency 1.7 2.4 3.8 4.7 4.5 0.1 2.2 Diagnostic and Therapeutic 74.1 16.0 18.0 29.3 11.7 18.7 18.2 Community Services 0.1 0.3 0.0 0.0 0.0 0.4 0.3 Research and Education 11.4 3.3 2.4 0.0 0.1 1.4 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 5.4 0.4 0.0 0.0 3.2 9.2 Support 0.0 14.1 1.5 0.0 0.1 10.0 25.7 Inpatient Nursing 0.0 29.1 2.6 0.9 0.8 0.3 33.7 Operating Room 0.0 2.5 0.4 0.2 1.6 0.1 4.8 Ambulatory Care 0.1 1.6 0.4 0.5 0.4 0.1 3.1 Emergency 0.0 1.6 0.3 0.1 0.2 0.0 2.2 Diagnostic and Therapeutic 1.8 10.8 1.3 0.7 0.4 3.2 18.2 Community Services 0.0 0.2 0.0 0.0 0.0 0.1 0.3 Research and Education 0.3 2.2 0.2 0.0 0.0 0.2 2.9 Total 2.4 67.6 7.0 2.4 3.5 17.2 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 64

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, 1982 1983 Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Administration 19.4 655.6 53.8 0.2 0.5 384.2 1,113.7 Support 0.0 1,649.2 185.2 2.4 10.3 1,175.7 3,022.8 Inpatient Nursing 0.0 3,470.7 325.4 109.8 97.1 32.9 4,036.0 Operating Room 0.0 294.5 48.5 27.2 196.1 9.4 575.7 Ambulatory Care 18.8 197.8 47.4 57.1 50.9 19.1 391.1 Emergency 6.8 201.6 32.5 14.0 19.1 2.9 276.8 Diagnostic and Therapeutic 221.7 1,288.7 156.9 86.5 49.6 371.1 2,174.5 Community Services 0.1 20.1 0.0 0.0 0.0 8.7 28.9 Research and Education 34.2 263.1 19.7 0.1 0.2 26.4 343.7 Total 300.9 8,041.4 869.4 297.3 423.8 2,030.4 11,963.1 Administration 18.9 14.2 25.0 18.1 12.1 15.7 15.3 Support --- 11.3 17.2 17.8 14.1 11.6 11.8 Inpatient Nursing --- 13.1 18.8 18.5 14.8 15.0 13.7 Operating Room --- 12.3 15.6 18.1 15.1 21.2 13.9 Ambulatory Care 20.8 17.5 18.5 18.1 15.4 21.5 17.8 Emergency 60.8 16.5 17.8 18.3 15.0 33.2 17.6 Diagnostic and Therapeutic 19.1 13.1 18.5 17.0 15.3 9.5 13.6 Community Services -73.5-4.0 20.3 --- --- 9.3-1.2 Research and Education 19.4 12.8 14.5 18.4 15.9 1.0 12.5 Total 19.8 12.9 18.4 17.9 15.0 12.0 13.5 Administration 1.7 58.9 4.8 0.0 0.0 34.5 100.0 Support 0.0 54.6 6.1 0.1 0.3 38.9 100.0 Inpatient Nursing 0.0 86.0 8.1 2.7 2.4 0.8 100.0 Operating Room 0.0 51.2 8.4 4.7 34.1 1.6 100.0 Ambulatory Care 4.8 50.6 12.1 14.6 13.0 4.9 100.0 Emergency 2.4 72.8 11.7 5.0 6.9 1.0 100.0 Diagnostic and Therapeutic 10.2 59.3 7.2 4.0 2.3 17.1 100.0 Community Services 0.3 69.5 0.0 0.0 0.0 30.2 100.0 Research and Education 9.9 76.5 5.7 0.0 0.1 7.7 100.0 Total 2.5 67.2 7.3 2.5 3.5 17.0 100.0 Administration 6.4 8.2 6.2 0.1 0.1 18.9 9.3 Support 0.0 20.5 21.3 0.8 2.4 57.9 25.3 Inpatient Nursing 0.0 43.2 37.4 36.9 22.9 1.6 33.7 Operating Room 0.0 3.7 5.6 9.2 46.3 0.5 4.8 Ambulatory Care 6.2 2.5 5.4 19.2 12.0 0.9 3.3 Emergency 2.2 2.5 3.7 4.7 4.5 0.1 2.3 Diagnostic and Therapeutic 73.7 16.0 18.1 29.1 11.7 18.3 18.2 Community Services 0.0 0.2 0.0 0.0 0.0 0.4 0.2 Research and Education 11.4 3.3 2.3 0.0 0.1 1.3 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.2 5.5 0.4 0.0 0.0 3.2 9.3 Support 0.0 13.8 1.5 0.0 0.1 9.8 25.3 Inpatient Nursing 0.0 29.0 2.7 0.9 0.8 0.3 33.7 Operating Room 0.0 2.5 0.4 0.2 1.6 0.1 4.8 Ambulatory Care 0.2 1.7 0.4 0.5 0.4 0.2 3.3 Emergency 0.1 1.7 0.3 0.1 0.2 0.0 2.3 Diagnostic and Therapeutic 1.9 10.8 1.3 0.7 0.4 3.1 18.2 Community Services 0.0 0.2 0.0 0.0 0.0 0.1 0.2 Research and Education 0.3 2.2 0.2 0.0 0.0 0.2 2.9 Total 2.5 67.2 7.3 2.5 3.5 17.0 100.0 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 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. Total 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 65

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, 1983 1984 Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 26.4 695.1 64.4 0.3 0.5 391.0 1,177.8 Support 0.0 1,793.4 212.6 2.7 11.7 1,308.8 3,329.2 Inpatient Nursing 0.0 3,803.0 377.7 122.8 109.7 35.0 4,448.2 Operating Room 0.0 319.1 54.8 30.5 222.2 10.9 637.6 Ambulatory Care 20.3 216.6 54.9 64.2 57.5 21.6 435.1 Emergency 8.0 225.5 37.2 15.7 21.6 3.2 311.1 Diagnostic and Therapeutic 247.3 1,406.0 181.6 97.8 56.1 420.2 2,409.0 Community Services 0.1 19.1 0.0 0.0 0.0 8.3 27.4 Research and Education 30.6 284.4 22.2 0.1 0.3 30.0 367.5 Total 332.7 8,762.1 1,005.4 334.0 479.6 2,229.1 13,143.0 (annual percentage change) Administration 36.4 6.0 19.7 12.3 17.5 1.8 5.8 Support --- 8.7 14.8 11.8 14.0 11.3 10.1 Inpatient Nursing --- 9.6 16.1 11.9 13.0 6.2 10.2 Operating Room --- 8.4 13.1 12.0 13.3 17.0 10.8 Ambulatory Care 8.0 9.5 15.9 12.5 12.8 13.3 11.3 Emergency 18.1 11.8 14.6 12.2 13.2 10.6 12.4 Diagnostic and Therapeutic 11.5 9.1 15.7 13.1 13.2 13.2 10.8 Community Services -23.6-4.9 25.1 --- --- -5.1-5.0 Research and Education -10.4 8.1 12.2 12.6 12.6 13.6 6.9 Total 10.6 9.0 15.6 12.4 13.2 9.8 9.9 (percentage distribution of Type of Expense by Functional Centre) Administration 2.2 59.0 5.5 0.0 0.0 33.2 100.0 Support 0.0 53.9 6.4 0.1 0.4 39.3 100.0 Inpatient Nursing 0.0 85.5 8.5 2.8 2.5 0.8 100.0 Operating Room 0.0 50.0 8.6 4.8 34.9 1.7 100.0 Ambulatory Care 4.7 49.8 12.6 14.8 13.2 5.0 100.0 Emergency 2.6 72.5 12.0 5.0 6.9 1.0 100.0 Diagnostic and Therapeutic 10.3 58.4 7.5 4.1 2.3 17.4 100.0 Community Services 0.3 69.6 0.0 0.0 0.0 30.2 100.0 Research and Education 8.3 77.4 6.0 0.0 0.1 8.2 100.0 Total 2.5 66.7 7.6 2.5 3.6 17.0 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 7.9 7.9 6.4 0.1 0.1 17.5 9.0 Support 0.0 20.5 21.1 0.8 2.4 58.7 25.3 Inpatient Nursing 0.0 43.4 37.6 36.8 22.9 1.6 33.8 Operating Room 0.0 3.6 5.5 9.1 46.3 0.5 4.9 Ambulatory Care 6.1 2.5 5.5 19.2 12.0 1.0 3.3 Emergency 2.4 2.6 3.7 4.7 4.5 0.1 2.4 Diagnostic and Therapeutic 74.3 16.0 18.1 29.3 11.7 18.9 18.3 Community Services 0.0 0.2 0.0 0.0 0.0 0.4 0.2 Research and Education 9.2 3.2 2.2 0.0 0.1 1.3 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 5.3 0.5 0.0 0.0 3.0 9.0 Support 0.0 13.6 1.6 0.0 0.1 10.0 25.3 Inpatient Nursing 0.0 28.9 2.9 0.9 0.8 0.3 33.8 Operating Room 0.0 2.4 0.4 0.2 1.7 0.1 4.9 Ambulatory Care 0.2 1.6 0.4 0.5 0.4 0.2 3.3 Emergency 0.1 1.7 0.3 0.1 0.2 0.0 2.4 Diagnostic and Therapeutic 1.9 10.7 1.4 0.7 0.4 3.2 18.3 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.2 Research and Education 0.2 2.2 0.2 0.0 0.0 0.2 2.8 Total 2.5 66.7 7.6 2.5 3.6 17.0 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 66

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, 1984 1985 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.9 Administration 26.8 734.8 68.5 0.3 0.6 399.2 1,230.1 Support 0.0 1,875.3 227.9 3.1 13.1 1,398.4 3,517.8 Inpatient Nursing 0.0 4,023.8 404.3 139.9 123.1 45.2 4,736.3 Operating Room 0.0 337.2 58.8 34.7 250.1 12.5 693.4 Ambulatory Care 24.4 241.0 58.7 73.1 64.7 23.7 485.5 Emergency 8.8 241.3 39.7 17.8 24.3 3.3 335.2 Diagnostic and Therapeutic 272.5 1,506.5 194.1 111.2 63.2 447.3 2,594.8 Community Services 0.1 17.7 0.0 0.0 0.0 8.0 25.7 Research and Education 32.6 298.1 23.8 0.1 0.3 36.9 391.9 Total 365.2 9,275.6 1,075.8 380.3 539.5 2,374.6 14,010.8 (annual percentage change) Administration 1.2 5.7 6.4 13.6 12.4 2.1 4.4 Support --- 4.6 7.2 14.0 12.4 6.8 5.7 Inpatient Nursing --- 5.8 7.0 13.9 12.2 29.3 6.5 Operating Room --- 5.7 7.2 13.9 12.6 14.7 8.8 Ambulatory Care 20.0 11.3 6.9 13.8 12.6 9.7 11.6 Emergency 10.1 7.0 6.8 13.9 12.4 3.7 7.7 Diagnostic and Therapeutic 10.2 7.1 6.9 13.7 12.6 6.4 7.7 Community Services -3.1-7.4 17.0 --- --- -3.8-6.3 Research and Education 6.7 4.8 7.4 13.7 12.9 23.3 6.6 Total 9.8 5.9 7.0 13.8 12.5 6.5 6.6 (percentage distribution of Type of Expense by Functional Centre) Administration 2.2 59.7 5.6 0.0 0.0 32.4 100.0 Support 0.0 53.3 6.5 0.1 0.4 39.8 100.0 Inpatient Nursing 0.0 85.0 8.5 3.0 2.6 1.0 100.0 Operating Room 0.0 48.6 8.5 5.0 36.1 1.8 100.0 Ambulatory Care 5.0 49.6 12.1 15.0 13.3 4.9 100.0 Emergency 2.6 72.0 11.8 5.3 7.2 1.0 100.0 Diagnostic and Therapeutic 10.5 58.1 7.5 4.3 2.4 17.2 100.0 Community Services 0.3 68.8 0.0 0.0 0.0 31.0 100.0 Research and Education 8.3 76.1 6.1 0.0 0.1 9.4 100.0 Total 2.6 66.2 7.7 2.7 3.9 16.9 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 7.3 7.9 6.4 0.1 0.1 16.8 8.8 Support 0.0 20.2 21.2 0.8 2.4 58.9 25.1 Inpatient Nursing 0.0 43.4 37.6 36.8 22.8 1.9 33.8 Operating Room 0.0 3.6 5.5 9.1 46.4 0.5 4.9 Ambulatory Care 6.7 2.6 5.5 19.2 12.0 1.0 3.5 Emergency 2.4 2.6 3.7 4.7 4.5 0.1 2.4 Diagnostic and Therapeutic 74.6 16.2 18.0 29.2 11.7 18.8 18.5 Community Services 0.0 0.2 0.0 0.0 0.0 0.3 0.2 Research and Education 8.9 3.2 2.2 0.0 0.1 1.6 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.2 5.2 0.5 0.0 0.0 2.8 8.8 Support 0.0 13.4 1.6 0.0 0.1 10.0 25.1 Inpatient Nursing 0.0 28.7 2.9 1.0 0.9 0.3 33.8 Operating Room 0.0 2.4 0.4 0.2 1.8 0.1 4.9 Ambulatory Care 0.2 1.7 0.4 0.5 0.5 0.2 3.5 Emergency 0.1 1.7 0.3 0.1 0.2 0.0 2.4 Diagnostic and Therapeutic 1.9 10.8 1.4 0.8 0.5 3.2 18.5 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.2 Research and Education 0.2 2.1 0.2 0.0 0.0 0.3 2.8 Total 2.6 66.2 7.7 2.7 3.9 16.9 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. 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 1976 1977 to 1994 1995. CIHI 2005. 67

