Canada - World Health Organization Regional Office for Europe

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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 This construction boom would produce an overhang of outdated hospital facilities that provincial ministries of health would have to address in subsequent decades through consolidation and closure on the one hand, and the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.
5 4 3 2 1 Health systems in transition Canada 83 Fig. 4.1 Acute care beds per 1 000 population in Canada and selected countries, 1990–2009 Beds (per 1000 population) 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: OECD (2011a). Notes: The sharp decline in 2005–2006 in Canada is due to adoption of a more consistent definition of acute care beds. From 1995 to 2005, some provinces reported rated capacity while others reported only beds staffed and in operation; from 2006, only acute care beds staffed and in operation outside of Quebec, and beds for short-term physical care in Quebec, were included (OECD, 2011b). Table 4.1 Acute inpatient hospitalization rates (per 100 000 population) in Canada, age-standardized, 1995–1996 and 2009–2010 Province or territory 1995–1996 2009–2010 14-year change (%) British Columbia 10 817 7 468 – 31.0 Alberta 11 507 8 442 – 26.6 Saskatchewan 14 764 10 953 – 25.8 Manitoba 11 743 9 000 – 23.4 Ontario 10 466 7 046 – 32.7 Quebec 10 696 7 473 – 30.1 New Brunswick 15 268 9 906 – 35.1 Nova Scotia 12 033 7 762 – 35.5 Prince Edward Island 14 697 10 333 – 29.7 Newfoundland and Labrador 13 347 9 285 – 30.4 Yukon 11 758 11 669 – 0.8 Northwest Territories 20 434 14 369 – 29.7 Nunavut 9 914 16 506 66.5 Canada 11 131 7 706 – 30.8 Source: CIHI (2011e). France Australia United Kingdom United States Sweden Canada
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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Abstract Canada is a high-income co
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