Canada - World Health Organization Regional Office for Europe

82
Health systems in transition Canada
4.1 Physical resources
4.1.1 Capital stock and investments
From the late 1940s until the 1960s, Canada experienced rapid growth in the
number and size of hospitals through the growth in demand for inpatient care.
This growth was fuelled by national hospital construction grants provided to the
provinces by the federal government and by the introduction of public hospital
insurance in Saskatchewan, Alberta and British Columbia by the end of the
1940s, and the remaining provinces by the end of the 1950s. This construction
boom would produce an overhang of outdated hospital facilities that provincial
ministries of health would have to address in subsequent decades through
consolidation and closure on the one hand, and the need for additional capital
investment on the other (Ostry, 2006).
By the mid-1970s, the investment in hospitals had slowed, and by the 1980s
and 1990s, provincial governments were encouraging hospital consolidation
with a concomitant reduction in the number of small and inefficient hospitals
(Mackenzie, 2004; Ostry, 2006). As provincial governments, RHAs and
hospital boards closed, consolidated and converted existing establishments in
an effort to reduce operating costs and increase organizational efficiencies,
there was a 20% drop in the total number of hospitals offering inpatient care
from the mid-1980s until the mid-1990s (Tully & Saint-Pierre, 1997).
4.1.2 Infrastructure
The number of acute care beds per capita has fallen continuously during the
past two decades. In this respect, the trend in Canada is similar to the trend
observed in Australia, France, Sweden, the United Kingdom and the United
States (Fig. 4.1). With the exception of two territories, all jurisdictions in
Canada have experienced a very similar rate of decline in hospitalization since
the mid-1990s (Table 4.1). At the same time, the average length of stay (ALOS)
in Canadian hospitals has increased since at least the mid-1990s (CIHI, 2010a).
As seen in Table 4.2, Canada now has a higher ALOS in hospitals, a higher
occupancy rate and a lower turnover rate than the other countries.