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Have Health Card Will Travel Kira Leeb Director, Health System - - PowerPoint PPT Presentation
Have Health Card Will Travel Kira Leeb Director, Health System - - PowerPoint PPT Presentation
Have Health Card Will Travel Kira Leeb Director, Health System Analysis Canadian Institute for Health Information (CIHI) June 2010 Outline > Background > Methodology > Results Pan-Canadian Regions in focus >
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Background
Why we did this work?
– Some provinces/territories were monitoring outflow but perhaps not inflow – Stories in the news about mothers in rural and remote north travelling to deliver their babies – Interest in costly procedures and payment variations (outside scope of this report)
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Background
> Canada Health Act contains a portability criterion that ensures Canadian residents receive insured health care services when temporarily absent from their province/territory or when moving to another province/territory > The analysis profiles patients who had an inpatient hospitalization at an acute care hospital in a province/territory outside of the province/territory that issued their health card
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Methods
Quebec
CIHI’s Hospitalization database (DAD)
- 2007/08 data
- Discharge Abstract
Database
- Med-Echo (Quebec)
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Result Highlights
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> The territories relied more on OP/T hospitalizations than other jurisdictions
– Nunavut—58% – Yukon—21% – Northwest Territories—18%
Inflow and Outflow as a Percent of Hospitalizations Within Jurisdictions
N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. N.W.T. Nun. Y.T. Inflow (%) 2 2 5 4 2 1 4 4 4 1 14 1 6 Outflow (%) 3 10 2 4 4 1 2 3 2 2 18 58 21
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Portability in Action
> Reasons Canadians access inpatient care outside
- f their home province or territory can include
– Urgent care needs while travelling – Services not being available locally – Patient choice, particularly for those who live close to provincial borders
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10th Percentile 25th Percentile Median 75th Percentile 90th Percentile 11 km 65 km 299 km 1,021 km 2,260 km
Note: Excluding Quebec Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.
How Far Are They From Home?
> Where you live mattered
– Provinces with hospitals close to provincial borders treated patients from neighbouring province/territory
Distance OP/T Patients Travelled From Home
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Distance from home varied by reason of hospitalization
Reason For Hospitalization 10th Percentile (km) Median Distance Travelled (km) 90th Percentile (km) Pregnant and Newborn 7 78 1,470 ICU Stay 11 306 2,090 Elective Procedures (non-urgent cases) 11 223 1,604 Elective Procedures (urgent cases) 12 440 2,731 Specialized Cardiac Procedures 30 300 1,891 Transplant Procedures 92 532 1,666
Note Excluding Quebec. Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.
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Note Based on major clinical categories (MCCs) as reported in the DAD for hospitalizations in Canada, excluding Quebec. Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.
Reasons for Hospitalization
> 63% of OP/T hospitalizations were urgent admissions > Both elective and urgent admissions are driven by
– Service availability – Access – Patient choice
> Specific clinical groupings drove OP/T volumes
– 23% birth-related hospitalizations – 12% diseases and disorders
- f the circulatory system
– 10% diseases and disorders
- f the digestive system
Hospitalizations Across Major Clinical Categories
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Mothers and Newborns
> Maternal and newborn stays accounted for approx. 23% of OP/T hospitalizations > 64% of mothers were pre-registered and expected at the hospital > 36% of mothers had unplanned or urgent admissions
Note Based on major clinical categories (MCCs) as reported in the DAD for hospitalizations in Canada, excluding Quebec. Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.
Hospitalizations Across Major Clinical Categories
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Stays in Intensive Care Units
> One in seven (14%) OP/T hospitalizations in 2007– 2008 included an ICU stay > ICU admissions were urgent (72%) rather than elective
– 40% were related to the circulatory system – 16% of ICU stays were for newborns and neonates
> ICU stays are expensive stays
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Province/Territory OP/T Hospitalizations With an ICU Stay Percent of All OP/T ICU Stays in Canada Number Percent N.L. 97 11 1 P.E.I. 46 14 <1 N.S. 765 19 11 N.B. 624 17 9 Que. 583 20 8 Ont. 1,561 15 22 Man. 507 11 7 Sask. 443 9 6 Alta. 1,835 14 26 B.C. 524 10 7 Y.T. 17 9 <1 N.W.T. 37 5 1 Nun. Canada 7,039 14 100
Out-of-Province/Territory Stays in Intensive Care Units
Sources Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information; Fichier des hospitalisations Med-Écho, 2007–2008, ministère de la Santé et des Services sociaux du Québec.
