Have Health Card Will Travel Kira Leeb Director, Health System - PowerPoint PPT Presentation

Have Health Card Will Travel Kira Leeb Director, Health System Analysis Canadian Institute for Health Information (CIHI) June 2010

Outline > Background > Methodology > Results – Pan-Canadian – Regions in focus > Conclude…propose some next steps

Background Why we did this work? – Some provinces/territories were monitoring outflow but perhaps not inflow – Stories in the news about mothers in rural and remote north travelling to deliver their babies – Interest in costly procedures and payment variations (outside scope of this report)

Background > Canada Health Act contains a portability criterion that ensures Canadian residents receive insured health care services when temporarily absent from their province/territory or when moving to another province/territory > The analysis profiles patients who had an inpatient hospitalization at an acute care hospital in a province/territory outside of the province/territory that issued their health card

Methods -2007/08 data -Discharge Abstract Database -Med-Echo (Quebec) CIHI’s Hospitalization database (DAD) Quebec

Result Highlights

> The territories relied more on OP/T hospitalizations than other jurisdictions – Nunavut—58% – Yukon—21% – Northwest Territories—18% Inflow and Outflow as a Percent of Hospitalizations Within Jurisdictions N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. N.W.T. Nun. Y.T. 2 2 5 4 2 1 4 4 4 1 14 1 6 Inflow (%) 3 10 2 4 4 1 2 3 2 2 18 58 21 Outflow (%)

Portability in Action > Reasons Canadians access inpatient care outside of their home province or territory can include – Urgent care needs while travelling – Services not being available locally – Patient choice, particularly for those who live close to provincial borders

How Far Are They From Home? > Where you live mattered – Provinces with hospitals close to provincial borders treated patients from neighbouring province/territory Distance OP/T Patients Travelled From Home 10th Percentile 25th Percentile Median 75th Percentile 90th Percentile 11 km 65 km 299 km 1,021 km 2,260 km Note: Excluding Quebec Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.

Distance from home varied by reason of hospitalization Median Distance Reason For Hospitalization 10th Percentile (km) Travelled (km) 90th Percentile (km) 7 78 1,470 Pregnant and Newborn 11 306 2,090 ICU Stay 11 223 1,604 Elective Procedures (non-urgent cases) 12 440 2,731 Elective Procedures (urgent cases) 30 300 1,891 Specialized Cardiac Procedures 92 532 1,666 Transplant Procedures Note Excluding Quebec. Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.

Reasons for Hospitalization > 63% of OP/T hospitalizations Hospitalizations Across Major Clinical Categories were urgent admissions > Both elective and urgent admissions are driven by – Service availability – Access – Patient choice > Specific clinical groupings drove OP/T volumes – 23% birth-related hospitalizations – 12% diseases and disorders of the circulatory system Note – 10% diseases and disorders Based on major clinical categories (MCCs) as reported in the DAD for hospitalizations in Canada, of the digestive system excluding Quebec. Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.

Mothers and Newborns Hospitalizations Across Major Clinical Categories > Maternal and newborn stays accounted for approx. 23% of OP/T hospitalizations > 64% of mothers were pre-registered and expected at the hospital > 36% of mothers had unplanned or urgent admissions Note Based on major clinical categories (MCCs) as reported in the DAD for hospitalizations in Canada, excluding Quebec. Source Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information.

Stays in Intensive Care Units > One in seven (14%) OP/T hospitalizations in 2007– 2008 included an ICU stay > ICU admissions were urgent (72%) rather than elective – 40% were related to the circulatory system – 16% of ICU stays were for newborns and neonates > ICU stays are expensive stays

Stays in Intensive Care Units (cont’d) Out-of-Province/Territory Stays in Intensive Care Units OP/T Hospitalizations With an ICU Stay Percent of All OP/T Number Percent Province/Territory ICU Stays in Canada 97 11 1 N.L. 46 14 <1 P.E.I. 765 19 11 N.S. 624 17 9 N.B. 583 20 8 Que. 1,561 15 22 Ont. 507 11 7 Man. 443 9 6 Sask. 1,835 14 26 Alta. 524 10 7 B.C. 17 9 <1 Y.T. 37 5 1 N.W.T. 0 0 0 Nun. 7,039 14 100 Canada Sources Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information; Fichier des hospitalisations Med-Écho, 2007–2008, ministère de la Santé et des Services sociaux du Québec.