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, 1985 1986 Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 29.5 787.1 71.5 0.3 0.6 468.5 1,357.6 Support 0.0 1,996.3 208.9 3.6 14.5 1,476.7 3,699.9 Inpatient Nursing 0.0 4,247.9 384.4 161.2 136.6 47.6 4,977.7 Operating Room 0.0 357.5 52.0 40.0 277.8 14.7 742.0 Ambulatory Care 24.1 274.9 55.5 84.4 72.2 27.3 538.4 Emergency 9.9 264.3 36.7 20.6 27.0 4.0 362.4 Diagnostic and Therapeutic 296.7 1,630.8 183.2 126.8 70.2 484.5 2,792.1 Community Services 0.0 13.8 0.0 0.0 0.0 8.7 22.5 Research and Education 33.2 325.8 20.4 0.2 0.3 41.7 421.6 Total 393.4 9,898.4 1,012.4 437.0 599.2 2,573.6 14,914.0 (annual percentage change) Administration 10.3 7.1 4.4 13.7 7.7 17.4 10.4 Support --- 6.5-8.4 14.7 10.4 5.6 5.2 Inpatient Nursing --- 5.6-4.9 15.2 10.9 5.2 5.1 Operating Room --- 6.0-11.6 15.3 11.0 17.1 7.0 Ambulatory Care -1.1 14.0-5.4 15.5 11.6 15.1 10.9 Emergency 12.6 9.6-7.7 15.4 11.0 21.0 8.1 Diagnostic and Therapeutic 8.8 8.2-5.6 14.0 11.1 8.3 7.6 Community Services -58.3-21.8 8.6 --- --- 8.9-12.4 Research and Education 1.8 9.3-14.5 15.7 12.1 12.9 7.6 Total 7.7 6.7-5.9 14.9 11.1 8.4 6.4 (percentage distribution of Type of Expense by Functional Centre) Administration 2.2 58.0 5.3 0.0 0.0 34.5 100.0 Support 0.0 54.0 5.6 0.1 0.4 39.9 100.0 Inpatient Nursing 0.0 85.3 7.7 3.2 2.7 1.0 100.0 Operating Room 0.0 48.2 7.0 5.4 37.4 2.0 100.0 Ambulatory Care 4.5 51.1 10.3 15.7 13.4 5.1 100.0 Emergency 2.7 72.9 10.1 5.7 7.4 1.1 100.0 Diagnostic and Therapeutic 10.6 58.4 6.6 4.5 2.5 17.4 100.0 Community Services 0.1 61.4 0.0 0.0 0.0 38.5 100.0 Research and Education 7.9 77.3 4.8 0.0 0.1 9.9 100.0 Total 2.6 66.4 6.8 2.9 4.0 17.3 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 7.5 8.0 7.1 0.1 0.1 18.2 9.1 Support 0.0 20.2 20.6 0.8 2.4 57.4 24.8 Inpatient Nursing 0.0 42.9 38.0 36.9 22.8 1.8 33.4 Operating Room 0.0 3.6 5.1 9.2 46.4 0.6 5.0 Ambulatory Care 6.1 2.8 5.5 19.3 12.0 1.1 3.6 Emergency 2.5 2.7 3.6 4.7 4.5 0.2 2.4 Diagnostic and Therapeutic 75.4 16.5 18.1 29.0 11.7 18.8 18.7 Community Services 0.0 0.1 0.0 0.0 0.0 0.3 0.2 Research and Education 8.4 3.3 2.0 0.0 0.1 1.6 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 5.3 0.5 0.0 0.0 3.1 9.1 Support 0.0 13.4 1.4 0.0 0.1 9.9 24.8 Inpatient Nursing 0.0 28.5 2.6 1.1 0.9 0.3 33.4 Operating Room 0.0 2.4 0.3 0.3 1.9 0.1 5.0 Ambulatory Care 0.2 1.8 0.4 0.6 0.5 0.2 3.6 Emergency 0.1 1.8 0.2 0.1 0.2 0.0 2.4 Diagnostic and Therapeutic 2.0 10.9 1.2 0.8 0.5 3.2 18.7 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.2 Research and Education 0.2 2.2 0.1 0.0 0.0 0.3 2.8 Total 2.6 66.4 6.8 2.9 4.0 17.3 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 68

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, 1986 1987 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.11 Administration 38.1 854.3 78.5 0.4 0.7 517.9 1,489.9 Support 0.0 2,080.6 229.1 4.0 16.3 1,542.1 3,872.2 Inpatient Nursing 0.0 4,464.5 421.9 182.9 153.6 50.9 5,273.7 Operating Room 0.0 376.7 57.0 45.5 312.6 17.0 808.8 Ambulatory Care 31.0 301.8 60.9 96.1 81.2 31.3 602.3 Emergency 11.0 287.3 40.2 23.4 30.3 4.0 396.3 Diagnostic and Therapeutic 324.6 1,748.8 201.2 143.8 79.0 546.3 3,043.7 Community Services 0.0 13.1 0.0 0.0 0.0 8.6 21.8 Research and Education 33.2 324.7 22.3 0.2 0.4 41.1 421.9 Total 438.0 10,452.0 1,111.1 496.3 674.1 2,759.3 15,930.7 (annual percentage change) Medical Supplies Administration 29.2 8.5 9.8 13.0 12.9 10.6 9.7 Support --- 4.2 9.7 13.1 12.6 4.4 4.7 Inpatient Nursing --- 5.1 9.8 13.5 12.4 7.0 5.9 Operating Room --- 5.4 9.7 13.6 12.5 15.6 9.0 Ambulatory Care 28.8 9.8 9.8 13.9 12.5 14.6 11.9 Emergency 11.5 8.7 9.8 13.7 12.5-1.0 9.3 Diagnostic and Therapeutic 9.4 7.2 9.8 13.5 12.5 12.8 9.0 Community Services 0.8-4.9 10.9 --- --- -0.4-3.1 Research and Education -0.1-0.3 9.5 14.0 12.5-1.3 0.1 Total 11.3 5.6 9.7 13.6 12.5 7.2 6.8 (percentage distribution of Type of Expense by Functional Centre) Administration 2.6 57.3 5.3 0.0 0.0 34.8 100.0 Support 0.0 53.7 5.9 0.1 0.4 39.8 100.0 Inpatient Nursing 0.0 84.7 8.0 3.5 2.9 1.0 100.0 Operating Room 0.0 46.6 7.1 5.6 38.6 2.1 100.0 Ambulatory Care 5.2 50.1 10.1 16.0 13.5 5.2 100.0 Emergency 2.8 72.5 10.2 5.9 7.6 1.0 100.0 Diagnostic and Therapeutic 10.7 57.5 6.6 4.7 2.6 17.9 100.0 Community Services 0.1 60.3 0.0 0.0 0.0 39.6 100.0 Research and Education 7.9 77.0 5.3 0.0 0.1 9.8 100.0 Total 2.7 65.6 7.0 3.1 4.2 17.3 100.0 (percentage distribution of Functional Centre by Type of Expense) Other Supplies and Sundries 1 Administration 8.7 8.2 7.1 0.1 0.1 18.8 9.4 Support 0.0 19.9 20.6 0.8 2.4 55.9 24.3 Inpatient Nursing 0.0 42.7 38.0 36.9 22.8 1.8 33.1 Operating Room 0.0 3.6 5.1 9.2 46.4 0.6 5.1 Ambulatory Care 7.1 2.9 5.5 19.4 12.0 1.1 3.8 Emergency 2.5 2.7 3.6 4.7 4.5 0.1 2.5 Diagnostic and Therapeutic 74.1 16.7 18.1 29.0 11.7 19.8 19.1 Community Services 0.0 0.1 0.0 0.0 0.0 0.3 0.1 Research and Education 7.6 3.1 2.0 0.0 0.1 1.5 2.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.2 5.4 0.5 0.0 0.0 3.3 9.4 Support 0.0 13.1 1.4 0.0 0.1 9.7 24.3 Inpatient Nursing 0.0 28.0 2.6 1.1 1.0 0.3 33.1 Operating Room 0.0 2.4 0.4 0.3 2.0 0.1 5.1 Ambulatory Care 0.2 1.9 0.4 0.6 0.5 0.2 3.8 Emergency 0.1 1.8 0.3 0.1 0.2 0.0 2.5 Diagnostic and Therapeutic 2.0 11.0 1.3 0.9 0.5 3.4 19.1 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 0.2 2.0 0.1 0.0 0.0 0.3 2.6 Total 2.7 65.6 7.0 3.1 4.2 17.3 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. 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 1976 1977 to 1994 1995. CIHI 2005. 69

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, 1987 1988 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 40.6 932.7 83.9 0.4 0.8 559.0 1,617.4 Support 0.0 2,213.8 253.4 4.5 17.8 1,611.4 4,100.8 Inpatient Nursing 0.0 4,791.8 462.4 203.8 166.8 58.7 5,683.5 Operating Room 0.0 409.8 63.5 50.9 339.9 19.7 883.8 Ambulatory Care 35.3 339.2 67.0 107.9 88.5 36.1 674.0 Emergency 11.9 324.9 44.3 26.2 32.9 5.1 445.4 Diagnostic and Therapeutic 364.9 1,924.7 220.7 161.2 85.9 597.2 3,354.6 Community Services 0.0 14.1 0.0 0.0 0.0 10.4 24.5 Research and Education 33.6 337.1 25.1 0.2 0.4 41.4 437.8 Total 486.4 11,288.3 1,220.3 555.1 732.9 2,939.0 17,221.9 (annual percentage change) Administration 6.5 9.2 6.9 11.6 6.8 7.9 8.6 Support --- 6.4 10.6 11.9 8.7 4.5 5.9 Inpatient Nursing --- 7.3 9.6 11.4 8.6 15.3 7.8 Operating Room --- 8.8 11.4 11.9 8.7 16.2 9.3 Ambulatory Care 13.9 12.4 9.9 12.2 9.0 15.3 11.9 Emergency 7.6 13.1 10.1 11.8 8.7 28.8 12.4 Diagnostic and Therapeutic 12.4 10.1 9.7 12.1 8.7 9.3 10.2 Community Services 4.9 7.3 12.0 --- --- 20.5 12.5 Research and Education 1.2 3.8 12.5 12.5 9.6 0.6 3.8 Total 11.0 8.0 9.8 11.8 8.7 6.5 8.1 (percentage distribution of Type of Expense by Functional Centre) Administration 2.5 57.7 5.2 0.0 0.0 34.6 100.0 Support 0.0 54.0 6.2 0.1 0.4 39.3 100.0 Inpatient Nursing 0.0 84.3 8.1 3.6 2.9 1.0 100.0 Operating Room 0.0 46.4 7.2 5.8 38.5 2.2 100.0 Ambulatory Care 5.2 50.3 9.9 16.0 13.1 5.4 100.0 Emergency 2.7 73.0 9.9 5.9 7.4 1.2 100.0 Diagnostic and Therapeutic 10.9 57.4 6.6 4.8 2.6 17.8 100.0 Community Services 0.1 57.5 0.0 0.0 0.0 42.4 100.0 Research and Education 7.7 77.0 5.7 0.0 0.1 9.5 100.0 Total 2.8 65.5 7.1 3.2 4.3 17.1 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 8.3 8.3 6.9 0.1 0.1 19.0 9.4 Support 0.0 19.6 20.8 0.8 2.4 54.8 23.8 Inpatient Nursing 0.0 42.4 37.9 36.7 22.8 2.0 33.0 Operating Room 0.0 3.6 5.2 9.2 46.4 0.7 5.1 Ambulatory Care 7.3 3.0 5.5 19.4 12.1 1.2 3.9 Emergency 2.4 2.9 3.6 4.7 4.5 0.2 2.6 Diagnostic and Therapeutic 75.0 17.1 18.1 29.0 11.7 20.3 19.5 Community Services 0.0 0.1 0.0 0.0 0.0 0.4 0.1 Research and Education 6.9 3.0 2.1 0.0 0.1 1.4 2.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 5.4 0.5 0.0 0.0 3.2 9.4 Support 0.0 12.9 1.5 0.0 0.1 9.4 23.8 Inpatient Nursing 0.0 27.8 2.7 1.2 1.0 0.3 33.0 Operating Room 0.0 2.4 0.4 0.3 2.0 0.1 5.1 Ambulatory Care 0.2 2.0 0.4 0.6 0.5 0.2 3.9 Emergency 0.1 1.9 0.3 0.2 0.2 0.0 2.6 Diagnostic and Therapeutic 2.1 11.2 1.3 0.9 0.5 3.5 19.5 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 0.2 2.0 0.1 0.0 0.0 0.2 2.5 Total 2.8 65.5 7.1 3.2 4.3 17.1 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 70

