Hospital Funding Using 1999/2000 Data · RD 9-12 Hospital Funding Formula using 1999/2000 Data Page 3 do other groups In order to develop hypot heses concerning which characteristics

Hospital Funding Report Using 1999/2000 Data

Prepared for the Hospital Funding Committee of the JPPC

Reference Document RD#9-12 October 2001

For additional copies of this report, please visit our web site at www.jppc.org

All inquiries and questions pertaining to the methodology applied to determine your hospital actual cost per weighted case should be sent to:

Nan Brooks, Consultant JPPC Secretariat Tel: (416) 599-5772 ext. 234 Fax: (416) 599-6630 [email protected]

Any concerns pertaining to the DATA used in the calculation should be directed to your Financial Representative in the Institutional Branch of the Ministry of Health and Long-Term Care.

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mailto:[email protected]

TABLE OF CONTENTS

EXECUTIVE SUMMARY...................................................................................................1

Current Hospital Funding ...........................................................................................1 A New Funding Methodology ....................................................................................1

The Volumes Model ...........................................................................................................2 Volume Adjustment Factors ................................................................................................2 The Rate Model of the JPPC ..............................................................................................4 The Rate Model Adjustment Factors ...................................................................................5

INTRODUCTION.................................................................................................................7

Historical Funding in Ontario ....................................................................................7 Enhancements to Rate and Volume Equity Funding Methodologies .............8 The JPPC Volume Sub-Committee...........................................................................9 The JPPC Rate Sub-Committee ................................................................................9 Overview of this Report...............................................................................................9

RATE METHODOLOGY..................................................................................................11

Process..........................................................................................................................11 Adjustment Factor Selection Criteria and Principles........................................11

1999-2000 Adjustment Factors .........................................................................................13 Rationale for Rate Methodology .............................................................................17 Overview of Model Application ...............................................................................17 Data Sources................................................................................................................18 Data Quality Review ...................................................................................................19 Methodological Steps ................................................................................................19

Step 1: Calculation of Actual Cost per Equivalent Weighted Case.......................................19 Step 2: Calculation of Adjustment Factors .........................................................................22 Step 3: Calibration and Evaluation of Model ......................................................................23 Step 4: Application of the Model for Recently Merged Facilities ...........................................25

1999/2000 Model Application ...................................................................................26 Model and Data Enhancements ........................................................................................26 Adjustment Factors that are on the Rate Sub-Committee Work Plan ...................................26

VOLUME METHODOLOGY............................................................................................29

Overview of the Recommended Volume Equity Model ....................................29 Allocation of Volumes to Communities ..............................................................................30 Allocation of Community-Specific Volumes (Base Year and Growth) to Hospitals.................31

Data Sources................................................................................................................32 Definition, Measurement and Allocation of Hospital Volumes.......................33

Weighted Cases as the Unit of Volumes Measurement ......................................................33 Measurement and Allocation of Hospital Volumes ..............................................................33 Step 1: Measurement of Community-Specific Weighted Cases ...........................................34 Step 2: Measurement and Summary of the Population Adjustment Factors .........................37 Factors used for Pregnancy, Childbirth, Newborns and Neonates .......................................39 Step 3: Analysis and Calibration of the Population-based Model .........................................39

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iii

TABLE OF CONTENTS

Medical and Surgical Case Mix.........................................................................................40 Newborn and Neonate Case Mix ......................................................................................44 MoHLTC Normalization of Case Mix .................................................................................44 Step 4: Growth Adjustment – Estimating the Impact of Demographic Growth and Aging to 2000/2001 .......................................................................................................................45 Step 5: Hospital Allocations (Base Year and Growth) .........................................................46

VOLUMES WORK PLAN................................................................................................48

CONCLUSION...................................................................................................................49

LIST OF APPENDICES...................................................................................................50

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iv

List of Exhibits

EXHIBIT 1: PATIENT ACTIVITY INCLUDED IN RATE MODEL BY TYPE OF HOSPITAL...............................18

EXHIBIT 2: UNIT COST RATIOS CALCULATED BY TYPE OF HOSPITAL................................................20

EXHIBIT 3: CALCULATION OF AN EMERGENCY EQUIVALENT W EIGHED CASE .....................................20

EXHIBIT 4: WEIGHTED CASE EQUIVALENCIES BY PATIENT TYPE .....................................................21

EXHIBIT 5: ADJUSTMENT FACTORS BY HOSPITAL TYPE .................................................................23

EXHIBIT 6: OUTLIER HOSPITALS ................................................................................................24

