An assessment of the potential for repatriating care from urban to rural Manitoba

OBJECTIVES. Following the closure of Manitoba hospital beds, the Manitoba g overnment adopted a strategy of shifting hospital care from more expensive urban hospitals to less expensive rural facilities. With this project, Mani toba Centre for Health Policy and Evaluation (MCHPE) studied the implicatio ns of the stated policy of "repatriation." RESEARCH DESIGN. The project first involved examining population-based patt erns of hospital utilization to define hospital service areas for 10 large rural hospitals. Three different hospital service area definitions were dev eloped for use in sensitivity testing. Rates of overall use of hospital ser vices, indicators of need for health care, and patterns of use of urban fac ilities are compared for these hospital service areas. Using a large rural hospital as a benchmark, patterns of adult surgical, adult medical, pediatr ic, 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 redir ection 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 insti tutions, the project raised issues of feasibility. Moreover, it identified that most of the redirected eases could be accommodated within existing cap acity.