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, 1988 1989 Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Table 2.13 Administration 51.8 1,017.8 87.9 0.5 0.8 623.1 1,781.9 Support 0.0 2,352.5 268.6 5.0 19.0 1,717.7 4,363.0 Inpatient Nursing 0.0 5,094.7 488.8 225.5 178.9 70.5 6,058.3 Operating Room 0.0 441.7 67.2 56.1 364.5 23.9 953.4 Ambulatory Care 29.1 378.3 70.3 119.1 94.9 43.0 734.7 Emergency 12.3 356.3 46.6 28.9 35.3 6.3 485.7 Diagnostic and Therapeutic 388.7 2,086.3 233.0 177.9 92.2 653.3 3,631.3 Community Services 0.0 12.9 0.0 0.0 0.0 9.4 22.3 Research and Education 36.1 377.9 26.7 0.2 0.4 51.8 493.2 Total 518.0 12,118.5 1,289.0 613.2 786.1 3,199.0 18,523.8 Administration 27.5 9.1 4.8 10.1 8.3 11.5 10.2 Support --- 6.3 6.0 10.8 7.2 6.6 6.4 Inpatient Nursing --- 6.3 5.7 10.6 7.3 20.1 6.6 Operating Room --- 7.8 5.8 10.4 7.2 21.0 7.9 Ambulatory Care -17.6 11.5 5.0 10.4 7.2 19.1 9.0 Emergency 3.5 9.6 5.1 10.5 7.2 23.0 9.1 Diagnostic and Therapeutic 6.5 8.4 5.6 10.4 7.4 9.4 8.3 Community Services -13.8-8.5 9.6 --- --- -10.0-9.1 Research and Education 7.6 12.1 6.4 10.2 6.9 25.2 12.6 d'activité 2 Total 6.5 7.4 5.6 10.5 7.2 8.8 7.6 Administration 2.9 57.1 4.9 0.0 0.0 35.0 100.0 Support 0.0 53.9 6.2 0.1 0.4 39.4 100.0 Inpatient Nursing 0.0 84.1 8.1 3.7 3.0 1.2 100.0 Operating Room 0.0 46.3 7.0 5.9 38.2 2.5 100.0 Ambulatory Care 4.0 51.5 9.6 16.2 12.9 5.9 100.0 Emergency 2.5 73.4 9.6 6.0 7.3 1.3 100.0 Diagnostic and Therapeutic 10.7 57.5 6.4 4.9 2.5 18.0 100.0 Community Services 0.1 57.9 0.0 0.0 0.0 42.0 100.0 Research and Education 7.3 76.6 5.4 0.0 0.1 10.5 100.0 d'activité 2 Total 2.8 65.4 7.0 3.3 4.2 17.3 100.0 Administration 10.0 8.4 6.8 0.1 0.1 19.5 9.6 Support 0.0 19.4 20.8 0.8 2.4 53.7 23.6 Inpatient Nursing 0.0 42.0 37.9 36.8 22.8 2.2 32.7 Operating Room 0.0 3.6 5.2 9.2 46.4 0.7 5.1 Ambulatory Care 5.6 3.1 5.5 19.4 12.1 1.3 4.0 Emergency 2.4 2.9 3.6 4.7 4.5 0.2 2.6 Diagnostic and Therapeutic 75.0 17.2 18.1 29.0 11.7 20.4 19.6 Community Services 0.0 0.1 0.0 0.0 0.0 0.3 0.1 Research and Education 7.0 3.1 2.1 0.0 0.1 1.6 2.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.3 5.5 0.5 0.0 0.0 3.4 9.6 Support 0.0 12.7 1.5 0.0 0.1 9.3 23.6 Inpatient Nursing 0.0 27.5 2.6 1.2 1.0 0.4 32.7 Operating Room 0.0 2.4 0.4 0.3 2.0 0.1 5.1 Ambulatory Care 0.2 2.0 0.4 0.6 0.5 0.2 4.0 Emergency 0.1 1.9 0.3 0.2 0.2 0.0 2.6 Diagnostic and Therapeutic 2.1 11.3 1.3 1.0 0.5 3.5 19.6 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 0.2 2.0 0.1 0.0 0.0 0.3 2.7 Total 2.8 65.4 7.0 3.3 4.2 17.3 100.0 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 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. Total 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 71

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, 1989 1990 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 46.8 1,125.2 102.2 0.5 0.9 675.8 1,951.3 Support 0.0 2,481.0 307.6 5.5 20.2 1,892.5 4,706.8 Inpatient Nursing 0.0 5,422.2 563.2 248.9 190.5 126.1 6,550.9 Operating Room 0.0 465.4 76.8 61.8 387.1 28.5 1,019.5 Ambulatory Care 24.2 407.8 81.6 130.6 100.8 49.8 794.8 Emergency 13.1 398.6 53.8 31.8 37.5 11.2 546.1 Diagnostic and Therapeutic 428.6 2,264.5 269.1 193.7 97.8 783.1 4,036.7 Community Services 0.0 9.0 0.0 0.0 0.0 2.9 11.9 Research and Education 16.4 360.5 30.3 0.3 0.5 174.3 582.2 Total 529.1 12,934.2 1,484.5 672.9 835.3 3,744.2 20,200.2 (annual percentage change) Administration -9.6 10.5 16.3 9.1 4.3 8.5 9.5 Support -100.0 5.5 14.5 9.7 6.0 10.2 7.9 Inpatient Nursing --- 6.4 15.2 10.4 6.5 79.0 8.1 Operating Room --- 5.4 14.2 10.0 6.2 19.1 6.9 Ambulatory Care -16.9 7.8 16.0 9.7 6.3 15.8 8.2 Emergency 6.5 11.9 15.5 10.1 6.4 77.5 12.4 Diagnostic and Therapeutic 10.3 8.5 15.5 8.9 6.1 19.9 11.2 Community Services -26.3-30.5 6.2 --- --- -68.6-46.5 Research and Education -54.7-4.6 13.4 9.6 6.5 236.3 18.1 Total 2.1 6.7 15.2 9.7 6.3 17.0 9.0 (percentage distribution of Type of Expense by Functional Centre) Administration 2.4 57.7 5.2 0.0 0.0 34.6 100.0 Support 0.0 52.7 6.5 0.1 0.4 40.2 100.0 Inpatient Nursing 0.0 82.8 8.6 3.8 2.9 1.9 100.0 Operating Room 0.0 45.6 7.5 6.1 38.0 2.8 100.0 Ambulatory Care 3.0 51.3 10.3 16.4 12.7 6.3 100.0 Emergency 2.4 73.0 9.8 5.8 6.9 2.0 100.0 Diagnostic and Therapeutic 10.6 56.1 6.7 4.8 2.4 19.4 100.0 Community Services 0.2 75.2 0.0 0.0 0.0 24.7 100.0 Research and Education 2.8 61.9 5.2 0.0 0.1 29.9 100.0 Total 2.6 64.0 7.3 3.3 4.1 18.5 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 8.8 8.7 6.9 0.1 0.1 18.1 9.7 Support 0.0 19.2 20.7 0.8 2.4 50.5 23.3 Inpatient Nursing 0.0 41.9 37.9 37.0 22.8 3.4 32.4 Operating Room 0.0 3.6 5.2 9.2 46.3 0.8 5.0 Ambulatory Care 4.6 3.2 5.5 19.4 12.1 1.3 3.9 Emergency 2.5 3.1 3.6 4.7 4.5 0.3 2.7 Diagnostic and Therapeutic 81.0 17.5 18.1 28.8 11.7 20.9 20.0 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 3.1 2.8 2.0 0.0 0.1 4.7 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 5.6 0.5 0.0 0.0 3.3 9.7 Support 0.0 12.3 1.5 0.0 0.1 9.4 23.3 Inpatient Nursing 0.0 26.8 2.8 1.2 0.9 0.6 32.4 Operating Room 0.0 2.3 0.4 0.3 1.9 0.1 5.0 Ambulatory Care 0.1 2.0 0.4 0.6 0.5 0.2 3.9 Emergency 0.1 2.0 0.3 0.2 0.2 0.1 2.7 Diagnostic and Therapeutic 2.1 11.2 1.3 1.0 0.5 3.9 20.0 Community Services 0.0 0.0 0.0 0.0 0.0 0.0 0.1 Research and Education 0.1 1.8 0.1 0.0 0.0 0.9 2.9 Total 2.6 64.0 7.3 3.3 4.1 18.5 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 72