EXHIBIT 7: ADJUSTMENT FACTOR COEFFICIENTS .........................................................................24

EXHIBIT 8: APPLICATION OF VOLUMES MODEL .............................................................................34

EXHIBIT 9: CALCULATION OF MARI INDEX ..................................................................................41

EXHIBIT 10: DISTRIBUTION OF MEDICAL AND SURGICAL MODEL NEEDS INDEX BY COMMUNITY, 99/00 ..41

EXHIBIT 11: CASE M IX - NORMALIZATION FACTOR TABLE (PRE-GROWTH) .......................................44

EXHIBIT 12: CASE M IX-NORMALIZATION FACTOR (POST-GROWTH).................................................46

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RD 9-12 Hospital Funding Formula using 1999/2000 Data Page 1

EXECUTIVE SUMMARY

Current Hospital Funding

Hospital funding has evolved significantly since the introduction of the government sponsored Hospital Insurance Plan in 1959. Today the funding for a hospital is made up of a variety of funding streams from the Ministry of Health and Long-Term Care (MoHLTC) and from fundraising activities. Hospitals also receive revenues from other sources: WSIB, out of province patients, out of country patients, etc. The MOHLTC provides funding to hospitals through:

• Global funding for the majority of in-patient and out-patient programs;

• Priority funding for special programs such as dialysis and hip and knee replacement;

• One-time funding which is based upon JPPC formulas, political decision and other various criteria; and,

• Designated nursing funding and emergency room funding.

The largest portion of a hospital’s funding comes through the global budget. Historically this budget has been based upon a hospital’s need as seen through its ability to negotiate funds with the MOHLTC. The relative resources of a hospital depend upon many factors including the economic status of the Province, the year that the hospital was opened, the ability of a hospital to convince the MoHLTC that additional funds are required for a program, the level of community support, etc.

The result is that the hospital sector has vast inequities in funding, with over 30% variation in hospital funding when measured on a comparable basis (i.e., cost per weighted case base). Some hospitals that have a low actual cost per weighted case expected cost per weighted cases are running deficits, while other hospitals operating above expected cost do not have deficits. This creates inequities in the quality, quantity and breadth of services a hospital can provide to the citizens of its region.

A New Funding Methodology

The Joint Policy and Planning Committee (JPPC) has been working, over the past four years, on a formula that will decrease the inequities in the volume of services hospitals provide and in the rate they are paid for that service.

The goal of Funding Formula is to ensure that each hospital is able to provide an equal share of appropriate services to their population, given the total hospital budget in Ontario. Essentially this is a resource sharing exercise. The question is

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“what is a hospital’s fair share of the pie?” not “how many resources should the hospital system get?” or “what is the appropriate size of the pie”.

There are two parts to the JPPC formula. The Volumes Model attempts to estimate how many cases a hospital should be treating in a given year (the number of patients who enter the hospital). The Rate Model attempts to estimate how much a hospital should be paid for each case (how much does the patient cost once he/she is in the door While these formulae have been developed independently, it is possible to consider multiplying the results together to estimate total funding, at least for a portion of the hospital budget.

The Volumes Model

The Volumes Model predicts acute care inpatient hospital volumes for three types of activity: medical and surgical, pregnancy and childbirth, neonatal and newborn. The model predicts the volume of care the hospital should expect to provide given the demographic makeup and other characteristics of its catchment / referral/market population. The Model then calculates the market share each hospital has in each region and allocates those volumes back to the hospitals. Finally region-specific growth is allocated to hospitals in the region that the growth occurs in the case of primary and secondary care.

Hospital activity is measured by weighted units, called Resource Intensity Weights (RIW’s). The weights used allow for the comparison of the relative costs of treating different types of patients. For example, we would expect a patient having open heart surgery to incur vastly different costs than a woman having a normal delivery, and this cost difference is reflected in the RIW’s.

The simplest way to estimate the expected volume of service which a hospital should provide is to do so on a per capita basis. By this method, we would simply calculate the ratio of weighted cases to total population for the entire province, and apply that ratio to the service population of an individual hospital.

For example, if there are 2,000,000 weighted cases completed in the Province, and there are 10,000,000 people, then you could expect the average to be 200 weighted cases per thousand population. If a hospital served a population of 50,000 people, they could be expected to perform 10,000 weighted cases.

