Canada provides least hospital inpatient care

Ontario provides even less hospital care than Canada

Canada is an extreme outlier in terms of hospital services. We provide hospital inpatient services to fewer patients than any other developed nation.

The 34 member "rich nations" club, the Organization for Economic Coordination and Development (OECD) has released its 2013 comparison of health statistics for its member states. For 2011 (or the reported year closest to 2011) the OECD reports that the average number of hospital discharges per 100,000 people is 15,561.

The Canadian rate reported is 8,249.

In other words, we have just over half (53%) the number of discharges as other developed nations. Only Mexico has a lower number -- although many would classify it as a developing nation rather than a rich one. Otherwise, Chile, which has 15% more discharges, is our nearest comparator. The rest range between 24% higher (Spain) to 333% higher (Austria). (You can download the complete 2013 OECD comparison by clicking here.)

Even this may understate the difference between Canada and the rest of the developed world. For some reason, Canada reports data only until 2010. As every previous year in Canada since 1982 (when the data was first reported) saw a significant decline, that probably also occurred in Canada in 2011, increasing the difference more.

Since 1982 we have experienced a reduction of 42% in Canada. Despite the fact that it is much harder to get into a hospital in Canada, the average length of stay is only slightly longer in Canada than in the other 34 OECD nations (7.7 days versus 7.5 days).

Why Canada? The particular focus on cutting hospital services may have to do with the particular nature of public health care in Canada. Under the Canada Health Act, the government is obliged to provide medically necessary services when the care occurs in a hospital. With the exception of medically necessary physician services, no such obligation exists for necessary health care services delivered through other providers. Accordingly, public coverage is much more spotty for drugs, home care, long term care, dental care, physiotherapists, psychotherapists, etc., etc.

So there's a secret incentive in Canada for governments to move services outside of hospital walls. An incentive that exists regardless of the quality of care.

Why Ontario? Ontario appears to have taken this furthest, with the lowest acute inpatient hospitalization rate of any province in Canada.

We are on the edge of the edge, it seems.

Photo: Christiana Care

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