title: The evolution of freestanding children's hospitals in Canada.
abstract: OBJECTIVE
  The purpose of the present article is to examine the evolution of freestanding children's hospitals in Canada over the past century. The results include documentation of the number of freestanding children's hospitals in Canada that have since closed, merged with other institutions or remained freestanding. Similar data are presented for the United States (US). Also included is an analysis of factors in the internal and external environment that contributed to the changing structure of children's hospitals.
  
  
  METHODS
  Sources of information included a review of the literature, publicly available data and statistics on children's hospitals in Canada and the US.
  
  
  RESULTS
  Nine of the 16 children's hospitals in Canada were freestanding at one time. Today, only two remain freestanding. Three formerly freestanding children's hospitals have merged with maternal health facilities and four formerly freestanding children's hospitals have merged with adult institutions. Similar trends are seen in the US.
  
  
  CONCLUSIONS
  The structure of children's hospitals in North America has changed significantly over the past century. This can be attributed to a number of factors, including the evolution of the health status of children due to medical advances, as well as external forces such as demographics and the rising cost of health care. The impact on the health of children and the mission of children's hospitals in terms of patient care, teaching and research remains to be seen.
authors.affiliation: Montreal Children's Hospital.
authors.forename: Antonia S
authors.initials: AS
authors.lastname: Stang
authors.forename: Arvind
authors.initials: A
authors.lastname: Joshi