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, 1990 1991 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Administration 51.7 1,234.8 117.5 0.6 0.9 707.7 2,113.1 Support 0.0 2,661.5 346.2 6.0 21.0 1,918.9 4,953.6 Inpatient Nursing 0.0 5,721.3 637.5 270.3 198.7 128.4 6,956.1 Operating Room 0.0 512.4 86.5 67.5 403.2 36.6 1,106.3 Ambulatory Care 31.3 464.7 92.9 143.3 104.9 56.8 893.9 Emergency 15.8 444.3 61.1 34.7 39.2 13.3 608.3 Diagnostic and Therapeutic 459.3 2,482.5 304.6 213.2 101.5 862.5 4,423.6 Community Services 0.0 11.0 0.0 0.0 0.0 3.3 14.3 Research and Education 18.3 390.3 34.0 0.3 0.5 197.4 640.8 Total 576.4 13,922.7 1,680.2 735.8 870.0 3,924.8 21,710.0 (annual percentage change) Administration 10.5 9.7 15.0 10.8 2.9 4.7 8.3 Support --- 7.3 12.5 9.4 4.3 1.4 5.2 Inpatient Nursing --- 5.5 13.2 8.6 4.3 1.8 6.2 Operating Room --- 10.1 12.7 9.3 4.2 28.6 8.5 Ambulatory Care 29.4 13.9 13.8 9.7 4.1 14.1 12.5 Emergency 20.2 11.5 13.5 9.1 4.4 18.6 11.4 Diagnostic and Therapeutic 7.2 9.6 13.2 10.1 3.8 10.1 9.6 Community Services -13.1 22.4 14.1 --- --- 12.1 19.8 Research and Education 11.8 8.3 12.3 10.4 4.7 13.3 10.1 Total 8.9 7.6 13.2 9.3 4.2 4.8 7.5 (percentage distribution of Type of Expense by Functional Centre) Administration 2.4 58.4 5.6 0.0 0.0 33.5 100.0 Support 0.0 53.7 7.0 0.1 0.4 38.7 100.0 Inpatient Nursing 0.0 82.2 9.2 3.9 2.9 1.8 100.0 Operating Room 0.0 46.3 7.8 6.1 36.4 3.3 100.0 Ambulatory Care 3.5 52.0 10.4 16.0 11.7 6.4 100.0 Emergency 2.6 73.0 10.0 5.7 6.4 2.2 100.0 Diagnostic and Therapeutic 10.4 56.1 6.9 4.8 2.3 19.5 100.0 Community Services 0.1 76.8 0.0 0.0 0.0 23.1 100.0 Research and Education 2.9 60.9 5.3 0.0 0.1 30.8 100.0 Total 2.7 64.1 7.7 3.4 4.0 18.1 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 9.0 8.9 7.0 0.1 0.1 18.0 9.7 Support 0.0 19.1 20.6 0.8 2.4 48.9 22.8 Inpatient Nursing 0.0 41.1 37.9 36.7 22.8 3.3 32.0 Operating Room 0.0 3.7 5.1 9.2 46.3 0.9 5.1 Ambulatory Care 5.4 3.3 5.5 19.5 12.1 1.4 4.1 Emergency 2.7 3.2 3.6 4.7 4.5 0.3 2.8 Diagnostic and Therapeutic 79.7 17.8 18.1 29.0 11.7 22.0 20.4 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 3.2 2.8 2.0 0.0 0.1 5.0 3.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.2 5.7 0.5 0.0 0.0 3.3 9.7 Support 0.0 12.3 1.6 0.0 0.1 8.8 22.8 Inpatient Nursing 0.0 26.4 2.9 1.2 0.9 0.6 32.0 Operating Room 0.0 2.4 0.4 0.3 1.9 0.2 5.1 Ambulatory Care 0.1 2.1 0.4 0.7 0.5 0.3 4.1 Emergency 0.1 2.0 0.3 0.2 0.2 0.1 2.8 Diagnostic and Therapeutic 2.1 11.4 1.4 1.0 0.5 4.0 20.4 Community Services 0.0 0.1 0.0 0.0 0.0 0.0 0.1 Research and Education 0.1 1.8 0.2 0.0 0.0 0.9 3.0 Total 2.7 64.1 7.7 3.4 4.0 18.1 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. 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 1976 1977 to 1994 1995. CIHI 2005. 73

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, 1991 1992 Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 64.5 1,369.0 137.9 0.6 1.0 718.2 2,291.2 Support 0.0 2,790.9 404.6 6.4 22.3 2,023.2 5,247.4 Inpatient Nursing 0.0 6,122.1 747.7 286.4 209.6 118.9 7,484.6 Operating Room 0.0 560.9 100.9 71.7 426.1 43.7 1,203.2 Ambulatory Care 32.4 538.5 109.2 151.7 110.9 68.9 1,011.6 Emergency 22.8 489.4 71.4 36.8 41.4 13.1 674.9 Diagnostic and Therapeutic 496.4 2,728.9 357.5 228.7 107.4 1,013.1 4,931.9 Community Services 0.3 10.7 0.0 0.0 0.0 3.5 14.5 Research and Education 18.6 359.5 39.6 0.3 0.5 186.0 604.6 Total 635.1 14,969.9 1,968.7 782.5 919.0 4,188.6 23,463.9 (annual percentage change) Administration 24.8 10.9 17.4 6.7 8.2 1.5 8.4 Support -100.0 4.9 16.9 6.5 6.1 5.4 5.9 Inpatient Nursing --- 7.0 17.3 5.9 5.5-7.4 7.6 Operating Room --- 9.5 16.6 6.1 5.7 19.4 8.8 Ambulatory Care 3.6 15.9 17.5 5.9 5.6 21.2 13.2 Emergency 45.0 10.2 16.9 5.9 5.6-1.3 11.0 Diagnostic and Therapeutic 8.1 9.9 17.4 7.3 5.7 17.5 11.5 Community Services --- -2.9 17.7 --- --- 5.0 1.3 Research and Education 1.9-7.9 16.6 5.5 5.4-5.8-5.6 Total 10.2 7.5 17.2 6.3 5.6 6.7 8.1 (percentage distribution of Type of Expense by Functional Centre) Administration 2.8 59.7 6.0 0.0 0.0 31.3 100.0 Support 0.0 53.2 7.7 0.1 0.4 38.6 100.0 Inpatient Nursing 0.0 81.8 10.0 3.8 2.8 1.6 100.0 Operating Room 0.0 46.6 8.4 6.0 35.4 3.6 100.0 Ambulatory Care 3.2 53.2 10.8 15.0 11.0 6.8 100.0 Emergency 3.4 72.5 10.6 5.4 6.1 1.9 100.0 Diagnostic and Therapeutic 10.1 55.3 7.2 4.6 2.2 20.5 100.0 Community Services 2.4 73.7 0.0 0.0 0.0 23.9 100.0 Research and Education 3.1 59.5 6.6 0.0 0.1 30.8 100.0 Total 2.7 63.8 8.4 3.3 3.9 17.9 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 10.2 9.1 7.0 0.1 0.1 17.1 9.8 Support 0.0 18.6 20.5 0.8 2.4 48.3 22.4 Inpatient Nursing 0.0 40.9 38.0 36.6 22.8 2.8 31.9 Operating Room 0.0 3.7 5.1 9.2 46.4 1.0 5.1 Ambulatory Care 5.1 3.6 5.5 19.4 12.1 1.6 4.3 Emergency 3.6 3.3 3.6 4.7 4.5 0.3 2.9 Diagnostic and Therapeutic 78.2 18.2 18.2 29.2 11.7 24.2 21.0 Community Services 0.1 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 2.9 2.4 2.0 0.0 0.1 4.4 2.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 5.8 0.6 0.0 0.0 3.1 9.8 Support 0.0 11.9 1.7 0.0 0.1 8.6 22.4 Inpatient Nursing 0.0 26.1 3.2 1.2 0.9 0.5 31.9 Operating Room 0.0 2.4 0.4 0.3 1.8 0.2 5.1 Ambulatory Care 0.1 2.3 0.5 0.6 0.5 0.3 4.3 Emergency 0.1 2.1 0.3 0.2 0.2 0.1 2.9 Diagnostic and Therapeutic 2.1 11.6 1.5 1.0 0.5 4.3 21.0 Community Services 0.0 0.0 0.0 0.0 0.0 0.0 0.1 Research and Education 0.1 1.5 0.2 0.0 0.0 0.8 2.6 Total 2.7 63.8 8.4 3.3 3.9 17.9 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 74

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, 1992 1993 Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Supplies Other Supplies and Sundries 1 Administration 66.5 1,370.5 141.7 0.6 1.0 691.4 2,271.6 Support 0.0 2,722.0 424.4 6.3 22.3 1,973.7 5,148.6 Inpatient Nursing 0.0 6,100.7 783.1 282.8 206.6 124.0 7,497.2 Operating Room 0.0 576.5 105.8 71.1 424.9 49.6 1,228.0 Ambulatory Care 36.1 589.3 115.3 150.9 111.2 77.9 1,080.7 Emergency 20.6 513.1 74.7 36.5 41.0 13.8 699.7 Diagnostic and Therapeutic 498.4 2,767.9 375.7 226.9 107.6 1,046.1 5,022.6 Community Services 0.2 11.4 0.0 0.0 0.0 3.1 14.7 Research and Education 22.6 389.3 41.8 0.3 0.5 195.8 650.3 Total 644.3 15,040.7 2,062.5 775.4 915.2 4,175.3 23,613.3 Administration 3.0 0.1 2.7-4.3 1.5-3.7-0.9 Support --- -2.5 4.9-1.3-0.1-2.4-1.9 Inpatient Nursing --- -0.4 4.7-1.2-1.4 4.2 0.2 Operating Room --- 2.8 4.9-0.8-0.3 13.6 2.1 Ambulatory Care 11.3 9.4 5.6-0.6 0.3 13.2 6.8 Emergency -9.9 4.8 4.7-0.7-0.9 5.0 3.7 Diagnostic and Therapeutic 0.4 1.4 5.1-0.8 0.3 3.3 1.8 Community Services -47.1 7.2 5.2 --- --- -11.7 1.4 Research and Education 21.1 8.3 5.5-1.2 0.1 5.2 7.6 Total 1.4 0.5 4.8-0.9-0.4-0.3 0.6 Administration 2.9 60.3 6.2 0.0 0.0 30.4 100.0 Support 0.0 52.9 8.2 0.1 0.4 38.3 100.0 Inpatient Nursing 0.0 81.4 10.4 3.8 2.8 1.7 100.0 Operating Room 0.0 46.9 8.6 5.8 34.6 4.0 100.0 Ambulatory Care 3.3 54.5 10.7 14.0 10.3 7.2 100.0 Emergency 2.9 73.3 10.7 5.2 5.9 2.0 100.0 Diagnostic and Therapeutic 9.9 55.1 7.5 4.5 2.1 20.8 100.0 Community Services 1.3 77.9 0.0 0.0 0.0 20.8 100.0 Research and Education 3.5 59.9 6.4 0.0 0.1 30.1 100.0 Total 2.7 63.7 8.7 3.3 3.9 17.7 100.0 Administration 10.3 9.1 6.9 0.1 0.1 16.6 9.6 Support 0.0 18.1 20.6 0.8 2.4 47.3 21.8 Inpatient Nursing 0.0 40.6 38.0 36.5 22.6 3.0 31.7 Operating Room 0.0 3.8 5.1 9.2 46.4 1.2 5.2 Ambulatory Care 5.6 3.9 5.6 19.5 12.2 1.9 4.6 Emergency 3.2 3.4 3.6 4.7 4.5 0.3 3.0 Diagnostic and Therapeutic 77.4 18.4 18.2 29.3 11.8 25.1 21.3 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 3.5 2.6 2.0 0.0 0.1 4.7 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Administration 0.3 5.8 0.6 0.0 0.0 2.9 9.6 Support 0.0 11.5 1.8 0.0 0.1 8.4 21.8 Inpatient Nursing 0.0 25.8 3.3 1.2 0.9 0.5 31.7 Operating Room 0.0 2.4 0.4 0.3 1.8 0.2 5.2 Ambulatory Care 0.2 2.5 0.5 0.6 0.5 0.3 4.6 Emergency 0.1 2.2 0.3 0.2 0.2 0.1 3.0 Diagnostic and Therapeutic 2.1 11.7 1.6 1.0 0.5 4.4 21.3 Community Services 0.0 0.0 0.0 0.0 0.0 0.0 0.1 Research and Education 0.1 1.6 0.2 0.0 0.0 0.8 2.8 Total 2.7 63.7 8.7 3.3 3.9 17.7 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. 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 1976 1977 to 1994 1995. CIHI 2005. 75

