Rates of avoidable deaths reduced, yet significant room for improvement remains

Fewer avoidable deaths suggest timely health care and disease prevention are having an impact

OTTAWA, May 24, 2012 /Canada NewsWire/ - The rate of deaths that could potentially be avoided through timely and effective health care and disease prevention dropped from 373 per 100,000 Canadians in 1979 to 185 per 100,000 Canadians in 2008. Health Indicators 2012, the most recent edition of the report produced annually by the Canadian Institute for Health Information (CIHI) and Statistics Canada, includes updates on more than 40 measures for Canadian regions, including a suite of new avoidable mortality indicators.

"When we look into pan-Canadian results for avoidable deaths," says Jeremy Veillard, Vice President, Research and Analysis, CIHI, "we can determine the respective impact of prevention efforts and of health care improvements."

The report reveals that the rate of deaths that could be avoided by preventing disease from developing or an injury from occurring has decreased by 47% over a 30-year period. The rate for Canadians went from 225 per 100,000 in 1979 to 119 per 100,000 in 2008.

Meanwhile, deaths that could have been avoided through timely and effective health care intervention were reduced by 56%. This rate went from 149 per 100,000 Canadians in 1979 to 66 per 100,000 in 2008.

The drop in avoidable deaths between 1979 and 2008 was mainly due to reductions in deaths related to circulatory diseases such as heart disease, which decreased by 72%. If death rates for these illnesses had remained unchanged for the 30-year period, the overall reduction in avoidable deaths would have been only 19%, based on gains related to other conditions, and not the observed 50%.

"Declines in some areas of avoidable mortality, such as circulatory diseases, demonstrate that great results can be achieved through collaboration across the health care system and other sectors," says Veillard. "But, there is still work to be done."

Provincial and territorial variations were observed for both the rates and trends over time. While rates of avoidable deaths have declined in almost all jurisdictions, some experienced greater reductions than others. Moreover, provinces with lower avoidable death rates in 1979 were among those with the highest rates 30 years later. A relatively smaller reduction in deaths due to injuries was one of the key drivers of this finding.

According to Health Indicators 2012, Canada's rates of avoidable mortality are the third lowest (behind Japan and France) of the G7 countries. Learning from the best, nationally and internationally, may provide insights on the successful strategies for reducing untimely deaths and help to identify areas for more detailed investigation.

Avoidable death rates vary greatly based on sex and income

Between 1979 and 2008, rates of avoidable mortality among men dropped by more than half (55%), compared with a 43% reduction among women. Men have higher rates of avoidable deaths than women, even after substantial reductions over the past 30 years. Circulatory diseases continue to be the number one cause of avoidable deaths among men, whereas cancers (such as lung and breast cancer) are the main cause of avoidable deaths among women.

Rates of avoidable deaths varied significantly by socio-economic group (as measured by neighbourhood income quintile). For example, people living in the least affluent neighbourhoods were twice as likely to die from preventable causes as those in the most affluent neighbourhoods.

About Health Indicators

CIHI's Health Indicators annual report, produced in partnership with Statistics Canada, presents more than 40 comparable measures of health and health system performance by health region, province and territory. For the first time, this year's report features a section on avoidable mortality that serves to focus attention on the influence of the health system on population health. In addition, the report introduces a suite of new acute-care readmission indicators, which will facilitate comprehensive evaluation of readmissions for all patient groups.

The report and the following figures and table are available from CIHI's website, at www.cihi.ca.

Ontario Hospital Association Welcomes National Hospital Reporting Project

Also Cautions Against Drawing Wrong Conclusions from Study

TORONTO, April 5, 2012 /Canada NewsWire/ - Ontario's hospitals deliver superior outcomes at the second lowest per capita cost in all of Canada the Ontario Hospital Association (OHA) stated today in response to questions arising from yesterday's release of the national Canadian Hospital Reporting Project by the Canadian Institute for Health Information (CIHI), which included comparative data respecting administrative costs and cost per weighted case.

"Ontario's hospitals are extremely efficient compared to hospitals in other provinces," said OHA Interim President and CEO Mark Rochon. "Compared to the average of all other provinces, the Government of Ontario spends $300 less per person on hospital care. This translates into a hospital efficiency dividend that benefits Ontario taxpayers by $4.1 billion dollars this year alone."

