HOSPITALIZATIONS FOR BACK AND NECK PROBLEMS - A COMPARISON BETWEEN THE PROVINCE OF ONTARIO AND WASHINGTON-STATE

Objective. To examine back and neck hospitalizations in the Province o f Ontario and Washington State. Because of their different organizatio n and financing, there has been considerable interest in comparing hea lthcare systems in Canada and the United States. Features of healthcar e systems might be expected to result in greater variations in care fo r elective than urgent conditions. Data Source. Automated hospital dis charge databases. Study Design. Previously developed algorithms were u sed to identify surgical and nonsurgical hospitalizations for back and neck problems in the administrative databases. We compared overall ra tes of hospitalization and lengths of hospital stay in Ontario and Was hington as well as small area variations within the province and state . Principal Findings. Surgical back and neck hospitalizations were thr ee times as common in Washington, but medical hospitalizations were tw ice as common in Ontario. Provincial lengths of stay were longer for b oth surgical and nonsurgical hospitalizations. Admission rates varied substantially and significantly among small areas in both Washington a nd Ontario. Variations in hospital length of stay were greater in Onta rio, particularly for nonsurgical back and neck hospitalizations. Conc lusion. The two jurisdictions had very different patterns of hospital utilization for one of the most common health problems seen by physici ans. Our results suggest that the global controls on hospital budgets and access to technology in Ontario were associated with lower rates o f surgery, higher rates of hospital-based medical care, and longer len gths of stay. They also indicate that the utilization review process i n Washington was associated with lower small area variation rates for medical back care.