Volume Adjustment Factors

However, this simple type of estimation would ignore many factors affecting hospital utilization which have been clearly documented in several international and Ontario studies. For instance, studies have shown that gender and age affect the rate of hospital usage. International literature has shown that people with low income require hospital care more often than people with higher incomes. It has also been shown that aboriginal people require more frequent hospital care than

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do other groups

In order to develop hypotheses concerning which characteristics of the population would impact utilization, the JPPC convened a sub-committee of hospital experts. These hypotheses were tested using the Ontario database and compared against actual experience in Ontario. The results of this analysis were to include age, sex, aboriginal status, mortality rates, and income level as predictors of hospital volumes in the statistical model developed.

Once the regional rates are calculated, the volumes are allocated to the hospitals, which treat patients from that region, in a second step of the model

Current Volume – Market Share and Proximity Models: The model makes a distinction between volumes of care necessary to treat the population present in the base year of the model, and volumes related to population growth between the base year and the funding year. For the population present in the base year, hospital volumes are allocated with respect to current market share. A hospital in Muskoka, for example, which serves patients whose residents reside in Toronto, but may be vacationing in Muskoka, gets its proportionate share of the volume of care required for residents of Toronto. For the population growth, which occurs between the base year and the funding year, however, a different method is used with respect to primary and secondary care. In this situation only those local hospitals, within the census division (or in some cases, census subdivision) receive any share of the hospital volumes associated with this growth population. In this instance, the volumes are assigned to reflect a policy of providing care close to home. The current volume of a hospital is calculated based on the people who actually come through the door (market share). This means that if a hospital has a lot of inflow from other regions, it gets credit for the service it provides to the citizens of that region. Now, if the model was left with just the current market share as the basis for funding, it would assume that new populations would follow old referral patterns and not give a hospital a chance to expand services to meet local growth.

For growth populations the model assumes that they are going to obtain non-tertiary hospital care at their closest hospital (proximity model). To arrive at this estimate, the projected volume growth in a census division is divided by the hospitals in that census division. Next year, a model will be developed that analyzes regional population growth, and the number of miles to the nearest hospital. It will allocate the volumes to the closest hospital and thereby better align population growth with local hospital services.

Tertiary services are assumed to follow historic referral patterns, with most tertiary cases being treated at the nearest teaching hospital. The teaching hospital, or other hospital that treats the tertiary case would get volume credit for the same portion of cases it has historically treated.

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2000-2001 Adjustment Factors – Volumes Model

As discussed above, the funding model takes into account a number of factors, which determine expected hospital volumes. The specific factors present in the Volumes Model are as follows:

Adjustment Factors for Medical/Surgical Volumes

• Age/Sex Makeup of the Population

• Excess mortality by age group

• Socio-economic status (as measured by average income)

• Percentage of Aboriginals living in the geographic area

• Percentage of the area which is deemed rural

Adjustment Factors for Pregnancy and Childbirth Volumes

• Age/Sex Makeup of the population

• Fertility Rate

Adjustment Factors for Newborn and Neonatal Volumes

• Age/Sex makeup of the population

• % of Low Birth Weight Infants (defined as infants with birth weight less than 2500g)

The Rate Model of the JPPC

While the Volumes Model predicts the number of cases (weighted) which the hospital should treat, the Rates Model predicts the cost performance of the hospital (measured by unit cost, or cost per weighted case).

The Rates model combines two previous cost models, the Adjustment Factors Model, which applied to community and teaching hospitals, and the Small Hospital Model, which applies to small hospitals. For instance, the models were used to help distribute nursing funding to hospitals in 1999. One of the notable features of The Rate Model is that it combines all acute hospitals into a single model, incorporating the adjustment factors of the two previous models. In addition, the Rate model includes chronic care activity and costs for the first time.

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Analogous to the per capita method for estimating hospital volumes, there is a simple method of estimating hospital cost performance, to simply use the provincial average cost per weighted case. Such an approach would ignore, however, the important distinction between hospitals. Indeed, almost any hospital can provide reasons why its cost performance may not be typical of that of other hospitals. In order to decide which “adjustment factors” should be used to account for cost differences, the JPPC worked through a committee of experts, with broad representation from hospitals across the province, and sought advice widely from those who work in the hospital field. The JPPC also sought the advice of a number of academics, both statisticians and economists, from Canada, England, and the United States, in developing its model.

The Rate Model Adjustment Factors

The Rate Model is applied to:

• All of the activity in small hospitals

• Acute, day surgery and chronic care activity in large hospitals

• Chronic care activity in stand alone chronic hospitals

After all of these deliberations, a model was developed which includes six adjustment factors. These are:

1. Isolation – Hospitals located in isolated areas (define) are expected to have higher costs than those which are not

2. Size- small hospitals are expected to incur higher costs per weighted case than larger hospitals, and an inverse size adjustment recognizes this effect

3. Teaching- Teaching hospitals are expected to have higher costs than other hospitals, and a measure of medical student days per patient day reflects this effect.