The CIHI's Canadian Hospital Reporting Project includes comparative information respecting administrative cost in Canadian hospitals. For Ontario and Quebec, the data is reported at the individual hospital level because only these two provinces retain independent hospital corporations. In all other provinces, the independent corporate status of hospitals has disappeared because of the creation of regional health authorities. This means that the administrative cost structure in hospitals within health authorities is fundamentally different. As a result, and in the view of the OHA, it is inappropriate to draw conclusions about hospital administrative costs by comparing jurisdictions.

"Comparing administrative costs using the CIHI study is an apples to oranges comparison," said Rochon. "But let's set that aside for a moment. What we want to drive home to the taxpayers of Ontario is that their hospitals are very efficient and that they are committed to making further efficiency gains while also improving performance."

The CIHI study reports that Ontario's overall cost per weighted case is high compared to other jurisdictions. However, it is wrong to conclude that these results mean that Ontario's hospitals are inefficient. Ontario admits far fewer patients per capita than other provinces while also emphasizing ambulatory care to a far greater degree. This means that patients who are admitted to hospital tend to be the most ill and most in need of intensive, higher cost treatment not accounted for in weighted cases. Ontario also has the largest number of academic hospitals in Canada, many of which provide services available in few or no other place in the country. Further, the wages and benefits for nurses in Ontario are higher compared to other jurisdictions.

"The OHA welcomes the Canadian Hospital Reporting Project because it adds to our knowledge of hospital performance," added Rochon. "But it is important not to rush to the wrong conclusion about how Ontario's hospitals perform either."

Each year 50,000 people respond to surveys designed to measure patient satisfaction with hospital care. 93% of respondent rate their experience as positive. Ontario has significantly lower wait times than other provinces. Ontario is one of only two provinces to complete 75% of their wait time procedures within established benchmarks.

About the OHA

The Ontario Hospital Association (OHA) is the voice of Ontario's public hospitals. Founded in 1924, the OHA uses advocacy, education and partnerships to build a strong, innovative and sustainable health care system for all Ontarians.

The baby boom effect: caring for Canada's aging population

New report examines how seniors use the health system and where improvements can be made

OTTAWA, December 1, 2011 /Canada NewsWire/ - As the baby boom generation begins to turn 65 this year, the aging of Canada's population will accelerate. As a result, the health care system will need to adapt to meet the future needs of a growing senior population, according to a new report released today by the Canadian Institute for Health Information (CIHI). Health Care in Canada, 2011: A Focus on Seniors and Aging shows that, while Canada's seniors (age 65 and older) are living longer and are healthier than ever, they are frequent users of the health system, costing more than any other segment of the population. Representing just 14% of the population, seniors use 40% of hospital services in Canada and account for about 45% of all provincial and territorial government health spending.

"Although the impact of population aging on health costs has remained relatively stable over time, health care planners and providers are rightfully looking at ways to meet the needs of a growing senior population," says John Wright, CIHI's President and CEO. "The number of Canadians age 65 and older is expected to nearly double to 25% of the population by 2036. Understanding where gaps exist and where efforts can be concentrated will help ensure that the system remains strong and efficient for Canadians of all ages."

CIHI's report identifies opportunities for the health system to meet these changing needs, including improved integration across the health care continuum, an increased focus on prevention and more efficient adoption and use of new technologies.

Improved integration across the health care continuum

Canada's seniors often require care from different providers across various settings, including a family doctor's office, a specialty clinic, a home care service, a pharmacy, a hospital and/or a long-term care facility. However, the study identifies gaps in the continuity of seniors' care.

As with Canadians of all ages, seniors who become acutely ill may require care in hospital, where they could encounter issues related to patient flow and appropriateness of care. Seniors who arrive at the hospital may first make contact with the emergency department, where they are likely to stay longer than non-senior adults do. CIHI's report shows that seniors spend more time in emergency departments than their younger counterparts before being admitted to hospital (3.7 hours compared with 2.7 hours in 2009-2010).

