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Health Care Use and Access

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Canada and the United States differ greatly in their hospital use for back and neck problems

Ontario, Canada and Washington State vary dramatically in their use of hospitalization for back and neck problems, according to a study supported in part by the Agency for Health Care Policy and Research (HS08194). It shows that residents of Washington were three times as likely to undergo spinal surgery, both fusion and non-fusion, than residents of Ontario. These higher surgical rates were associated with both the greater availability of spinal surgeons and advanced noninvasive imaging technologies in Washington.

On the other hand, Ontario residents were more than twice as likely as residents of Washington to receive medical treatment in a hospital for their back and neck problems, perhaps as a substitute for surgical care. However, this finding may reflect the lack of utilization review of medical back admissions in Ontario and the existence of such a program in Washington. Finally, Ontario residents had much longer lengths of hospital stay for both medical and surgical conditions, and lengths of stay varied more among counties in Ontario than in Washington State. This may be associated with different levels of managed care in different States, suggests principal investigator Richard A. Deyo, M.D., M.P.H., of the University of Washington.

The researchers conclude that the Ontario system, with its global controls on budgets and access to technology, can control overall levels of the use of expensive and controversial surgery but cannot control levels of less technologically dependent medical care or lengths of stay. In contrast, Washington State, with utilization review efforts, reduced at least nonsurgical admission rates and lengths of stay. These findings were based on analysis of the Canadian Institute for Health Information database for fiscal year 1992-1993 and the 1992 Comprehensive Hospital Abstract Reporting System for Washington hospitalization data.

See "Hospitalizations for back and neck problems: A comparison between the province of Ontario and Washington State," by Victoria M. Taylor, M.D., M.P.H., Geoffrey M. Anderson, M.D., Ph.D., Brad McNeney, M.S., and others, in the October 1998 Health Services Research 33(4), pp. 929-945.

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