4. Neonate Tertiary – Hospitals with Neonatal Tertiary programs are expected to have higher costs than expected, and an adjustment is made corresponding to the relative size of the neonatal tertiary care program present in the hospital

5. Non-neonate Tertiary – Hospitals providing tertiary care are also expected to have higher costs, and an adjustment for the percentage of non-neonate tertiary cases is included in the model

6. Free Standing Chronic Care Facility- in order to insure that free standing chronic care facilities are not systematically disadvantaged in the model, a free standing adjustment aligns the distribution of costs of these facilities with those of acute care hospitals.

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Isolation hypothesis: Hospitals that are isolated may have increased costs due to the higher transportation costs of supplies, and the inability to share other overhead compared to non-isolated hospitals.

Size hypothesis: Small hospitals have higher fixed costs, as they must provide a full range of services, even if those services are used infrequently.

These hypotheses were tested against the data, and it was determined that these factors do increase the cost of providing service. A model was developed that gave hospitals the same adjustment for size, and compensated hospitals depending on the distance between their hospitals and the next closest hospital.

Teaching hypothesis: The occurrence of teaching in a hospital increases costs and the number of third and fourth year medical students and residents in a hospital is a proxy for these increased costs. This hypothesis was tested and it was found that teaching hospitals did have a higher cost structure that was related to teaching third and fourth year medical students and residents.

Neonate and Non-neonate Tertiary hypothesis: The cost weighting does not accurately reflect the true cost of providing tertiary services.

Ontario has not had detailed cost data in the past. Until 1999-2000, all of the financial data used to calculate the cost per weighted case was obtained from the State of Maryland. The hospitals in Maryland collected the amount they charged for each type of case and transferred it into a database. Unfortunately, the Maryland hospitals had a practice of subsidizing high cost, low volume cases, such as neonate cases and quaternary adult cases, with high volume low cost cases such as normal vaginal delivery. This, in effect, “compressed” their charge scale (vaginal delivery was more expensive, neonates in incubators were less expensive than actual costs).

Ontario does not charge the patient directly and does attempt to fund the hospital for the actual cost of providing a treatment. Therefore, a method of “de-compressing” the Maryland charge data was developed using a neonate tertiary adjustment factor and non-neonate tertiary adjustment factor.

Since 1999, Canadian data has been added to the Maryland data set. At this point in time, the cost data is primarily Canadian, and Maryland charge data is only being used where the volume of cases is not large enough to provide an accurate measure. It is expected that over time the neonate and non-neonate tertiary adjustment factors will decrease in size as the Canadian cost data increases in volume.

Freestanding chronic care hypothesis: The cost structure associated with providing care in a freestanding facility is different than one associated with providing care in a mixed chronic and acute facility. In a mixed acute facility the overhead costs of running the facility are spread across more cases than in a stand alone chronic facility.

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INTRODUCTION

Historical Funding in Ontario

Hospital funding has evolved significantly since the introduction of the government sponsored Hospital Insurance Plan in 1959. Hospitals have been funded through various funding mechanisms including line-by-line and global funding formulae. Since the early 1990’s, the Joint Policy and Planning Committee (JPPC) of the Ministry of Health and Long Term Care and the Ontario Hospital Association has pursued the development of hospital funding formulae and policies to improve funding equity in the hospital system.

Cost equity has been evaluated by comparing each hospital’s unit cost to a hospital specific target based on the average cost per weighted case in the province for similar facilities. These evaluations have been used to distribute available equity funds to low unit cost hospitals, and to disproportionately reduce the funding to high unit cost hospitals. The Adjustment Factors Sub-Committee of the JPPC Hospital Funding Committee (HFC) developed a model for setting large/community hospital expected cost per weighted case for acute and day surgery activity, and the Small Hospital Sub-Committee developed a unique model that was applicable to small hospitals. In each model, hospital specific cost per weighted case targets were set taking into consideration factors that:

• Are measurable;

• Are based on available data;

• Have a material influence on hospital cost per weighted case; and

• Are thought to be beyond management control.

The large/community acute funding model, historically called the Adjustment Factors model, was based on a weighted least squares regression model that predicted a hospital’s cost per weighted case based on adjustments for three factors, including:

• Non-neonate tertiary activity;

• Newborn and neonate tertiary activity; and,

• Teaching intensity.