Also related to patient flow for hospitalized patients is alternate level of care (ALC) stays. Patients are considered ALC patients when they have completed the acute care phase of their treatment but remain in an acute care bed. Seniors account for 85% of all ALC patients—approximately 85,000 cases a year. CIHI data shows that nearly half of all senior ALC patients (47%) were waiting to be moved to a long-term care facility.

"Our health system can no longer afford to operate in silos. Ensuring continuity of care across the continuum will not only lead to a more efficient use of resources, it can potentially lead to better care and in turn better quality of life," explains health policy researcher Marcus Hollander. "This is particularly important in the senior population, because they receive care from many different care providers in various settings."

The study also highlights the fact that improved integration can help promote safe and appropriate drug use in seniors. Many Canadian seniors take several prescription drugs, and the number of seniors taking multiple drugs is on the rise. In 2009, almost two out of three (63%) Canadians age 65 and older took 5 or more prescription drugs from different drug classes, with close to one-quarter (23%) taking 10 or more—up from 59% and 20%, respectively, in 2002.

It is not only the number of different medications, but also the specific medications seniors are taking that present challenges. CIHI data shows that, in 2009, 1 out of 10 Canadian seniors was taking a drug from the Beers list, an internationally recognized list of prescription drugs identified as potentially inappropriate for use by seniors. The use of these drugs has declined over the past decade. Seniors also take more over-the-counter medications and vitamins or other supplements than any other age group, possibly adding to the risks associated with multiple medications.

"As medications may be prescribed by different health care providers, without an accurate account of current treatments, seniors can be at increased risk of potential interactions or adverse events," explains Dr. Pamela Jarrett, a geriatrician in New Brunswick. "While all health care providers do their best to ensure seniors are not taking medications that may negatively interact with each other, regular medication reviews with their family doctors or pharmacists can help reduce the risk of medication interactions."

John Wright explains:

"Team-based approaches to delivering primary care may help ensure seniors are receiving appropriate care. Physicians and pharmacists working together in the same practice can lead to increased communication on prescribing and lower the risk of a senior experiencing adverse drug interactions or side effects."

An increased focus on prevention

Multiple chronic conditions—more than age—are associated with high use of the health care system. As the risk of developing chronic conditions increases with age (76% of seniors reported at least 1 of 11 major chronic conditions in 2008), prevention plays a key role in healthy aging, both to manage existing chronic conditions and to delay or prevent the onset of new ones.

Research shows that good primary health care in the community can help patients with chronic conditions—such as asthma, congestive heart failure or diabetes—avoid costly hospital admissions. The report estimates that 1 out of every 11 emergency department visits by seniors is for a chronic condition that can potentially be managed in the community. Of these seniors, nearly half (47%) are hospitalized.

Many health professionals may have a role in supporting and promoting prevention strategies. Family physicians often act as an initial contact, and although 95% of Canadian seniors have access to a family physician, some reported challenges accessing primary care. In 2009, less than half could get same- or next-day appointments, and more than one-third (34%) reported waiting six or more days for an appointment. This could result in potentially avoidable visits to emergency departments or walk-in clinics for care.

Seniors also visit other primary health care providers—such as psychiatrists, social workers and dentists—less often than younger adults, potentially reducing the amount of preventive care received. In 2008-2009, nearly half (44%) of Canada's seniors had not had a dental check-up in the previous year. Studies have shown that poor oral care can contribute to poor health in older age, affecting nutrition, body weight and the progression of many diseases.

Preventing falls is another important strategy to keep seniors healthy. Falls are the leading cause of injury hospitalization among seniors, accounting for 9% of all emergency department visits and almost 80,000 hospital admissions in 2009-2010. The study highlights an opportunity to prevent falls in several settings across the continuum of care. About 1 out of 14 (7%) seniors hospitalized in complex continuing care beds fell within a month of assessment, compared with about 1 out of 8 (12%) in residential care facilities. More than one-quarter (28%) of seniors receiving home care services experience a fall within 90 days of assessment.

Efficient use of new health technologies

The use of new health innovations and technologies can help ensure that seniors are receiving appropriate care. For example, widespread adoption of electronic health records could facilitate physician decision-making by ensuring access to complete information on patients' medical conditions and medications.