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, 1993 1994 Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies and Sundries 1 Total ($ 000,000) Administration 77.7 1,308.4 156.6 0.7 1.0 675.9 2,220.3 Support 0.0 2,723.8 456.3 6.2 21.9 1,945.7 5,153.8 Inpatient Nursing 0.0 5,980.5 850.7 281.5 200.8 131.1 7,444.6 Operating Room 0.0 566.5 113.7 71.4 415.9 56.1 1,223.6 Ambulatory Care 36.2 620.7 124.8 152.4 109.2 85.2 1,128.4 Emergency 21.8 522.1 81.3 36.7 40.1 15.6 717.5 Diagnostic and Therapeutic 498.3 2,845.8 409.6 233.1 105.2 1,052.5 5,144.4 Community Services 0.1 13.7 0.0 0.0 0.0 4.2 17.9 Research and Education 24.0 348.2 44.5 0.3 0.5 177.2 594.7 Total 658.0 14,929.7 2,237.3 782.3 894.6 4,143.3 23,645.2 (annual percentage change) Administration 16.9-4.5 10.5 20.6 4.3-2.2-2.3 Support --- 0.1 7.5-1.5-1.8-1.4 0.1 Inpatient Nursing --- -2.0 8.6-0.5-2.8 5.7-0.7 Operating Room --- -1.7 7.4 0.5-2.1 13.0-0.4 Ambulatory Care 0.3 5.3 8.2 1.0-1.8 9.3 4.4 Emergency 5.8 1.7 8.7 0.5-2.2 13.1 2.5 Diagnostic and Therapeutic 0.0 2.8 9.0 2.8-2.3 0.6 2.4 Community Services -61.7 19.6 0.5 --- --- 35.8 22.0 Research and Education 6.3-10.6 6.4 0.8-1.0-9.5-8.5 Total 2.1-0.7 8.5 0.9-2.3-0.8 0.1 (percentage distribution of Type of Expense by Functional Centre) Administration 3.5 58.9 7.1 0.0 0.0 30.4 100.0 Support 0.0 52.8 8.9 0.1 0.4 37.8 100.0 Inpatient Nursing 0.0 80.3 11.4 3.8 2.7 1.8 100.0 Operating Room 0.0 46.3 9.3 5.8 34.0 4.6 100.0 Ambulatory Care 3.2 55.0 11.1 13.5 9.7 7.6 100.0 Emergency 3.0 72.8 11.3 5.1 5.6 2.2 100.0 Diagnostic and Therapeutic 9.7 55.3 8.0 4.5 2.0 20.5 100.0 Community Services 0.4 76.4 0.0 0.0 0.0 23.2 100.0 Research and Education 4.0 58.6 7.5 0.1 0.1 29.8 100.0 Total 2.8 63.1 9.5 3.3 3.8 17.5 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 11.8 8.8 7.0 0.1 0.1 16.3 9.4 Support 0.0 18.2 20.4 0.8 2.4 47.0 21.8 Inpatient Nursing 0.0 40.1 38.0 36.0 22.4 3.2 31.5 Operating Room 0.0 3.8 5.1 9.1 46.5 1.4 5.2 Ambulatory Care 5.5 4.2 5.6 19.5 12.2 2.1 4.8 Emergency 3.3 3.5 3.6 4.7 4.5 0.4 3.0 Diagnostic and Therapeutic 75.7 19.1 18.3 29.8 11.8 25.4 21.8 Community Services 0.0 0.1 0.0 0.0 0.0 0.1 0.1 Research and Education 3.6 2.3 2.0 0.0 0.1 4.3 2.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 5.5 0.7 0.0 0.0 2.9 9.4 Support 0.0 11.5 1.9 0.0 0.1 8.2 21.8 Inpatient Nursing 0.0 25.3 3.6 1.2 0.8 0.6 31.5 Operating Room 0.0 2.4 0.5 0.3 1.8 0.2 5.2 Ambulatory Care 0.2 2.6 0.5 0.6 0.5 0.4 4.8 Emergency 0.1 2.2 0.3 0.2 0.2 0.1 3.0 Diagnostic and Therapeutic 2.1 12.0 1.7 1.0 0.4 4.5 21.8 Community Services 0.0 0.1 0.0 0.0 0.0 0.0 0.1 Research and Education 0.1 1.5 0.2 0.0 0.0 0.7 2.5 Total 2.8 63.1 9.5 3.3 3.8 17.5 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. CIHI 2005. 76

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, 1994 1995 3 Current Dollars Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total 3 614.2 13,832.5 2,165.2 742.6 821.2 4,108.8 22,284.5 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total -6.6-7.3-3.2-5.1-8.2-0.8-5.8 Administration Support Inpatient Nursing Operating Room Ambulatory Care Emergency Diagnostic and Therapeutic Community Services Research and Education Total 2.8 62.1 9.7 3.3 3.7 18.4 100.0 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 2.8 62.1 9.7 3.3 3.7 18.4 100.0 1 Other Supplies and Sundries are combined from 1976 1977 to 1994 1995. Other Supplies are reported separately in subsequent years. 2 There are no expenses allocated to All Other Functional Centre from 1976 1977 to 1994 1995. 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, 1994 1995, Statistics Canada (available by total expenses only). CIHI 2005. 77

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, 1995 1996 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies Sundries Total ($ 000,000) Administration 63.8 713.1 163.4 0.7 1.2 127.5 376.1 1,445.7 Support 4.7 2,744.0 445.4 6.0 23.4 1,261.0 250.5 4,735.0 Inpatient Nursing 87.1 5,087.1 854.7 260.2 208.7 86.5 44.7 6,629.1 Operating Room 9.8 723.2 107.9 66.7 440.8 64.0 20.0 1,432.5 Ambulatory Care 55.0 755.0 123.4 145.1 115.6 72.9 37.4 1,304.3 Emergency 29.9 513.3 77.6 34.3 42.0 18.8 4.9 720.8 Diagnostic and Therapeutic 517.1 2,543.0 405.2 222.5 112.3 476.4 156.7 4,433.2 Community Services 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 Research and Education 95.1 306.3 40.5 0.3 0.5 134.8 37.4 614.8 All Other 19.3 298.9 198.8 44.5 4.6 147.3 114.7 828.2 Total 881.7 13,683.8 2,417.0 780.4 949.0 2,389.4 1,042.3 22,143.6 (annual percentage change) Administration --- --- --- --- --- --- --- --- Support --- --- --- --- --- --- --- --- Inpatient Nursing --- --- --- --- --- --- --- --- Operating Room --- --- --- --- --- --- --- --- Ambulatory Care --- --- --- --- --- --- --- --- Emergency --- --- --- --- --- --- --- --- Diagnostic and Therapeutic --- --- --- --- --- --- --- --- Community Services --- --- --- --- --- --- --- --- Research and Education --- --- --- --- --- --- --- --- All Other --- --- --- --- --- --- --- --- Total 43.5-1.1 11.6 5.1 15.6-16.5-0.6 (percentage distribution of Type of Expense by Functional Centre) Administration 4.4 49.3 11.3 0.0 0.1 8.8 26.0 100.0 Support 0.1 58.0 9.4 0.1 0.5 26.6 5.3 100.0 Inpatient Nursing 1.3 76.7 12.9 3.9 3.1 1.3 0.7 100.0 Operating Room 0.7 50.5 7.5 4.7 30.8 4.5 1.4 100.0 Ambulatory Care 4.2 57.9 9.5 11.1 8.9 5.6 2.9 100.0 Emergency 4.1 71.2 10.8 4.8 5.8 2.6 0.7 100.0 Diagnostic and Therapeutic 11.7 57.4 9.1 5.0 2.5 10.7 3.5 100.0 Community Services 0.1 1.8 1.3 0.0 0.0 93.2 3.6 100.0 Research and Education 15.5 49.8 6.6 0.0 0.1 21.9 6.1 100.0.3 36.1 24.0 5.4 0.6 17.8 13.8 100.0 Total 4.0 61.8 10.9 3.5 4.3 10.8 4.7 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 7.2 5.2 6.8 0.1 0.1 5.3 36.1 6.5 Support 0.5 20.1 18.4 0.8 2.5 52.8 24.0 21.4 Inpatient Nursing 9.9 37.2 35.4 33.3 22.0 3.6 4.3 29.9 Operating Room 1.1 5.3 4.5 8.6 46.4 2.7 1.9 6.5 Ambulatory Care 6.2 5.5 5.1 18.6 12.2 3.1 3.6 5.9 Emergency 3.4 3.8 3.2 4.4 4.4 0.8 0.5 3.3 Diagnostic and Therapeutic 58.6 18.6 16.8 28.5 11.8 19.9 15.0 20.0 Community Services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Research and Education 10.8 2.2 1.7 0.0 0.1 5.6 3.6 2.8.2 2.2 8.2 5.7 0.5 6.2 11.0 3.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 3.2 0.7 0.0 0.0 0.6 1.7 6.5 Support 0.0 12.4 2.0 0.0 0.1 5.7 1.1 21.4 Inpatient Nursing 0.4 23.0 3.9 1.2 0.9 0.4 0.2 29.9 Operating Room 0.0 3.3 0.5 0.3 2.0 0.3 0.1 6.5 Ambulatory Care 0.2 3.4 0.6 0.7 0.5 0.3 0.2 5.9 Emergency 0.1 2.3 0.4 0.2 0.2 0.1 0.0 3.3 Diagnostic and Therapeutic 2.3 11.5 1.8 1.0 0.5 2.2 0.7 20.0 Community Services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Research and Education 0.4 1.4 0.2 0.0 0.0 0.6 0.2 2.8 All Other 0.1 1.3 0.9 0.2 0.0 0.7 0.5 3.7 Total 4.0 61.8 10.9 3.5 4.3 10.8 4.7 100.0 CIHI 2005. 78

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, 1996 1997 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.21 Administration 54.8 757.4 164.8 0.6 0.2 138.8 356.0 1,472.7 Support 5.5 2,507.6 411.6 5.4 21.5 1,183.1 245.2 4,379.9 Inpatient Nursing 118.1 4,844.4 822.9 243.7 197.2 143.5 54.0 6,423.8 Operating Room 11.0 661.8 104.2 61.5 446.6 54.1 19.9 1,359.1 Ambulatory Care 56.7 781.9 124.4 160.3 117.1 69.5 43.5 1,353.3 Emergency 40.5 502.4 80.3 32.5 41.1 35.7 5.7 738.1 Diagnostic and Therapeutic 466.9 2,413.9 388.6 225.8 122.6 544.5 145.0 4,307.5 Community Services 0.6 1.4 0.2 0.0 0.1 0.1 207.3 209.6 Research and Education 74.1 317.0 39.4 2.2 0.4 125.8 33.2 592.1 All Other 8.0 321.7 169.9 53.3 5.8 147.4 95.0 801.2 Total 836.1 13,109.4 2,306.4 785.6 952.6 2,442.5 1,204.8 21,637.4 (annual percentage change) Administration -14.0 6.2 0.8-5.6-83.2 8.9-5.3 1.9 Support 15.2-8.6-7.6-9.5-7.8-6.2-2.1-7.5 Inpatient Nursing 35.7-4.8-3.7-6.3-5.5 65.8 20.8-3.1 Operating Room 11.7-8.5-3.5-7.8 1.3-15.5-0.5-5.1 Ambulatory Care 3.2 3.6 0.8 10.5 1.3-4.7 16.3 3.8 Emergency 35.5-2.1 3.5-5.4-2.0 89.6 15.2 2.4 Diagnostic and Therapeutic -9.7-5.1-4.1 1.5 9.1 14.3-7.5-2.8 Community Services --- --- --- --- --- -17.3 --- --- Research and Education -22.1 3.5-2.7 689.8-24.8-6.6-11.3-3.7 All Other -58.6 7.6-14.5 19.8 27.1 0.0-17.1-3.3 Total -5.2-4.2-4.6 0.7 0.4 2.2 15.6-2.3 (percentage distribution of Type of Expense by Functional Centre) Administration 3.7 51.4 11.2 0.0 0.0 9.4 24.2 100.0 Support 0.1 57.3 9.4 0.1 0.5 27.0 5.6 100.0 Inpatient Nursing 1.8 75.4 12.8 3.8 3.1 2.2 0.8 100.0 Operating Room 0.8 48.7 7.7 4.5 32.9 4.0 1.5 100.0 Ambulatory Care 4.2 57.8 9.2 11.8 8.7 5.1 3.2 100.0 Emergency 5.5 68.1 10.9 4.4 5.6 4.8 0.8 100.0 Diagnostic and Therapeutic 10.8 56.0 9.0 5.2 2.8 12.6 3.4 100.0 Community Services 0.3 0.6 0.1 0.0 0.0 0.0 98.9 100.0 Research and Education 12.5 53.5 6.7 0.4 0.1 21.3 5.6 100.0 All Other 1.0 40.2 21.2 6.7 0.7 18.4 11.9 100.0 Total 3.9 60.6 10.7 3.6 4.4 11.3 5.6 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 6.6 5.8 7.1 0.1 0.0 5.7 29.6 6.8 Support 0.7 19.1 17.8 0.7 2.3 48.4 20.4 20.2 Inpatient Nursing 14.1 37.0 35.7 31.0 20.7 5.9 4.5 29.7 Operating Room 1.3 5.0 4.5 7.8 46.9 2.2 1.7 6.3 Ambulatory Care 6.8 6.0 5.4 20.4 12.3 2.8 3.6 6.3 Emergency 4.8 3.8 3.5 4.1 4.3 1.5 0.5 3.4 Diagnostic and Therapeutic 55.8 18.4 16.9 28.7 12.9 22.3 12.0 19.9 Community Services 0.1 0.0 0.0 0.0 0.0 0.0 17.2 1.0 Research and Education 8.9 2.4 1.7 0.3 0.0 5.2 2.8 2.7 All Other 1.0 2.5 7.4 6.8 0.6 6.0 7.9 3.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 3.5 0.8 0.0 0.0 0.6 1.6 6.8 Support 0.0 11.6 1.9 0.0 0.1 5.5 1.1 20.2 Inpatient Nursing 0.5 22.4 3.8 1.1 0.9 0.7 0.2 29.7 Operating Room 0.1 3.1 0.5 0.3 2.1 0.3 0.1 6.3 Ambulatory Care 0.3 3.6 0.6 0.7 0.5 0.3 0.2 6.3 Emergency 0.2 2.3 0.4 0.2 0.2 0.2 0.0 3.4 Diagnostic and Therapeutic 2.2 11.2 1.8 1.0 0.6 2.5 0.7 19.9 Community Services 0.0 0.0 0.0 0.0 0.0 0.0 1.0 1.0 Research and Education 0.3 1.5 0.2 0.0 0.0 0.6 0.2 2.7 All Other 0.0 1.5 0.8 0.2 0.0 0.7 0.4 3.7 Total 3.9 60.6 10.7 3.6 4.4 11.3 5.6 100.0 Drugs Medical Supplies Other Supplies Sundries Total CIHI 2005. 79