The small acute funding model was based on a non-linear weighted least squares regression model that separated direct and overhead expenditures and included adjustments for size and isolation.

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Population equity has been promoted by the development of formulae to measure the anticipated growth in hospital volumes that will result from population growth and aging. Hospitals that serve high growth communities and have received additional funding to support anticipated growth pressures.

Enhancements to Rate and Volume Equity Funding Methodologies

Application of formulae, such as the adjustment factors and growth funding formula, has improved relative funding equity by rewarding providers that are low cost providers and that have communities with substantial growth. However, there are a number of enhancements that are needed to improve the fairness, responsiveness and scope of relevance of these formulae, including:

• The measurement and inclusion of all components of the hospital system (e.g. chronic care, rehabilitation, outpatient, etc.);

• The integration of all funding formulae (e.g. small and large/community hospital formula, acute care and chronic care funding);

• A methodology that is sensitive to both relative population needs and population growth; and,

• A methodology for the evaluation of base Ministry of Health and Long Term Care funding and the ability of hospitals to generate revenue from other sources.

The JPPC Volume Sub-Committee’s recommended volume model introduces population equity by setting hospital volumes based on the population demographics and relative needs of each hospital’s referral population. In addition, the volume model provides a means with which to estimate the impact on hospital volumes of population growth and aging. The JPPC rate formula and the JPPC volume formula to be discussed in this report address the first three of these enhancements. The JPPC Rate Sub-Committee’s recommended rate-equity model includes chronic care activity in cost per equivalent weighted case as measured by Resource Utilization Groups, version III (RUG-III) weighted days. The relative weights for the RUG-III grouper were developed by the JPPC Complex Continuing Care Funding Working Group. In addition, the small and large/community hospital formulas have been integrated into one formula that makes adjustments for size and isolation, along with the teaching and tertiary factors of the large/community hospital formula.

The model presented in this report is based on a “pie sharing” exercise. The process for applying the model is that the Ministry of Health and Long Term Care (MOHLTC) determines the amount of money to be applied under the model (whether that be new funding, or the total hospital allotment), and then the model

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will determine how that money should be distributed most equitably among hospitals. The model does not determine the appropriate level of funding for the hospital system in total.

The JPPC Volume Sub-Committee

“The Volume Sub-Committee’s mandate was to attempt to develop a method of estimating the expected volume of hospital activity, given the characteristics of the population served by the hospital and the impact of other health service providers on the hospital activity rate.

The Volume Sub-Committee has divided its work plan into two phases:

Phase 1: to identify the population factors that affect hospital utilization.

Phase 2: to allocate the impact of these factors to service providers (i.e., hospitals).”1

A Discussion Paper “Predicting Hospital Volumes for Communities” was released by the Volume Sub-Committee in June of 1999 that was a culmination of phase one of their work. The Terms of Reference for the Volumes Committee are founding Appendix 1, with the Committee Membership listed in Appendix 2.

The JPPC Rate Sub-Committee

The current/historical funding models have been developed to adjust a global budget that a hospital has received from the MOHLTC for rate factors that are beyond the management of the hospital’s control. This has created a situation where there could be two hospitals, each providing services below the expected unit cost, and one hospital could be in a deficit position and the other in a surplus position. This intuitively is inequitable, and has spurred the drive to develop a new funding model.

In the past, funding models in Ontario have focused solely on the costs of providing services. In the context of this new funding model. The Rate Sub-Committee is responsible for the Rate Model. The terms of reference of the Rate Sub-Committee are in Appendix 3. The members of the Rate Sub-Committee are listed in Appendix 4.

Overview of this Report

This report provides the detail on the JPPC committee processes for developing the model, the hypotheses justifying specific rate and volume adjustments, and the rationale for the application of the models. Some of the detailed technical

1 Predicting Hospital Volumes for Communities, JPPC Discussion Paper #DP3-5, June 1999, pg. 5

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methodology applied in developing both the rate and volume methodologies is described. Further detailed technical information on the methods employed to derive the expected rate and volume levels calculated for hospitals can be found in JPPC reference document #9-8, “Integrated Population Based Allocation (IPBA) Formula.”

The methodology for the rate model is discussed first. The data sources included in the methodology are described. The general rationale for the methodology is highlighted and a step-by-step description of the methodology is provided. Also included are model refinements and data enhancements applied to the 1999/2000 data. The adjustment factors that are on the Rate Sub-Committee work plan are discussed. This section concludes with a comparison of hospitals’ actual and expected cost per equivalent weighted case with 1999/2000 data.

