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- W3149965664 abstract "data described so far, and then adjusting for the mixture of factors just mentioned – including chronic disease prevalence, and risk factors including smoking and obesity, is shown by the next steepest line. These statistical adjustments reduce the 90th to 10th percentile regional hospitalization ratio a bit more, down to 2.0. Finally, there are further, albeit more distal, socio-economic health determinants which might also account for some of these large differences in hospitalization rates across health regions in Canada. To account for this, the least steep line incorporates further statistical adjustments for these socioeconomic status (SES) factors – including income, education, race, and immigration status. The 90 – 10 hospitalization ratio now declines further from 2.0 to 1.7. Interestingly, this last adjustment has about the same impact as the first two sets of adjustments combined – age and sex, and illness, risk factors and other health care use. Compared to the early 1990s when the idea of the social determinants of health having a major role in understanding why some people are healthy and others not6 was still a contested academic curiosum, it is now widely accepted. The results in this graph clearly reinforce this substantive point. But after almost two decades of discussion and effort, it still has not penetrated to the structure of Canada’s health information to any substantial degree. Chart 1 required major, special efforts, and these kinds of data are not routinely produced. Moreover, these statistical adjustments do not make the wide variations in hospitalization rates go away. Indeed, we may have over-adjusted. So there must be an important range of other factors – presently unknown – driving such large variations in utilization of one of the most expensive parts of Canada’s health care sector. Similar analysis in the United States using their national Medicare data clearly indicated that the observed 3:1 small area variations indicated major inefficiencies, and these results have been central to their recent health care reforms (Fisher et al., 2003; Gawande, 2009; Gawande" @default.
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- W3149965664 date "2011-01-01" @default.
- W3149965664 modified "2023-09-26" @default.
- W3149965664 title "Health Care is a Knowledge Industry, and Should Be More So" @default.
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