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, 1997 1998 Current Dollars Functional Centre Physician Compensation Salaries Benefits Type of Expense Medical Drugs Supplies Other Supplies Sundries Total ($ 000,000) Administration 50.1 880.9 143.9 0.6 0.7 130.0 389.3 1,595.5 Support 5.9 2,581.0 405.5 6.0 23.0 1,252.0 281.6 4,555.1 Inpatient Nursing 139.1 5,164.6 836.1 275.6 225.2 122.1 64.5 6,827.2 Operating Room 11.2 741.3 107.6 75.0 493.9 63.6 28.5 1,521.1 Ambulatory Care 61.7 895.7 139.1 187.3 144.4 62.1 54.9 1,545.3 Emergency 43.4 565.2 89.1 42.5 46.8 24.4 8.4 819.7 Diagnostic and Therapeutic 477.1 2,545.7 391.7 229.4 147.7 543.6 160.3 4,495.6 Community Services 0.9 52.6 6.2 0.0 0.0 29.6 5.4 94.8 Research and Education 73.6 347.1 39.7 0.5 0.5 145.0 28.5 634.8 All Other 30.9 202.4 157.0 58.7 9.4 149.3 163.4 771.0 Total 893.9 13,976.5 2,316.0 875.6 1,091.7 2,521.8 1,184.8 22,860.2 (annual percentage change) Administration -8.5 16.3-12.7-0.3 273.5-6.3 9.3 8.3 Support 9.0 2.9-1.5 10.4 6.9 5.8 14.8 4.0 Inpatient Nursing 17.7 6.6 1.6 13.1 14.2-14.9 19.5 6.3 Operating Room 2.3 12.0 3.3 21.9 10.6 17.5 42.8 11.9 Ambulatory Care 8.8 14.6 11.8 16.8 23.3-10.5 26.4 14.2 Emergency 7.1 12.5 10.9 30.8 13.8-31.7 48.7 11.0 Diagnostic and Therapeutic 2.2 5.5 0.8 1.6 20.5-0.2 10.6 4.4 Community Services 52.0 --- --- 566.6-35.0 --- -97.4-54.8 Research and Education -0.6 9.5 0.8-79.4 24.5 15.2-14.1 7.2 85.8-37.1-7.6 10.0 61.8 1.3 71.9-3.8 Total 6.9 6.6 0.4 11.5 14.6 3.2-1.7 5.7 (percentage distribution of Type of Expense by Functional Centre) Administration 3.1 55.2 9.0 0.0 0.0 8.1 24.4 100.0 Support 0.1 56.7 8.9 0.1 0.5 27.5 6.2 100.0 Inpatient Nursing 2.0 75.6 12.2 4.0 3.3 1.8 0.9 100.0 Operating Room 0.7 48.7 7.1 4.9 32.5 4.2 1.9 100.0 Ambulatory Care 4.0 58.0 9.0 12.1 9.3 4.0 3.6 100.0 Emergency 5.3 69.0 10.9 5.2 5.7 3.0 1.0 100.0 Diagnostic and Therapeutic 10.6 56.6 8.7 5.1 3.3 12.1 3.6 100.0 Community Services 0.9 55.5 6.6 0.1 0.0 31.2 5.7 100.0 Research and Education 11.6 54.7 6.3 0.1 0.1 22.8 4.5 100.0 All Other 4.0 26.2 20.4 7.6 1.2 19.4 21.2 100.0 Total 3.9 61.1 10.1 3.8 4.8 11.0 5.2 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 5.6 6.3 6.2 0.1 0.1 5.2 32.9 7.0 Support 0.7 18.5 17.5 0.7 2.1 49.6 23.8 19.9 Inpatient Nursing 15.6 37.0 36.1 31.5 20.6 4.8 5.4 29.9 Operating Room 1.3 5.3 4.6 8.6 45.2 2.5 2.4 6.7 Ambulatory Care 6.9 6.4 6.0 21.4 13.2 2.5 4.6 6.8 Emergency 4.8 4.0 3.8 4.9 4.3 1.0 0.7 3.6 Diagnostic and Therapeutic 53.4 18.2 16.9 26.2 13.5 21.6 13.5 19.7 Community Services 0.1 0.4 0.3 0.0 0.0 1.2 0.5 0.4 Research and Education 8.2 2.5 1.7 0.1 0.0 5.7 2.4 2.8 All Other 3.5 1.4 6.8 6.7 0.9 5.9 13.8 3.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 3.9 0.6 0.0 0.0 0.6 1.7 7.0 Support 0.0 11.3 1.8 0.0 0.1 5.5 1.2 19.9 Inpatient Nursing 0.6 22.6 3.7 1.2 1.0 0.5 0.3 29.9 Operating Room 0.0 3.2 0.5 0.3 2.2 0.3 0.1 6.7 Ambulatory Care 0.3 3.9 0.6 0.8 0.6 0.3 0.2 6.8 Emergency 0.2 2.5 0.4 0.2 0.2 0.1 0.0 3.6 Diagnostic and Therapeutic 2.1 11.1 1.7 1.0 0.6 2.4 0.7 19.7 Community Services 0.0 0.2 0.0 0.0 0.0 0.1 0.0 0.4 Research and Education 0.3 1.5 0.2 0.0 0.0 0.6 0.1 2.8 All Other 0.1 0.9 0.7 0.3 0.0 0.7 0.7 3.4 Total 3.9 61.1 10.1 3.8 4.8 11.0 5.2 100.0 CIHI 2005. 80

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, 1998 1999 Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Drugs Supplies ($ 000,000) Administration 58.0 927.0 180.8 0.4 0.4 160.8 413.1 1,740.5 Support 4.0 2,400.6 410.7 6.8 23.6 1,310.0 314.5 4,470.2 Inpatient Nursing 169.9 5,618.1 935.7 302.7 244.6 345.8 88.9 7,705.8 Operating Room 14.4 750.1 112.2 71.3 553.0 74.4 26.2 1,601.7 Ambulatory Care 81.9 962.7 157.2 185.9 167.3 82.3 62.0 1,699.2 Emergency 52.3 600.7 96.1 48.1 51.2 22.4 7.5 878.5 Diagnostic and Therapeutic 511.1 2,608.5 414.1 245.3 171.0 620.3 175.2 4,745.5 Community Services 46.0 190.5 34.4 44.1 16.8 226.5 49.9 608.2 Research and Education 60.4 371.9 41.8 0.4 0.5 189.4 34.7 699.1 All Other 11.8 411.3 161.7 69.8 11.1 347.3 183.2 1,196.1 Total 1,009.9 14,841.5 2,544.7 974.8 1,239.6 3,379.2 1,355.2 25,344.8 (annual percentage change) Other Supplies Administration 15.7 5.2 25.6-44.5-43.0 23.6 6.1 9.1 Support -32.6-7.0 1.3 13.5 2.6 4.6 11.7-1.9 Inpatient Nursing 22.1 8.8 11.9 9.9 8.6 183.2 37.8 12.9 Operating Room 28.3 1.2 4.3-4.8 12.0 17.0-8.1 5.3 Ambulatory Care 32.8 7.5 13.0-0.8 15.8 32.4 12.9 10.0 Emergency 20.7 6.3 7.9 13.2 9.4-7.8-10.3 7.2 Diagnostic and Therapeutic 7.1 2.5 5.7 6.9 15.7 14.1 9.3 5.6 Community Services --- 262.3 451.8 --- --- 665.4 819.1 541.6 Research and Education -17.9 7.1 5.3-3.1 2.0 30.7 21.7 10.1 All Other -61.9 103.2 3.0 19.0 18.5 132.5 12.1 55.1 Total 13.0 6.2 9.9 11.3 13.5 34.0 14.4 10.9 (percentage distribution of Type of Expense by Functional Centre) Administration 3.3 53.3 10.4 0.0 0.0 9.2 23.7 100.0 Support 0.1 53.7 9.2 0.2 0.5 29.3 7.0 100.0 Inpatient Nursing 2.2 72.9 12.1 3.9 3.2 4.5 1.2 100.0 Operating Room 0.9 46.8 7.0 4.5 34.5 4.6 1.6 100.0 Ambulatory Care 4.8 56.7 9.3 10.9 9.8 4.8 3.6 100.0 Emergency 6.0 68.4 10.9 5.5 5.8 2.6 0.9 100.0 Diagnostic and Therapeutic 10.8 55.0 8.7 5.2 3.6 13.1 3.7 100.0 Community Services 7.6 31.3 5.7 7.2 2.8 37.2 8.2 100.0 Research and Education 8.6 53.2 6.0 0.1 0.1 27.1 5.0 100.0 All Other 1.0 34.4 13.5 5.8 0.9 29.0 15.3 100.0 Total 4.0 58.6 10.0 3.8 4.9 13.3 5.3 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 5.7 6.2 7.1 0.0 0.0 4.8 30.5 6.9 Support 0.4 16.2 16.1 0.7 1.9 38.8 23.2 17.6 Inpatient Nursing 16.8 37.9 36.8 31.1 19.7 10.2 6.6 30.4 Operating Room 1.4 5.1 4.4 7.3 44.6 2.2 1.9 6.3 Ambulatory Care 8.1 6.5 6.2 19.1 13.5 2.4 4.6 6.7 Emergency 5.2 4.0 3.8 4.9 4.1 0.7 0.6 3.5 Diagnostic and Therapeutic 50.6 17.6 16.3 25.2 13.8 18.4 12.9 18.7 Community Services 4.6 1.3 1.4 4.5 1.4 6.7 3.7 2.4 Research and Education 6.0 2.5 1.6 0.0 0.0 5.6 2.6 2.8 All Other 1.2 2.8 6.4 7.2 0.9 10.3 13.5 4.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 3.7 0.7 0.0 0.0 0.6 1.6 6.9 Support 0.0 9.5 1.6 0.0 0.1 5.2 1.2 17.6 Inpatient Nursing 0.7 22.2 3.7 1.2 1.0 1.4 0.4 30.4 Operating Room 0.1 3.0 0.4 0.3 2.2 0.3 0.1 6.3 Ambulatory Care 0.3 3.8 0.6 0.7 0.7 0.3 0.2 6.7 Emergency 0.2 2.4 0.4 0.2 0.2 0.1 0.0 3.5 Diagnostic and Therapeutic 2.0 10.3 1.6 1.0 0.7 2.4 0.7 18.7 Community Services 0.2 0.8 0.1 0.2 0.1 0.9 0.2 2.4 Research and Education 0.2 1.5 0.2 0.0 0.0 0.7 0.1 2.8 All Other 0.0 1.6 0.6 0.3 0.0 1.4 0.7 4.7 Total 4.0 58.6 10.0 3.8 4.9 13.3 5.3 100.0 Sundries Total CIHI 2005. 81