A discussion of the volume model follows. An overview of the data sources and model development is provided. A step-by-step methodology for predicting population model allocations is then detailed. Hospital base-year and growth allocations are also detailed. A comparison of hospitals’ actual and expected weighted cases concludes this section.

The creation of this methodology and this report has included the dedication and experience of over 95 hospital representatives. The JPPC would like to thank all of those volunteers who have worked diligently to help us improve the equity in funding for Ontario Hospitals.

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RATE METHODOLOGY

Process

The Rate Sub-Committee reviewed the application of the 1999/2000 funding model to the 1999/2000 data.

The Rate Sub-Committee relied mainly on the following sources of data:

• Canadian Institute for Health Information Discharge Abstract Database (CIHI DAD)

• Ontario Cost Distribution Methodology (OCDM)

• Ontario Hospital Recording System (OHRS)

• Statistics Canada

• CIHI Ontario Chronic Care Patient System (CIHI OCCPS) – the provincial Minimum Data Set version 2.0 (MDS 2.0) database

The JPPC is in the middle of a multi-year project to develop case weighting methodologies for all hospital activity. To date work has been completed on the acute, day surgery and chronic care sectors. Emergency Room data has been collected by hospitals since June 2000. It is hoped that this data will be available for funding modeling starting with the 2001/2002 financial data. The JPPC has presented a report to the MOHLTC suggesting that the CIHI Functional Independence Measure (FIM)-based minimum data set be used for the collection of inpatient rehabilitation data. No date for rehabilitation data collection had been set at the time of this printing.

Adjustment Factor Selection Criteria and Principles

1. Largely beyond management control

The intent of this principle is to adjust for factors that are beyond management’s ability to manipulate in the short term to affect the funding of a hospital. While it is acknowledged that all factors that a hospital manages are within management’s control in the long term, the factors that are being considered in the funding models are not likely to be modified in the short term in response to a funding model.

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2. Measurable, reliable and readily available

The event being measured should have discrete values that lend themselves to measurement. All data that is used must be collected under accepted rules and principles. There must be perceived consistency around the data collection. At the same time, it is acknowledged that no data set is perfect.

3. Simple to understand

The logic behind choosing the adjustment factor should be simple to understand and easily explainable to a colleague in the health administration field. Although the statistical method that is used to develop the adjustment factor may not be simple to understand, the general process and logic must be.

4. Material

There are two aspects to materiality. In order to be statistically material, a coefficient must contribute to the model’s predictive ability. A coefficient must also be weighed according to its political materiality.

5. Equity between hospitals in entitlement

The historic funding in Ontario has been based on a global budget supplemented by adjustment factors. This model has not been devised through an analysis of services provided by a hospital, but rather through modifications to historic funding levels, and political climates during negotiation sessions. This model will provide more equitable access among hospitals to funds based on the volume and type of services provided.

6. Transparency

The process, logic and statistical methodology must be clear and open.

7. Timeliness

The data and assumptions used in this methodology must be collected and decided upon in a timely manner. The data being used must be timely as there are many modifications in a hospital’s organizational structure and in medical protocols each year. The working group will not be accepting assumptions written in the past, but will re-evaluate assumptions to ensure that they are valid given the current health care environment.

8. Discriminating power and distinct

Each adjustment factor used must be discrete from other factors in its power to distinguish between hospitals and in its power over the model.

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9. Robust

The model must be valid across different types of hospitals and across time.

10. Comprehensive yet flexible

History would tell us that the model is not going to be drastically changed each year. There will be significant changes that we would hope would be reflected in the model. The model must be sturdy enough that it is not open to gaming and flexible enough that it does not break with the tiniest of changes to the system.

1999-2000 Adjustment Factors

Teaching Activity

The Adjustment Factor Sub-Committee of the JPPC established teaching activity in 1995 as a cost adjustment factor for Ontario funding models2. It was shown, and continues to be shown that the cost of completing medical education increases the cost of running a hospital. For academically based university affiliated hospitals the presence of teaching activity is beyond management’s control although the amount of teaching activity over the long term is within management’s control. For some community hospitals a decision to accept a medical teaching role is within management’s control. It was felt that medical education in all spheres of medical practice is important enough that it should be supported by adjustment factors, regardless of the degree of management control.

Hospitals with teaching activity have higher costs per weighted case which may be due to: the existence and maintenance of the required teaching infrastructure and more specialized programs; higher utilization of diagnostic testing, aggressive or innovative treatment procedures, ancillary services, and other resources by residents and academic physicians. Accordingly, hospitals with teaching activity incur higher cost per weighted case than hospitals without teaching activity.