Expensive Procedures Out-of-Province/Territory Hospitalizations With Expensive Procedures OP/T Hospitalizations With Expensive Procedures Percent of All OP/T Expensive Number Percent Province/Territory Procedures in Canada 31 4 1 N.L. 7 2 <1 P.E.I. 596 15 18 N.S. 109 3 3 N.B. 498 17 15 Que. 703 7 21 Ont. 205 4 6 Man. 63 1 2 Sask. 878 7 27 Alta. 181 3 6 B.C. 3,272 6 100 Canada Sources Discharge Abstract Database, 2007–2008, Canadian Institute for Health Information; Fichier des hospitalisations Med-Écho, 2007–2008, ministère de la Santé et des Services sociaux du Québec.

Payments made by provinces/territories for their Out-of-Province/-Territory Patients > Just under $313 million was spent by provinces and territories (excluding Quebec) involving 41,464 claims for OP/T inpatient hospital services (2007–2008) > The highest payments were made by British Columbia ($55M), followed by Ontario ($46M) and New Brunswick ($42M)

Regions in Focus > Provinces and Territories at a Glance

Regions in Focus 12,769 10,200 7,531 7,701 8,529 Alberta 2,851 Ontario Quebec 4,084 2,183 Nova Scotia Inflow Outflow

Region in Focus: Alberta Inflow Contributing Provinces: British Columbia (36) Outflow Contributing Provinces: Saskatchewan (27) Saskatchewan (46) British Columbia (34) Patient Profile Inflow Outflow 49 58 Female 9 14 0–12 Months 12 9 1–19 Years 61 57 20–64 Years 18 20 65+ Years Circulatory Issues (12) Pregnancy and Childbirth (17) Most Common Major Trauma (12) Newborns and Neonates (13) Clinical Categories Pregnancy and Childbirth (11) Digestive Issues (12)

Region in Focus: Ontario Inflow Contributing Province: Quebec (63) Outflow Contributing Provinces: Manitoba (30) Alberta (20) Quebec (17) Patient Profile Inflow Outflow 55 50 Female 17 9 0–12 Months 11 11 1–19 Years 52 59 20–64 Years 20 21 65+ Years Pregnancy and Childbirth (17) Pregnancy and Childbirth (12) Most Common Major Circulatory Issues (14) Trauma (12) Clinical Categories Newborns and Neonates (14) Circulatory Issues (12)

Region in Focus: Quebec Inflow Contributing Provinces: Ontario (46) Outflow Contributing Provinces: New Brunswick (35) Ontario (75) New Brunswick (16) Patient Profile Inflow Outflow 44 57 Female 5 19 0–12 Months 16 11 1–19 Years 58 49 20–64 Years 22 21 65+ Years N/A Pregnancy and Childbirth (18) Most Common Major Newborns and Neonates (17) Clinical Categories Circulatory Issues (12)

Region in Focus: Nova Scotia Inflow Contributing Provinces: New Brunswick (43) Outflow Contributing Provinces: Prince Edward Island (29) New Brunswick (51) Ontario (17) Alberta (16) Patient Profile Inflow Outflow 49 49 Female 11 7 0–12 Months 20 9 1–19 Years 49 54 20–64 Years 20 29 65+ Years Circulatory Issues (21) Trauma (13) Most Common Major Digestive Issues (8) Circulatory Issues (11) Clinical Categories Ear, Nose, Mouth and Throat (8) Digestive Issues (10)

Conclusion > Cost of providing care to out of province/territory patients was a large focus of the media attention we received after the release of this report. > Cost to the jurisdictions did not end up as part of this analysis – these are calculated on an annual basis by a governing committee that involves all jurisdictions and is supported by Health Canada. > Our main focus was to identify and quantify these patients across jurisdictions to provide a national picture of the portability of care.

Questions to address….. > Consider a cost analysis approach? > Look at trends over time – Alberta remain the hot spot? Can we determine reasons? – Is there more to be said about travel and maternal/infant care?

Have Health Card Will Travel (available at www.CIHI.ca)