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, 1999 2000 Current Dollars Type of Expense Functional Centre Physician Compensation Salaries Benefits Drugs Medical Supplies Other Supplies Sundries Total ($ 000,000) Administration 58.2 1,200.9 187.2 1.6 1.5 261.6 471.5 2,182.5 Support 2.9 2,349.9 408.1 7.0 31.1 1,306.5 305.8 4,411.3 Inpatient Nursing 166.3 5,820.2 999.5 347.5 305.4 159.9 185.0 7,983.8 Operating Room 9.2 629.9 98.5 75.5 620.0 50.6 42.6 1,526.3 Ambulatory Care 68.7 976.8 156.8 174.8 175.3 86.2 63.6 1,702.2 Emergency 64.7 769.2 119.8 58.0 57.6 38.7 12.6 1,120.6 Diagnostic and Therapeutic 526.1 2,760.4 452.4 275.1 199.9 658.2 194.2 5,066.3 Community Services 10.4 175.6 48.3 86.9 26.4 44.8 19.3 411.8 Research and Education 32.4 353.4 40.6 0.2 0.3 147.4 47.4 621.6 All Other 9.0 285.9 123.2 88.7 5.1 153.7 387.7 1,053.3 Total 947.8 15,322.2 2,634.4 1,115.2 1,422.7 2,907.7 1,729.8 26,079.7 (annual percentage change) Administration 0.3 29.5 3.6 350.7 264.3 62.7 14.1 25.4 Support -27.4-2.1-0.6 3.4 31.5-0.3-2.7-1.3 Inpatient Nursing -2.1 3.6 6.8 14.8 24.8-53.8 108.1 3.6 Operating Room -36.5-16.0-12.2 5.8 12.1-31.9 62.7-4.7 Ambulatory Care -16.2 1.5-0.3-5.9 4.8 4.8 2.6 0.2 Emergency 23.7 28.0 24.6 20.5 12.4 72.5 67.5 27.6 Diagnostic and Therapeutic 2.9 5.8 9.3 12.1 16.9 6.1 10.8 6.8 Community Services -77.4-7.8 40.2 97.1 57.7-80.2-61.3-32.3 Research and Education -46.5-5.0-2.9-56.3-39.9-22.2 36.8-11.1 All Other -23.6-30.5-23.8 27.1-54.2-55.7 111.6-11.9 Total -6.2 3.2 3.5 14.4 14.8-14.0 27.6 2.9 (percentage distribution of Type of Expense by Functional Centre) Administration 2.7 55.0 8.6 0.1 0.1 12.0 21.6 100.0 Support 0.1 53.3 9.3 0.2 0.7 29.6 6.9 100.0 Inpatient Nursing 2.1 72.9 12.5 4.4 3.8 2.0 2.3 100.0 Operating Room 0.6 41.3 6.5 4.9 40.6 3.3 2.8 100.0 Ambulatory Care 4.0 57.4 9.2 10.3 10.3 5.1 3.7 100.0 Emergency 5.8 68.6 10.7 5.2 5.1 3.5 1.1 100.0 Diagnostic and Therapeutic 10.4 54.5 8.9 5.4 3.9 13.0 3.8 100.0 Community Services 2.5 42.7 11.7 21.1 6.4 10.9 4.7 100.0 Research and Education 5.2 56.8 6.5 0.0 0.0 23.7 7.6 100.0 All Other 0.9 27.1 11.7 8.4 0.5 14.6 36.8 100.0 Total 3.6 58.8 10.1 4.3 5.5 11.1 6.6 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 6.1 7.8 7.1 0.1 0.1 9.0 27.3 8.4 Support 0.3 15.3 15.5 0.6 2.2 44.9 17.7 16.9 Inpatient Nursing 17.5 38.0 37.9 31.2 21.5 5.5 10.7 30.6 Operating Room 1.0 4.1 3.7 6.8 43.6 1.7 2.5 5.9 Ambulatory Care 7.2 6.4 6.0 15.7 12.3 3.0 3.7 6.5 Emergency 6.8 5.0 4.5 5.2 4.0 1.3 0.7 4.3 Diagnostic and Therapeutic 55.5 18.0 17.2 24.7 14.1 22.6 11.2 19.4 Community Services 1.1 1.1 1.8 7.8 1.9 1.5 1.1 1.6 Research and Education 3.4 2.3 1.5 0.0 0.0 5.1 2.7 2.4 All Other 0.9 1.9 4.7 8.0 0.4 5.3 22.4 4.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.2 4.6 0.7 0.0 0.0 1.0 1.8 8.4 Support 0.0 9.0 1.6 0.0 0.1 5.0 1.2 16.9 Inpatient Nursing 0.6 22.3 3.8 1.3 1.2 0.6 0.7 30.6 Operating Room 0.0 2.4 0.4 0.3 2.4 0.2 0.2 5.9 Ambulatory Care 0.3 3.7 0.6 0.7 0.7 0.3 0.2 6.5 Emergency 0.2 2.9 0.5 0.2 0.2 0.1 0.0 4.3 Diagnostic and Therapeutic 2.0 10.6 1.7 1.1 0.8 2.5 0.7 19.4 Community Services 0.0 0.7 0.2 0.3 0.1 0.2 0.1 1.6 Research and Education 0.1 1.4 0.2 0.0 0.0 0.6 0.2 2.4 All Other 0.0 1.1 0.5 0.3 0.0 0.6 1.5 4.0 Total 3.6 58.8 10.1 4.3 5.5 11.1 6.6 100.0 CIHI 2005. 82

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, 2000 2001 Current Dollars Physician Compensation Salaries Benefits Type of Expense ($ 000,000) Table 2.25 Administration 81.5 1,267.1 180.0 0.4 1.2 297.1 489.5 2,316.8 Support 3.1 2,509.8 415.8 6.9 27.9 1,456.3 347.8 4,767.5 Inpatient Nursing 203.7 6,319.1 1,024.2 364.1 302.5 158.5 158.4 8,530.4 Operating Room 12.5 674.2 101.5 76.9 671.5 53.6 44.3 1,634.5 Ambulatory Care 100.4 1,104.4 170.8 199.9 203.7 61.4 74.5 1,915.1 Emergency 134.3 857.8 125.9 65.0 62.3 26.6 14.1 1,286.0 Diagnostic and Therapeutic 573.5 2,997.6 467.6 274.4 231.9 809.9 218.8 5,573.7 Community Services 15.3 226.1 45.3 107.9 25.9 56.8 27.7 505.1 Research and Education 50.5 391.0 43.8 0.1 0.2 155.6 59.0 700.2 All Other 16.4 249.3 152.4 109.1 6.3 158.1 184.8 876.4 Total 1,191.2 16,596.3 2,727.3 1,204.8 1,533.2 3,233.9 1,619.0 28,105.7 (annual percentage change) Administration 40.1 5.5-3.8-72.8-22.8 13.6 3.8 6.2 Support 6.2 6.8 1.9-0.6-10.4 11.5 13.7 8.1 Inpatient Nursing 22.5 8.6 2.5 4.8-1.0-0.9-14.4 6.8 Operating Room 35.9 7.0 3.0 1.9 8.3 5.8 4.1 7.1 Ambulatory Care 46.2 13.1 9.0 14.3 16.2-28.8 17.1 12.5 Emergency 107.5 11.5 5.1 12.1 8.2-31.2 11.8 14.8 Diagnostic and Therapeutic 9.0 8.6 3.4-0.2 16.0 23.0 12.7 10.0 Community Services 47.5 28.7-6.3 24.2-1.9 26.7 43.6 22.7 Research and Education 56.1 10.6 7.8-68.6-31.2 5.6 24.5 12.6 All Other 82.7-12.8 23.7 23.0 22.8 2.9-52.3-16.8 Total 25.7 8.3 3.5 8.0 7.8 11.2-6.4 7.8 (percentage distribution of Type of Expense by Functional Centre) Administration 3.5 54.7 7.8 0.0 0.1 12.8 21.1 100.0 Support 0.1 52.6 8.7 0.1 0.6 30.5 7.3 100.0 Inpatient Nursing 2.4 74.1 12.0 4.3 3.5 1.9 1.9 100.0 Operating Room 0.8 41.2 6.2 4.7 41.1 3.3 2.7 100.0 Ambulatory Care 5.2 57.7 8.9 10.4 10.6 3.2 3.9 100.0 Emergency 10.4 66.7 9.8 5.1 4.8 2.1 1.1 100.0 Diagnostic and Therapeutic 10.3 53.8 8.4 4.9 4.2 14.5 3.9 100.0 Community Services 3.0 44.8 9.0 21.4 5.1 11.2 5.5 100.0 Research and Education 7.2 55.8 6.3 0.0 0.0 22.2 8.4 100.0 All Other 1.9 28.4 17.4 12.5 0.7 18.0 21.1 100.0 Total 4.2 59.0 9.7 4.3 5.5 11.5 5.8 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 6.8 7.6 6.6 0.0 0.1 9.2 30.2 8.2 Support 0.3 15.1 15.2 0.6 1.8 45.0 21.5 17.0 Inpatient Nursing 17.1 38.1 37.6 30.2 19.7 4.9 9.8 30.4 Operating Room 1.0 4.1 3.7 6.4 43.8 1.7 2.7 5.8 Ambulatory Care 8.4 6.7 6.3 16.6 13.3 1.9 4.6 6.8 Emergency 11.3 5.2 4.6 5.4 4.1 0.8 0.9 4.6 Diagnostic and Therapeutic 48.1 18.1 17.1 22.8 15.1 25.0 13.5 19.8 Community Services 1.3 1.4 1.7 9.0 1.7 1.8 1.7 1.8 Research and Education 4.2 2.4 1.6 0.0 0.0 4.8 3.6 2.5 All Other 1.4 1.5 5.6 9.1 0.4 4.9 11.4 3.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 4.5 0.6 0.0 0.0 1.1 1.7 8.2 Support 0.0 8.9 1.5 0.0 0.1 5.2 1.2 17.0 Inpatient Nursing 0.7 22.5 3.6 1.3 1.1 0.6 0.6 30.4 Operating Room 0.0 2.4 0.4 0.3 2.4 0.2 0.2 5.8 Ambulatory Care 0.4 3.9 0.6 0.7 0.7 0.2 0.3 6.8 Emergency 0.5 3.1 0.4 0.2 0.2 0.1 0.1 4.6 Diagnostic and Therapeutic 2.0 10.7 1.7 1.0 0.8 2.9 0.8 19.8 Community Services 0.1 0.8 0.2 0.4 0.1 0.2 0.1 1.8 Research and Education 0.2 1.4 0.2 0.0 0.0 0.6 0.2 2.5 All Other 0.1 0.9 0.5 0.4 0.0 0.6 0.7 3.1 Total 4.2 59.0 9.7 4.3 5.5 11.5 5.8 100.0 Drugs Medical Supplies Other Supplies Sundries Total CIHI 2005. 83