A common misunderstanding is that the teaching adjustment provided in the formula is a payment per medical student. This is not the case. In fact, teaching activity was the variable that was being measured, not simply the number of medical students in a hospital. Through the JPPC’s analysis it was found that the ratio of medical trainee days per patient census in a teaching hospital was an appropriate proxy to reflect the “intensity” of teaching activity in relation to the size of the institution.

Hospitals and/or affiliated medical schools annually submit information to the JPPC detailing the number of medical trainees and their respective amount of time spent

2 Replacing Peer Groups with Adjustment Factors, JPPC, Discussion Paper #3-2, November 1995, pages. 15-16

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in medical training at each hospital. Thus, the number of medical trainees divided by a hospital’s average daily census is the formula used to represent teaching intensity in the adjustment factors funding formula.”3

The 1999/2000 teaching adjustment was calculated as follows:

Teaching Activity Measure = Medical Student Days/ Patient Census

The following issues have been raised regarding the medical student data:

• Student numbers are not consistently reported and therefore difficult to validate records based on text fields such as name.

• CPSO number is a mandatory field but hospitals don’t consistently keep this information.

• University data is not a reliable means of auditing data – University data is usually planning data and is inconsistently managed.

• Year one and Two students are not included in calculations - need to re-evaluate which years of student data should be included in the model.

• Hospitals need to respect time lines and reporting standards.

• Data is self-reported so collection should be part of MIS reporting.

It was decided that since a process and edit checks were in place for the medical student trainee data, the data would be used for the 2001-2002 funding year. Continued follow-up on the outstanding issues is being pursued at the time of this printing.

Level of Care

“In 1994, the HAY Group of Health Care consultants developed a methodology to categorize cases into primary, secondary and tertiary levels of care. Referred to as the HAY Group Level of Care methodology, the measure has been adapted for use by the JPPC in determining what constitutes a tertiary case.

3 Methodology Used to Calculate 1999/2000 Adjustment Factors Funding Model, JPPC, Reference Document #7-4, July 1998, page 3

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The measure is a CMG-based categorization of cases based on three criteria: 1) the intensity of resources required to treat the patient (i.e., RIW value); 2) the number of hospitals which treat the particular case in Ontario; and 3) hospitals treating these cases do so for patients from other communities (i.e. Percent of Metropolitan Toronto volumes provided to patients outside of the Greater Toronto Area). For a technical review of the methodology refer to: The HAY Group Level of Care Methodology – JPPC reference document 6-9.”4

Non-Neonate Tertiary

“Tertiary care is defined as hospital services provided to patients requiring complex treatment. Tertiary care frequently involves a wide range of services, equipment, or techniques that are specialized and expensive. Hospitals that provide tertiary level of care services (i.e. tertiary centers) are believed to have higher cost per weighted case. The extra costs incurred by tertiary centers are associated with the variable utilization of specialized programs and equipment; the high proportion of transfer cases; and the treatment of more complex cases (i.e. more severe cases within the CMGs). Accordingly, hospitals that treat a higher than average proportion of tertiary level patient might incur higher cost per weighted case.”5

This hypothesis has been supported by annual data analysis over the past five years. The model measuring the amount of impact tertiary care has on a hospital basis has been refined over the years. In 1999 the adult tertiary adjustment was found to be the most powerful predictor of cost per weighted case.

It is believed that one factor that contributes to the need for the tertiary factor is that the RIW does not account fully for the tertiariness of a case. The tertiary cases are in effect undervalued by the RIW system. This is due to the fact that prior to 1999 the RIW was based on Maryland data of the amount charged to patients for the various cases. This charge data is “compressed”. What happened is that the Maryland hospitals subsidize the low volume, extremely high cost cases with low cost, high volume cases. For example, by adding a small amount on to the charge of each normal vaginal delivery, the cost of a neonatal case is reduced. In 1999 Canadian case cost data was introduced to the RIW database, and it is expected that as the RIW database relies more heavily on Canadian cost data, the level of care will be more accurately reflected in the RIW, and the need for a tertiary adjustment factor could be reduced.

4 Methodology Used to Calculate 1999/2000 Adjustment Factors Funding Model, JPPC, Reference Document #7-4, July 1998, page 2 5 Methodology Used to Calculate 1999/2000 Adjustment Factors Funding Model, JPPC, Reference Document #7-4, July 1998, page 2

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Neonate Tertiary

“It is commonly believed that very elderly patients cost more than other patients because they have longer lengths of stay per hospital visit and utilize more resources (i.e., nursing care) than the average patient. Similarly, the very young are also perceived to be more expensive as they require more intensive nursing care and ancillary resources than adult patients.

