The quick and the dead: "Managing" inpatient care in British Columbia Hospitals, 1969-1995/96

Objective. To examine changes in hospital use in British Columbia during a decade of capacity reductions. Data Sources/Study Setting. The data used are all separation records for Br itish Columbia hospitals for the years 1969, 1978, 1985/86, 1993/94, and 19 95/96. Separation records include acute care, rehabilitation, extended care , and surgical day care hospital encounters in British Columbia that were c oncluded during the years of interest. Study Design. Analyses were based on per capita use of services for five-ye ar age groups of the population to ages 90+; the emphasis was on looking at changes in the use of specific types of hospital services over the 26 year s of study, with a particular focus on the most recent decade. Data Collection/Extraction Methods. Data were extracted from hospital separ ations files owned by the British Columbia Ministry of Health and housed at the Centre for Health Services and Policy Research. All separation records for the years of interest were included in the study. Principal Findings. Acute care use continued to fall over the last decade. The rate of decline increased during the last time period of study and affe cted seniors to the same degree as younger patients. At the same time, use of extended care decreased, compared to steady increases in earlier years. The result was that by 1995/96 nearly 40 percent of inpatient days were use d by people who died in hospital, compared to 9 percent in 1969. These peop le, however, still represent a small proportion of separations. Conclusions. The "bed blocker" problem common to many hospital systems appe ars to have been largely alleviated in British Columbia over the decade 198 5-95. The concurrent decrease in extended care use, however, makes it diffi cult to say where and how these people are now being cared for. Care for th e dying has become a bigger issue for hospitals, but whether this is becaus e of heroic interventions at the end of life is not clear. A "top-down," ca pacity-driven management approach to hospital use in British Columbia has p roduced effects that may seem familiar to those involved in more "bottom-up " managed care approaches in the United States.