The vast majority (93%) of Canadian seniors live at home—and technological advances can allow them to stay at home for longer. For example, for seniors receiving home care services, a medication monitoring system equipped with a sensor-trigger system allows family members to monitor which medications were taken when from anywhere in the world.

"We know that the growing proportion of seniors in Canada's population is going to impact the health care system," says Jean-Marie Berthelot, CIHI's Vice President of Programs. "Collecting more comparable data, on a variety of settings across the care continuum, can help policy-makers identify and understand key issues across sectors of care and ultimately better plan and prepare for the future."

The report is available on their website at www.cihi.ca.

Health spending in Canada to reach $200 billion in 2011

Compensation of health professionals, evolution in the use of services important cost drivers of past decade

OTTAWA, November 3, 2011 /Canada NewsWire/ - Total spending on health care in Canada is expected to grow by more than $7 billion this year to reach a forecast $200.5 billion in 2011. This amounts to roughly $5,800 per Canadian, about $150 more per person than last year, according to a new report released today by the Canadian Institute for Health Information (CIHI).

National Health Expenditure Trends, 1975 to 2011, one of two CIHI reports released today, shows that growth in health care spending is slowing down. Spending is expected to increase by 4.0% in 2011 over last year—the lowest annual growth rate seen in the last 15 years. In contrast, average annual growth in health care spending between 1998 and 2008 was 7.4%.

While health care spending continues to rise faster than inflation and population growth, it is expected to grow more slowly than the overall economy this year. Spending on health care is forecast to reach 11.6% of Canada's gross domestic product (GDP) in 2011, a slight decrease from the historic peak of 11.9% in 2009 and 2010.

"Like in many other countries in the developed world, health care in Canada has seen a period of tremendous growth and major reinvestments in the new millennium," explains CIHI's President and CEO, John Wright. "While the pace of that growth appears to be slowing down, it's important to understand how we reached the $200-billion mark this year. In light of global economic uncertainty and efforts here at home to address government deficits, it's important to examine what's been driving health care costs in order to better plan for the future of the health system."

Main factors that drove health expenditures since 1998

CIHI is also releasing another major study today, called Health Care Cost Drivers: The Facts. The report examines the key factors that contributed to the $200-billion milestone. It focuses on public-sector health care spending between 1998 and 2008—a boom period when annual health expenditure in Canada more than doubled—and identifies issues to monitor in the future.

The study shows that in Canada, as in many countries in the Organisation for Economic Co-operation and Development (OECD), there was a tendency to spend more on health care during a period of economic growth and higher income. From a fiscal policy perspective, the period from 1998 to 2008 saw a reduction in the interest that governments in Canada had to pay on outstanding debt, which allowed them to divert resources to overall program spending and tax reduction. The major cost drivers of public-sector health care spending in the past decade were compensation of health care providers, increased use of services and an evolution in the types of services provided and used.

Compensation of health professionals a major cost driver

CIHI's data shows that compensation paid to health care providers has been one of the most significant cost drivers of public-sector health care spending. Hospitals represent the largest category of public-sector spending (37%), and compensation represents about 60% of total hospital budgets. Between 1999 and 2008, the number of hospital workers grew by 21%, while their compensation increased faster than that of workers in the general labour market. The hourly paid hospital employees wage index from Statistics Canada increased by an average of 3.3% per year, compared with an average annual wage increase of 2.7% in the general economy.

After hospitals, physicians represent the second-largest category of public-sector health care spending (20% in 2011). Between 1998 and 2008, physician expenditures increased on average by 6.8% a year. CIHI data shows that the price of doctors' services was the most important cost driver of spending in this category, with compensation for doctors' services growing by 3.6% a year—faster than that for other health workers and the labour market in general. However, physician compensation grew more slowly than the prices of other public goods and services from 1975 until 1998.

"Over the last decade, a host of factors may have contributed to the compensation hike for physicians and other health professionals," explains Wright. "For example, increased competition between provinces to recruit and retain health providers, tighter credentialing of health professionals and stronger bargaining positions due to increased government revenues may have all played a role."

With the number of practising doctors on the rise in Canada, CIHI data shows that spending on physicians is expected to be one of the fastest-growing categories of health expenditure in Canada in 2011, outpacing growth in spending on drugs and hospitals for the fifth year in a row.

