Hospital performance is all over the map

Its long been a truism of the Canadian health care system that where you live determines the kind of care you receive Large hospitals in growing urban centres tend to have more resources and equipment than smaller rural hospitals with remote and ageing populations

But a new project tracking the performance of the most of the countrys hospitals the first ever publicly released in Canada shows just how much where you live might make a difference in how likely you are to survive a heart attack stroke or major surgery or whether youre more likely to give birth naturally or by cesarean section

The hospital reporting project released today by the Canadian Institute for Health Information compares 600 of the countrys hospitals more than half of which are small community health centres on a host of issues such as deaths in hospital after strokes and major surgery trauma from giving birth and how much of a hospitals budget goes toward its administration costs instead of patient care

For example you have a 40 per cent greater chance of dying in hospital of a heart attack or stroke in Newfoundland than in Saskatchewan or Alberta but youre more than twice as likely to die within days of a major surgery in Saskatchewan than in Prince Edward Island You stand nearly double the chances of suffering what hospitals call a nursing related adverse event such as a bedsore in Nova Scotia than in Prince Edward Island

Alberta has the lowest wait times for surgery for hip fractures with nearly 83 per cent of patients being treated within 48 hours of breaking their hips compared to 76 per cent in Saskatchewan

There are also dramatic differences among hospitals in the same province In Ontario for instance 30 out of every 100 stroke patients died in Brockville General Hospital compared to fewer than 9 of every 100 in The Scarborough Hospital in Toronto

Overall hospitals have been getting safer and patients more likely to survive major illnesses and medical procedures But there are still unexplained differences between the hospitals that are leading the country and the ones that are struggling

Were seeing that hospitals are moving in the right direction said Jeanie Lacroix manager of hospital reports at CIHI But were still seeing the variation that weve seen for many years and we need to assess why thats still happening

Among the most striking differences are the rates for cesarean sections for lowrisk pregnancies a measure that matters because cesarean are both more expensive than natural births and harder on both the mother and the child

In Manitoba 21 per cent of lowrisk births were performed by csection compared to 33 per cent in Newfoundland At the hospital level the range was even greater At Burin Peninsula Hospital in Newfoundland 47 per cent of births were by csection compared to just 245 per cent of births at Slave Lake Healthcare Centre in Alberta

The amount of money spent on both administration and patient care also varies between provinces Newfoundland had the highest costs per case of the provinces at nearly 6250 per patient or about 20 per cent higher than the Canadian average of 5167 Costs have been going up across the country up 13 per cent in 2009 and 34 per cent in 2008

The proportion of hospital budgets that gets spent on administration has gradually been dropping but was highest in Ontario where 19 billion or nearly six per cent of overall expenses went toward administration costs Thats nearly double the 35 per cent spent in Alberta

The report comes at a time when hospital executive compensation has been under intense scrutiny in Ontario as the minority Liberal government heads into its first postelection budget

Mark Rochon head of the Ontario Hospital Association questions just how much the hospital spending can be compared between provinces since Ontario has 150 separate hospital corporations each with their own CEO and executives while Alberta has a single health care administrator

The issue for us is whether were truly comparing apples to apples when we look at Alberta versus Ontario he says

Ontarios per capita health spending is 300 below the national average and well below what Alberta spends Still he says there are benefits to studying a system like Alberta with fewer hospital CEOS and more centralized administration

If there is an opportunity for us through different organizational relationships to improve the performance of the heath care system in Ontario then were for it

Ontario Health Minister Deb Matthews said the province has no plans to move toward more centralized hospital administration which has seemed to cut down on administration costs in Western provinces

I think a community voice at the table is important she says Hospital boards raise a lot of money for their hospitals They do bring a lot of value to the communities So we have no plans at all to move toward taking over all the hospitals

Ontarios high administration costs are largely a byproduct of an increasing array of hospital reporting requirements being handed down from the province that forces health care centres to hire legions of managers and executives rather than doctors and nurses says Natalie Mehra executive director of the Ontario Health Coalition an advocacy group

The administration office used to be a suite of offices in the hospital building she says Now they have whole separate buildings used for administration and hospitals will say fairly so that this is not their fault That theyre required to report on more and more and more things and thats true in Ontario

Its a very technocratic approach to health care that this government has and its led to the elevation of the whole managerial class of technocrats and consultants and review after review after review of the same thing Its really unpopular with the public

Meanwhile officials in Prince Edward Island were getting set for damage control after the hospital tracking project reported that the provinces Health PEI spent nearly 16 per cent of its budget on administrative costs

Executives said the number was a data entry error and that their administrative costs were around 47 per cent of their budget CIHI said its data on Health PEI was under review

If 16 per cent of our total health care budget was spent on administrative costs right now my job would be a lot easier says CEO Keith Dewar Its really three times the amount were spending on administration We couldnt sustain it right now Were not allowed to do that and I dont know what wed do with all of those resources

Date : 05 Apr, 2012
Reference : http://www2.macleans.ca/2012/04/04/hospital-performance-is-all-over-the-map/

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