USING THE INFORMATION-SYSTEM TO ASSESS CHANGE - THE IMPACT OF DOWNSIZING THE ACUTE SECTOR

A population-based approach was used to monitor impact of hospital bed closures in Winnipeg, Manitoba. Four years of administrative data wer e analyzed. Access to hospital services was not adversely affected: Th e reduction in beds resulted in increases in outpatient surgery and ea rlier discharges. In addition, access favored the admission of persons with more health care needs. Quality of care, as measured by mortalit y within 3 months of admission, readmission rates within 30 days of di scharge, and increased contact with physicians within 30 days of disch arge, did not change. The health status of the Winnipeg population, me asured by premature mortality, did not change. However, health status and hospital use was found to be strongly related to socioeconomic sta tus. In light of this gradient, the authors conclude that well designe d and evaluated experiments that focus on the determinants of health, rather than on providing more health care services, could help identif y ways of reducing hospital use.