Increased use of services and evolving types of services used

Over the past decade, population growth contributed about 1% annually to health care costs. Beyond the demographic factors, the data shows that Canadians are using more health care in some areas. For example, the volume of drugs sold in Canada contributed an average increase in spending of 6.2% a year between 1998 and 2007, even after accounting for population growth and aging. Overall drug spending grew by an average of 10.1% per year during this period. This makes increased utilization the single largest cost driver of drug spending over the past decade. The increased volume was driven largely by use of anti-hypertensive, cholesterol-lowering and gastrointestinal drugs.

Canadians are also seeing their doctors more often and getting more medical procedures. Over the past decade, use of physician services grew by 1.5% annually per Canadian, after adjusting for population aging. The 10-year period also saw a significant increase in the number of Canadians receiving priority-area procedures, such as hip and knee replacements; diagnostic imaging exams, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans; and cataract surgery procedures.

A change in the types of health services used by Canadians—such as the emergence of new drugs and new diagnostic and surgical tools—has also contributed to the growth in health costs. For example, changes in the types of drugs used were an important driver of drug spending, particularly during the last five years. New cancer drugs and immunosuppressants were two of the fastest-growing drug classes during this period. Investments in technologies, such as diagnostic imaging equipment, also grew significantly over this period. Between 1997 and 2010, the number of CT scanners operating in Canada nearly doubled (from 245 to 484), while the number of MRI machines increased more than fivefold (from 55 to 281).


Aging population a modest health care cost driver

CIHI also analyzed the extent to which the aging population is driving costs.

The report demonstrates that population aging is a cost driver of modest importance relative to other drivers, accounting for less than 1% of average annual growth in health care spending (0.8% per year) from 1998 to 2008.

"There is no doubt that as we grow older, we often need more health services and that this costs the health system more money. However, while the Canadian population is aging, it is aging slowly as a whole," says Jean-Marie Berthelot, Vice President of Programs at CIHI. "Over the past decade, the proportion of health dollars spent on seniors by provincial and territorial governments has remained relatively stable at 44%. This tells us that spending on seniors is not growing faster than spending for the population at large."

CIHI data shows, however, that the impact of aging on health care spending varies considerably by province. It is more significant in the Atlantic provinces and Quebec, for example, than in Ontario and the west.

Health care spending not growing as share of provincial and territorial government budgets

Since health care delivery is a provincial/territorial responsibility in Canada, the vast majority of public-sector health dollars are spent by provincial and territorial governments. In 2010, the latest year of available data, health care is estimated to account for about 38% of provincial/territorial government spending. However, this proportion varies among provinces, from 30.4% in Quebec and 33.9% in Newfoundland and Labrador to 44.5% in Manitoba and 47.2% in Nova Scotia.

"Our study identifies several areas to monitor for the future in terms of health care spending," says Berthelot. "For example, increases in the number of health professionals, changes in their scope of practice and the introduction of new technologies—such as new cancer biologic drugs—may all continue to have a significant impact on what we collectively pay for health care. Canadian governments, and society as a whole, will need to balance the health needs of the population against overall costs to ensure Canadians have an efficient, effective and sustainable system."

About National Health Expenditure Trends, 1975 to 2011

This annual report provides an overview of health care spending trends from 1975 to 2009, as well as forecasts for 2010 and 2011. The report draws upon data compiled from CIHI's National Health Expenditure (NHEX) Database, Canada's most comprehensive source of information on health care spending. Where appropriate, the report provides data in both current and constant dollars. Current dollars measure actual expenditure in a given year. Constant dollars remove the effects of inflation to measure expenditure based on price levels prevailing in a base year (in this case, 1997). Real growth rates measure annual changes of data reported in these constant dollars.

About Health Care Cost Drivers: The Facts.

This supplement to CIHI's annual NHEX report analyzes the areas that drove health care spending in the public sector during the major growth period of the last decade (1998 to 2008), as well as issues to watch in the future. Public-sector spending represents 70% of the total health bill, a proportion that has remained relatively stable since 1997. The report examines factors within the three major categories of public health expenditure—hospitals, physicians and drugs—as well as those affecting health care spending overall.

The reports are available on their website at www.cihi.ca

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