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, 2001 2002 Current Dollars Physician Compensation Salaries Benefits Type of Expense Drugs Medical Supplies Other Supplies Sundries Total ($ 000,000) Administration 79.6 1,376.0 198.2 0.9 0.5 281.0 518.6 2,454.8 Support 3.6 2,737.0 455.9 6.2 28.2 1,583.4 359.7 5,174.0 Inpatient Nursing 333.9 6,792.9 1,104.9 389.8 298.2 176.4 116.8 9,212.9 Operating Room 19.8 726.5 113.4 84.9 741.1 63.1 53.9 1,802.7 Ambulatory Care 201.1 1,244.1 202.5 252.7 245.1 86.2 71.1 2,302.9 Emergency 176.3 962.8 140.0 75.1 68.1 32.3 16.9 1,471.6 Diagnostic and Therapeutic 647.2 3,278.5 512.4 292.4 255.9 890.5 237.8 6,114.8 Community Services 17.0 257.8 40.1 95.8 10.6 127.2 28.1 576.7 Research and Education 55.8 421.7 49.1 0.3 0.3 174.9 56.3 758.3 All Other 16.2 293.9 130.5 139.1 6.4 199.9 168.1 954.2 Total 1,550.6 18,091.2 2,947.2 1,337.2 1,654.5 3,614.9 1,627.3 30,822.9 (annual percentage change) Administration -2.3 8.6 10.1 100.4-59.2-5.4 5.9 6.0 Support 18.0 9.1 9.7-10.7 1.2 8.7 3.4 8.5 Inpatient Nursing 63.9 7.5 7.9 7.1-1.4 11.3-26.3 8.0 Operating Room 58.8 7.7 11.7 10.5 10.4 17.7 21.6 10.3 Ambulatory Care 100.3 12.6 18.6 26.4 20.4 40.4-4.5 20.3 Emergency 31.3 12.3 11.2 15.6 9.4 21.2 19.2 14.4 Diagnostic and Therapeutic 12.8 9.4 9.6 6.6 10.4 9.9 8.7 9.7 Community Services 10.9 14.0-11.3-11.2-58.9 124.1 1.5 14.2 Research and Education 10.5 7.9 12.1 307.4 21.5 12.4-4.7 8.3 All Other -1.3 17.9-14.4 27.4 2.9 26.5-9.0 8.9 Total 30.2 9.0 8.1 11.0 7.9 11.8 0.5 9.7 (percentage distribution of Type of Expense by Functional Centre) Administration 3.2 56.1 8.1 0.0 0.0 11.4 21.1 100.0 Support 0.1 52.9 8.8 0.1 0.5 30.6 7.0 100.0 Inpatient Nursing 3.6 73.7 12.0 4.2 3.2 1.9 1.3 100.0 Operating Room 1.1 40.3 6.3 4.7 41.1 3.5 3.0 100.0 Ambulatory Care 8.7 54.0 8.8 11.0 10.6 3.7 3.1 100.0 Emergency 12.0 65.4 9.5 5.1 4.6 2.2 1.1 100.0 Diagnostic and Therapeutic 10.6 53.6 8.4 4.8 4.2 14.6 3.9 100.0 Community Services 3.0 44.7 7.0 16.6 1.8 22.1 4.9 100.0 Research and Education 7.4 55.6 6.5 0.0 0.0 23.1 7.4 100.0 All Other 1.7 30.8 13.7 14.6 0.7 21.0 17.6 100.0 Total 5.0 58.7 9.6 4.3 5.4 11.7 5.3 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 5.1 7.6 6.7 0.1 0.0 7.8 31.9 8.0 Support 0.2 15.1 15.5 0.5 1.7 43.8 22.1 16.8 Inpatient Nursing 21.5 37.5 37.5 29.2 18.0 4.9 7.2 29.9 Operating Room 1.3 4.0 3.8 6.4 44.8 1.7 3.3 5.8 Ambulatory Care 13.0 6.9 6.9 18.9 14.8 2.4 4.4 7.5 Emergency 11.4 5.3 4.8 5.6 4.1 0.9 1.0 4.8 Diagnostic and Therapeutic 41.7 18.1 17.4 21.9 15.5 24.6 14.6 19.8 Community Services 1.1 1.4 1.4 7.2 0.6 3.5 1.7 1.9 Research and Education 3.6 2.3 1.7 0.0 0.0 4.8 3.5 2.5 All Other 1.0 1.6 4.4 10.4 0.4 5.5 10.3 3.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 4.5 0.6 0.0 0.0 0.9 1.7 8.0 Support 0.0 8.9 1.5 0.0 0.1 5.1 1.2 16.8 Inpatient Nursing 1.1 22.0 3.6 1.3 1.0 0.6 0.4 29.9 Operating Room 0.1 2.4 0.4 0.3 2.4 0.2 0.2 5.8 Ambulatory Care 0.7 4.0 0.7 0.8 0.8 0.3 0.2 7.5 Emergency 0.6 3.1 0.5 0.2 0.2 0.1 0.1 4.8 Diagnostic and Therapeutic 2.1 10.6 1.7 0.9 0.8 2.9 0.8 19.8 Community Services 0.1 0.8 0.1 0.3 0.0 0.4 0.1 1.9 Research and Education 0.2 1.4 0.2 0.0 0.0 0.6 0.2 2.5 All Other 0.1 1.0 0.4 0.5 0.0 0.6 0.5 3.1 Total 5.0 58.7 9.6 4.3 5.4 11.7 5.3 100.0 CIHI 2005. 84

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, 2002 2003 Current Dollars Physician Compensation Salaries Benefits Type of Expense Medical Drugs Supplies ($ 000,000) Other Supplies Administration 101.8 1,388.4 267.8 0.5 0.6 277.3 561.9 2,598.4 Support 6.4 2,850.7 510.0 7.6 30.3 1,631.6 404.1 5,440.7 Inpatient Nursing 473.9 7,161.7 1,235.1 430.0 315.9 196.1 125.5 9,938.2 Operating Room 34.9 764.2 126.1 87.7 812.9 65.5 48.2 1,939.5 Ambulatory Care 214.5 1,352.8 235.2 275.1 273.7 76.8 76.1 2,504.3 Emergency 205.4 1,034.0 159.2 80.3 73.7 35.3 19.5 1,607.5 Diagnostic and Therapeutic 712.7 3,470.2 578.6 331.2 274.8 963.2 279.9 6,610.5 Community Services 25.6 298.1 51.1 113.0 10.5 132.8 42.4 673.5 Research and Education 61.7 428.2 53.5 0.1 0.7 190.5 57.2 792.1 All Other 18.7 257.8 158.1 168.6 7.3 203.4 178.4 992.4 Total 1,855.5 19,006.1 3,374.9 1,494.2 1,800.5 3,772.5 1,793.3 33,097.0 (annual percentage change) Administration 27.9 0.9 35.1-42.9 22.8-1.3 8.3 5.8 Support 76.0 4.2 11.9 22.4 7.5 3.0 12.4 5.2 Inpatient Nursing 41.9 5.4 11.8 10.3 5.9 11.2 7.4 7.9 Operating Room 76.4 5.2 11.2 3.3 9.7 3.8-10.6 7.6 Ambulatory Care 6.6 8.7 16.1 8.9 11.7-10.9 7.1 8.7 Emergency 16.5 7.4 13.7 6.9 8.2 9.2 15.8 9.2 Diagnostic and Therapeutic 10.1 5.8 12.9 13.3 7.4 8.2 17.7 8.1 Community Services 50.3 15.7 27.3 18.0-1.5 4.4 50.7 16.8 Research and Education 10.6 1.5 9.1-47.3 178.6 8.9 1.7 4.5 All Other 15.2-12.3 21.2 21.2 13.4 1.7 6.1 4.0 Total 19.7 5.1 14.5 11.7 8.8 4.4 10.2 7.4 (percentage distribution of Type of Expense by Functional Centre) Administration 3.9 53.4 10.3 0.0 0.0 10.7 21.6 100.0 Support 0.1 52.4 9.4 0.1 0.6 30.0 7.4 100.0 Inpatient Nursing 4.8 72.1 12.4 4.3 3.2 2.0 1.3 100.0 Operating Room 1.8 39.4 6.5 4.5 41.9 3.4 2.5 100.0 Ambulatory Care 8.6 54.0 9.4 11.0 10.9 3.1 3.0 100.0 Emergency 12.8 64.3 9.9 5.0 4.6 2.2 1.2 100.0 Diagnostic and Therapeutic 10.8 52.5 8.8 5.0 4.2 14.6 4.2 100.0 Community Services 3.8 44.3 7.6 16.8 1.6 19.7 6.3 100.0 Research and Education 7.8 54.1 6.8 0.0 0.1 24.0 7.2 100.0 All Other 1.9 26.0 15.9 17.0 0.7 20.5 18.0 100.0 Total 5.6 57.4 10.2 4.5 5.4 11.4 5.4 100.0 (percentage distribution of Functional Centre by Type of Expense) Administration 5.5 7.3 7.9 0.0 0.0 7.4 31.3 7.9 Support 0.3 15.0 15.1 0.5 1.7 43.2 22.5 16.4 Inpatient Nursing 25.5 37.7 36.6 28.8 17.5 5.2 7.0 30.0 Operating Room 1.9 4.0 3.7 5.9 45.2 1.7 2.7 5.9 Ambulatory Care 11.6 7.1 7.0 18.4 15.2 2.0 4.2 7.6 Emergency 11.1 5.4 4.7 5.4 4.1 0.9 1.1 4.9 Diagnostic and Therapeutic 38.4 18.3 17.1 22.2 15.3 25.5 15.6 20.0 Community Services 1.4 1.6 1.5 7.6 0.6 3.5 2.4 2.0 Research and Education 3.3 2.3 1.6 0.0 0.0 5.0 3.2 2.4 All Other 1.0 1.4 4.7 11.3 0.4 5.4 9.9 3.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 (percentage distribution of Total) Administration 0.3 4.2 0.8 0.0 0.0 0.8 1.7 7.9 Support 0.0 8.6 1.5 0.0 0.1 4.9 1.2 16.4 Inpatient Nursing 1.4 21.6 3.7 1.3 1.0 0.6 0.4 30.0 Operating Room 0.1 2.3 0.4 0.3 2.5 0.2 0.1 5.9 Ambulatory Care 0.6 4.1 0.7 0.8 0.8 0.2 0.2 7.6 Emergency 0.6 3.1 0.5 0.2 0.2 0.1 0.1 4.9 Diagnostic and Therapeutic 2.2 10.5 1.7 1.0 0.8 2.9 0.8 20.0 Community Services 0.1 0.9 0.2 0.3 0.0 0.4 0.1 2.0 Research and Education 0.2 1.3 0.2 0.0 0.0 0.6 0.2 2.4 All Other 0.1 0.8 0.5 0.5 0.0 0.6 0.5 3.0 Total 5.6 57.4 10.2 4.5 5.4 11.4 5.4 100.0 Sundries Total CIHI 2005. 85

Appendix A Statistical Variables and Data Matching

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 1976 1977 to 1994 1995 and extracted from the CMDB for 1995 1996 onward. Financial data from 1976 1977 to 2001 2002 included in the Data Tables were originally published in National Health Expenditure Trends, 1975 to 2004 and extracted in the Fall of 2004. Financial data for 2002 2003 and statistical data from 1995 1996 to 2002 2003 were extracted at the end of January 2005 before the CMDB had completely closed data collection for 2002. Consequently, data for 2002 2003 may differ slightly from what are used in the CMDB Annual Report, Canadian MIS Database (CMDB), Hospital Financial Performance Indicators, 1999 2000 to 2002 2003. 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

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 2002 2003 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

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 115 116 310 and 350 401 403 S410 411 416 and 418 and 450 458 and 459 Administrative Services P110201 P111083 Support Services P110191 P111243 Less P111083 P111113 Operating Room P109151 Nursing Inpatient Services P109191 Less P109151 P102176 P102177 P102147 P102157 P102196 P102197 P102206 P102207 Emergency P110011 P108375 Less P108345 Specialty Day and Night Care P110031 P110041 P108335 P108385 Specialty Clinics P110021 P108241 P108242 Laboratory P104135 P110051 Diagnostic and Therapeutic P106185 P107015 P107045 P110221 Less P110011 P110021 P110031 P110041 P110051 P110171 P110191 P110201 P106131 P106132 P106154 P107095 Community Services P110171 Research and Education P111071 P111113 A 3

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 P102147 Patient days, adults and children P102157 Patient days, newborns P102176 Admissions, adults and children P102177 Admissions, newborns P102196 Discharges, adults and children P102197 Discharges, newborns P102206 Deaths, adults and children P102207 Deaths, newborns P104135 Total units for laboratory P106131 Examinations, procedures and units, 1982 1983 to 1994 1995 P106132 Examinations, procedures and units for outpatients, 1982 1983 to 1994 1995 P106154 Examinations for both inpatients and outpatients for inpatients, 1976 1977 to 1981 1982 P106185 Units for diagnostic radiology P107015 Time units for physiotherapy services P107045 Time units for occupational therapy P107095 Treatments and diagnostic procedures (under respiratory technology) P108241 Number of visits, ambulatory care units, outpatients P108242 Number of visits, ambulatory care units, inpatients P108335 Number of visits, day and night care programs, outpatients P108345 Number of visits, surgical day care in Emergency unit P108375 Number of visits, emergency unit P108385 Number of visits, all surgical day care program units P109151 Paid hours, surgical suite P109191 Paid hours, nursing inpatient services excluding emergency P110011 Paid hours, emergency P110021 Paid hours, general and special clinics P110031 Total paid hours, surgical day care P110041 Total paid hours, all other ambulatory care P110051 Paid hours, laboratory P110171 Paid hours, hospital-based home care P110191 Paid hours, ambulance (excluding motor transportation) P110201 Paid hours, chief of medical staff and heads of services P110221 Total accumulated paid hours, diagnostic and therapeutic, emergency and chief of medical staff and heads of services P111083 Paid hours, hospital administration P111113 Paid hours, staff education program P111243 Total paid hours, administrative and support services P102145 Approved beds P102155 Approved newborn bassinets P102146 Beds staffed and in operation P102156 Newborn bassinets staffed and in operation A 4

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