Historical trends in public general hospitals.

This article examines utilization trends in Canadian public general hospitals from 1976 to 1986-87. These trends are then compared with a previous period, and with hospital trends in the United States. Findings for this report are based on both provincial and national data. There was an overall decline in the number of hospitals with a decrease in small (1-49 beds) and an increase in large (300+ beds) hospitals. The net result is a 7% increase in the number of beds, though due to the larger population there was a 3% decrease in the bed rate per population. The bed occupancy rate increased from 77% to 83% and the average length of stay also increased. The number of separations increased slightly but rates per population declined. Patient-days per population increased in most provinces and there was a significant increase in long-stay units. Despite general uniformity amongst the provinces there were some notable variations. The trends indicate a reversal of the situation in the 1953-1973 period which was marked by an expansion in the hospital system. Hospitals in the United States showed somewhat similar trends with the exception of length of stay. The trends may be ascribed to factors such as increased efficiency, the development of alternatives to inpatient care, technical improvements, demographic changes and the individuality of the provincial health care systems.

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.