Comparing negative health indicators in male and female veterans with the Canadian general population.

INTRODUCTION: Sex-based information on differences between Canadian veterans and the general population is important to understand veterans' unique health needs and identify areas requiring further research. This study compared various health indicators in male and female veterans with their Canadian counterparts. METHODS: Health indicators for recent-era Regular Force veterans (released between 1998 and 2015) were obtained from the 2016 Life After Service Survey and compared with the general population in the 2015-16 Canadian Community Health Survey using a cross-sectional approach. Age-adjusted rates and 95% CIs were calculated for males and females separately. RESULTS: Compared with Canadians, veterans (both sexes) reported higher prevalence of fair or poor health and mental health, needing help with one or more activity of daily living, lifetime suicidal ideation and being diagnosed with mood and anxiety disorders, post-traumatic stress disorder, migraines, back problems, chronic pain, arthritis, ever having cancer, hearing problems, chronic pain and gastrointestinal problems. A higher prevalence of cardiovascular disease (all types) and high blood pressure was observed in male veterans compared with their Canadian counterparts. Within veterans only, males reported a higher prevalence of diagnosed hearing problems and cardiovascular disease compared with females; conversely females reported a higher prevalence of diagnosed migraines, mood, anxiety and gastrointestinal disorders, and needing help with activities of daily living. These sex differences are similar to the Canadian general population. Some similarities in reporting prevalence between male and female veterans (eg, fair or poor mental health, lifetime suicidal ideation, arthritis, asthma, lifetime cancer incidence, chronic pain and diabetes) were not observed in other Canadians. CONCLUSION: Male and female veterans differed from comparable Canadians, and from each other, in various areas of health. Further research is needed to explore these findings, and veteran-based policies and services should consider sex differences.

Measuring hospital productivity and output: the omission of outpatient services.

A common measure of hospital productivity is the "cost per patient day". This measure, however, has a variety of drawbacks, one of which is its omission of outpatient care in the measure of hospital output, since a patient day is merely a measure of the volume of patient services, while the cost of outpatient services is included in the input. This study uses information from the Statistics Canada Annual Return of Hospitals to examine the volume of inpatient, outpatient and total patient services, to separate inpatient and outpatient costs and to study hospital productivity from 1976 to 1987-88 using both inpatient cost per patient day and outpatient cost per outpatient visit. Operating costs for Canadian public hospitals, in constant dollars, increased by 38.5% from 1976 to 1987-88. A large increase in hospital costs is not cause for concern unless costs are rising faster than hospital output. There does seem to be some indication that this is the case. The productivity of public hospitals in Canada, measured by "cost per patient day," has fallen by 19.8% from 1976 to 987-88. However, a major drawback to this measure of hospital productivity is that outpatient services were not included in the measure of output and therefore the productivity of hospitals is underestimated. When inpatient costs and services are separated from outpatient costs and services, inpatient services productivity as measured by inpatient cost per patient day still declines but only by 16.3%. On the other hand, outpatient cost per outpatient visit decreased by 2.3%, indicating an increase in productivity.