An assessment of the potential for repatriating care from urban to rural Manitoba.
OBJECTIVE
Following the closure of Manitoba hospital beds, the Manitoba government adopted a strategy of shifting hospital care from more expensive urban hospitals to less expensive rural facilities. With this project, Manitoba Centre for Health Policy and Evaluation (MCHPE) studied the implications of the stated policy of "repatriation."


METHODS
The project first involved examining population-based patterns of hospital utilization to define hospital service areas for 10 large rural hospitals. Three different hospital service area definitions were developed for use in sensitivity testing. Rates of overall use of hospital services, indicators of need for health care, and patterns of use of urban facilities are compared for these hospital service areas. Using a large rural hospital as a benchmark, patterns of adult surgical, adult medical, pediatric, and obstetric care were examined for the hospital service areas. Number and percent of cases provided by the index hospital and by urban hospitals were compared, to assess the feasibility and the potential impact of redirection of care to the benchmark level.


CONCLUSIONS
Although in theory a significant percentage of care delivered to rural residents by Winnipeg hospitals might be redirected to rural institutions, the project raised issues of feasibility. Moreover, it identified that most of the redirected cases could be accommodated within existing capacity.
Manitoba Centre for Health Policy and Evaluation, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
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Burchill
D000328:Adult; D019985:Benchmarking; D018672:Community Health Planning; D005240:Feasibility Studies; D006271:Health Facility Closure; D006291:Health Policy; D006297:Health Services Accessibility; D006752:Hospital Planning / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000458:organization & administration*; D006801:Humans; D008350:Manitoba; D020380:Needs Assessment / Q000458:organization & administration*; D012680:Sensitivity and Specificity