This study used Manitoba data from 1991 to 1996 to assess the effects of health reforms and technological advances on hospitalization patterns, patient mortality, and readmission rates. Cholecystectomy and hernia repair served as indicators of response to both new technology and health reforms, while appendectomy and hysterectomy helped gauge the impact of health reforms alone. Neither the introduction of new technology (i.e. laparoscopy) nor the health reform initiatives (i.e. shorter hospital stays) adversely affected surgical volumes, postsurgical mortality, or postsurgical readmissions.
Get full access to this article
View all access options for this article.
References
1.
DavisK. Common Concerns: International Issues in Health Care System Reform. New York, NY, The Commonwealth Fund.1998 Annual Report.
2.
DonelanKBlendonRJSchoenCDavisKBinnsK. The cost of health system change: Public discontent in five nations. Health Affairs (Millwood)1999; 18(3): 206–216.
3.
NaylorCD. Health care in Canada: Incrementalism under fiscal duress. Health Affairs (Millwood)1999; 18(3): 9–26.
4.
CohenMMYoungWTheriaultM-EHernandezR. Has laparoscopic cholecystectomy changed patterns of practice and patient outcome in Ontario?Canadian Medical Association Journal1996; 154(4): 491–500.
5.
RutkowIM. The recurrence rate in hernia surgery. How important is it? Archives of Surgery1995; 130(6): 575–576.
6.
JuulPChristensenK. Randomized clinical trial of laparoscopic versus open inguinal hernia repair. British Journal of Surgery1999; 86(3): 316–319.
7.
HusseinMKKhouryGSTahaAM. Laparoscopic inguinal hernia repair. International Surgery1998; 83(3): 253–256.
8.
MarshallDHaileyDHirschNClarkEMenonD. The Introduction of Laparoscopic Cholecystectomy in Canada and Australia, Ottawa (ON): Canadian Coordinating Office for Health Technology Assessment; 1994.
9.
PriestL. Safety first: Hotline points out perils: New York State moves to arm the public with artillery of tough questions to ask surgeons. Toronto Star. 21 September 1997.
10.
BrookRHLohrKN. Monitoring quality of care in the Medicare program: Two proposed systems. Journal of the American Medical Association1987; 258(21): 3138–3141.
11.
CorriganJMMartinJB. Identification of factors associated with hospital readmission and development of a predictive model. Health Services Research1992; 27(1): 81–101.
12.
EpsteinAMBogenJDreyerPThorpeKE. Trends in length of stay and rates of readmission in Massachusetts: Implications for monitoring quality of care. Inquiry1991; 28(Spring):19–28.
13.
GoodingJJetteAM. Hospital readmissions among the elderly. Journal of the American Geriatrics Society1985; 33(9): 595–601.
14.
RileyGLubitzJ. Outcomes of surgery in the Medicare aged population: Rehospitalization after surgery. Health Care Financing Review1986; 8(1): 23–34.
15.
ThomasJWHollowayJJ. Investigating early readmission as an indicator for quality of care studies. Medical Care1991; 29(4): 377–394.
16.
BrownellMDRoosNPBurchillC. Monitoring the impact of hospital downsizing on access to care and quality of care. Medical Care1999; 37(6 Suppl): JS135–JS150.
17.
ShanahanMSteinbachCBurchillCFriesenDBlackC. Adding up provincial expenditures on health care for Manitobans. Medical Care1999; 37(6 Suppl): JS60–JS82.
18.
RoosLLSharpSMWajdaA. Assessing data quality: A computerized approach. Social Science and Medicine1989; 28(2): 175–182.
19.
RoosLLMustardCANicolJPMcLerranDFMalenkaDJYoungTK. Registries and administrative data: Organization and accuracy. Medical Care1993; 31(3): 201–212.
20.
CharlsonMEPompeiPAlesKLMcKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases1987; 40(5): 373–383.
21.
RomanoPSRoosLLJollisJ. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectives. Journal of Clinical Epidemiology1993; 46(10): 1075–1079.
22.
Canadian Institute for Health Information.Comparative Analysis Report: Hospital Utilization in Canada, 1994. Ottawa, ON, Canadian Institute for Health Information, 1994; p. 5.
23.
RoosLLStrancLCJamesRLiJ. Complications, comorbidities, and mortality: Improving predictions of outcomes. Health Services Research1997; 32(2): 231–240.
24.
AgrestiA. Categorical Data Analysis, New York, NY, John Wiley and Sons, Inc., 1990. 100–102.
25.
BrownellMDRoosNPBurchillC. Monitoring the Winnipeg hospital system: 1990/91 through 1996/97. Winnipeg, MB, Manitoba Centre for Health Policy and Evaluation, February 1999.
26.
KrahenbuhlLSchaferMFeodoroviciMABuchlerMW. Laparoscopic hernia surgery: An overview. Digestive Surgery1998; 15(2): 158–166.
27.
BarkunJSWexlerMJHincheyEJThibeaultDMeakinsJL. Laparoscopic versus open inguinal herniorrhaphy: Preliminary results of a randomized controlled trial. Surgery1995; 118(4): 703–710.
28.
DeCosterCCarriereKCPetersonSWalldRMacWilliamL. Surgical Waiting Times in Manitoba. Winnipeg, MB, Manitoba Centre for Health Policy and Evaluation, June 1998.
29.
BrossartBHaderJLiuL. Saskatchewan rural residents' health status, access to acute care services not affected by 1993 funding cuts to small hospitals. A Closer Look 1999; Fall: 1–2; Saskatoon SK, Health Services Utilization and Research Commission.
30.
Manitoba Health Reform Impact Study Final Report. Winnipeg, MB, Department of Community Health Sciences, University of Manitoba, 1996; p. 8.
31.
DeCosterCCarriereKCPetersonSWalldRMacWilliamL. Waiting times for surgical procedures. Medical Care1999; 37(6 Suppl): JS187–JS205.
32.
MenecVHRoosNPNowickiDLMacWilliamLFinlaysonGBlackC. Seasonal Patterns of Winnipeg Hospital Use. Winnipeg, MB, Manitoba Centre for Health Policy and Evaluation, October 1999.