Chances of surviving a myocardial infarction (MI) or having a cesarean section may depend on where you live, the second annual health report from the Canadian Institute for Health Information (CIHI) and Statistics Canada says.
Jennifer Zelmer, coauthor of Health Care in Canada 2001 (www.cihi.ca), told CMAJ that the reasons for these regional variations need to be analysed carefully. “It's important to know how our care compares [in different] parts of the country and to work to improve patients' health.”
The most extensively studied regional difference involved mortality rates for patients who had acute MIs (adjusted for regional differences in age, sex and comorbid conditions). In large health regions (population greater than 100 000), 13% of these patients (1998/99) died in hospital within 30 days of admission. However, the rate varied widely: it was 18% in St. John's, but only 8% in Calgary.
The report, which documents key measures of health and health care for 63 of Canada's largest health regions outside of Quebec, speculates that this difference may be due in part to patient characteristics and regional determinants of health, such as income and lifestyle, but is also partly attributable to caseloads. (A CMAJ study published at the same time [164(10):1431-5] reached a similar conclusion about caseloads.) The authors of the CIHI report speculate that higher caseloads allow hospitals to perfect procedures.
Does this mean hospitals with low case loads should stop performing those procedures? “The data suggest we have too many centres undertaking complex procedures such as heart surgery,” said Michael Decter, chair of the CIHI board. “The result may be unnecessary complications and unnecessary death.”
The report also took a careful look at growth in health care spending. Public and private spending on health care increased by 6.9% in 1999/2000, reaching about $95 billion, or $3000 per capita — an increase of about $175 from the previous year.
Signature
Barbara Sibbald
CMAJ