Stays in Intensive Care Units (cont’d)
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Expensive Procedures
Province/Territory OP/T Hospitalizations With Expensive Procedures Percent of All OP/T Expensive Procedures in Canada Number Percent N.L. 31 4 1 P.E.I. 7 2 <1 N.S. 596 15 18 N.B. 109 3 3 Que. 498 17 15 Ont. 703 7 21 Man. 205 4 6 Sask. 63 1 2 Alta. 878 7 27 B.C. 181 3 6 Canada 3,272 6 100
Out-of-Province/Territory Hospitalizations With Expensive Procedures
Sources Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information; Fichier des hospitalisations Med-Écho, 2007–2008, ministère de la Santé et des Services sociaux du Québec.
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Payments made by provinces/territories for their Out-of-Province/-Territory Patients
> Just under $313 million was spent by provinces and territories (excluding Quebec) involving 41,464 claims for OP/T inpatient hospital services (2007–2008) > The highest payments were made by British Columbia ($55M), followed by Ontario ($46M) and New Brunswick ($42M)
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Regions in Focus
> Provinces and Territories at a Glance
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Regions in Focus
Nova Scotia
4,084 2,183
Quebec
2,851 8,529
Ontario
10,200 7,701
Alberta
12,769 7,531
Inflow Outflow
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Region in Focus: Alberta
Outflow Contributing Provinces: Saskatchewan (46) British Columbia (34) Inflow Contributing Provinces: British Columbia (36) Saskatchewan (27)
Patient Profile Inflow Outflow Female 49 58 0–12 Months 9 14 1–19 Years 12 9 20–64 Years 61 57 65+ Years 18 20 Most Common Major Clinical Categories Circulatory Issues (12) Trauma (12) Pregnancy and Childbirth (11) Pregnancy and Childbirth (17) Newborns and Neonates (13) Digestive Issues (12)
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Region in Focus: Ontario
Outflow Contributing Provinces: Manitoba (30) Alberta (20) Quebec (17) Inflow Contributing Province: Quebec (63)
Patient Profile Inflow Outflow Female 55 50 0–12 Months 17 9 1–19 Years 11 11 20–64 Years 52 59 65+ Years 20 21 Most Common Major Clinical Categories Pregnancy and Childbirth (17) Circulatory Issues (14) Newborns and Neonates (14) Pregnancy and Childbirth (12) Trauma (12) Circulatory Issues (12)
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Region in Focus: Quebec
Outflow Contributing Provinces: Ontario (75) New Brunswick (16) Inflow Contributing Provinces: Ontario (46) New Brunswick (35)
Patient Profile Inflow Outflow Female 44 57 0–12 Months 5 19 1–19 Years 16 11 20–64 Years 58 49 65+ Years 22 21 Most Common Major Clinical Categories N/A Pregnancy and Childbirth (18) Newborns and Neonates (17) Circulatory Issues (12)
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Region in Focus: Nova Scotia
Inflow Contributing Provinces: New Brunswick (43) Prince Edward Island (29) Outflow Contributing Provinces: New Brunswick (51) Ontario (17) Alberta (16)
Patient Profile Inflow Outflow Female 49 49 0–12 Months 11 7 1–19 Years 20 9 20–64 Years 49 54 65+ Years 20 29 Most Common Major Clinical Categories Circulatory Issues (21) Digestive Issues (8) Ear, Nose, Mouth and Throat (8) Trauma (13) Circulatory Issues (11) Digestive Issues (10)
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Conclusion
> Cost of providing care to out of province/territory patients was a large focus of the media attention we received after the release of this report. > Cost to the jurisdictions did not end up as part of this analysis – these are calculated on an annual basis by a governing committee that involves all jurisdictions and is supported by Health Canada. > Our main focus was to identify and quantify these patients across jurisdictions to provide a national picture of the portability of care.
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Questions to address…..
> Consider a cost analysis approach? > Look at trends over time
– Alberta remain the hot spot? Can we determine reasons? – Is there more to be said about travel and maternal/infant care?
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