The two beliefs differ in one key aspect. For paediatrics, the belief is that the cost driver is an increased use of resources per day; for elderly patients the cost driver is an increased length of stay. If the Resource Intensity Weights (RIWs) are fairly valued, then all patients should have the same cost per weighted case. However, if the RIWs for patients of a specific age group are under-valued, then this would explain the higher cost per weighted case of hospitals with disproportionate shares of patients in these age groups.

The results of the analysis conducted by the JPPC substantiated this hypothesis for newborn/neonate CMGs. The JPPC’s analysis revealed that for Ontario, the State of Maryland’s Resource Intensity Weights for newborns/neonates CMGs are undervalued and thus, care in this patient group is more expensive than the weights suggest. This finding was validated using the Ontario Case Cost Project’s database. Further analysis conducted in 1997 revealed that due to changes in RIW values for newborns, there was no longer a need for an adjustment factor for newborns. Therefore, in 1997, the Adjustment factors model was modified to limit the scope of the newborn and neonate factor to tertiary neonate cases.”6

Hospital Size

Hypothesis: Smaller hospitals have higher percentage of indirect costs per unit due to the low volume of cases

It was previously found by the JPPC Small Hospitals Sub-Committee that “very small hospitals face a unique range of challenges by virtue of their size, typical geographical location and constitution of the population that they serve.”7 The Rate Sub-Committee decided to investigate hospital size as an adjustment factor.

Isolation

Isolated hospitals must offer all essential services, despite low volume or sporadic demand as the sole provider of health care services in a specific location. More isolated communities have relatively more facilities and services per capita than other communities of their size. Consequently, the hospitals incur increased costs of operating programs due to the low volumes involved. Increased costs result

6Methodology Used to Calculate 1999/2000 Adjustment Factors Funding Model, JPPC, Reference Document #7-4, July 1998, pages 3-4. 7 An Approach for Funding Small Hospitals, JPPC, Reference Document #5-1, page 5.

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from higher clinical, staffing, administration and support costs. The increase in resources required to provide a given service is described as the ‘basket of goods’ by the Small Hospitals Sub-Group.”8

Chronic Care

The cost structure associated with providing care in a freestanding facility is different than one associated with providing care in a mixed chronic and acute facility. In a mixed acute facility the overhead costs of running the facility are spread across more cases than in a stand alone chronic facility.

Rationale for Rate Methodology

The rate model allows an evaluation of cost equity by comparing each hospital’s actual cost per weighted case with a unique expected cost per weighted case that takes into account factors beyond management control that influence unit cost.

An expected unit cost has been calculated for large/community and small acute care facilities for the last several years. For large/community acute care facilities, the rate, expressed as “cost per weighted case”, has focused only on acute inpatient and day surgery activity. As well, there have been separate formulae for large/community and for small facilities. The rate model integrates these formulae to include, where possible, other patient activity types into the model. Specifically the model:

• Integrates the small and large/community hospital acute funding formulae; and,

• Introduces chronic activity into hospital unit cost comparisons

Overview of Model Application

The recommended rate model includes small and large/community acute care facilities, as well as stand-alone chronic care facilities. The small hospital population includes any hospital that met the following criteria in the 1997/98 funding year:

• Less than 3,500 equivalent weighted cases (EWC) (acute inpatient and day surgery weighted cases, emergency visit EWC, chronic patient day EWC, rehabilitation patient day EWC);

• Less than 20,000 ESI referral population; and,

• Single, provincial community provider.

8An Approach for Funding Small Hospitals, JPPC, Reference Document #5-1, p. 5

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The small hospital formula has historically included all activity and expenses, with the exception of clinic and day/night care activity. The introduction of RUGS-III-weighted days allows chronic care to be included in the model for small and large/community acute facilities as well as for stand-alone chronic hospitals. With the exception for smaller facilities, all other activity and expenses (e.g. rehabilitation, outpatient) will be dealt with outside of this funding formula. Exhibit 1 indicates the patient types included in the model by type of hospital.

Exhibit 1: Patient Activity Included in Rate Model by Type of Hospital

The small hospital group includes 53 organizations in the 1999/2000 fiscal year. Large/community acute care facilities include both community and teaching facilities. There are 11 teaching organizations and 78 community organizations in 1999/2000. The stand-alone chronic care group includes 15 organizations that provide chronic care but do not provide acute care. It is important to note that several mergers occurred following the 1999/2000 fiscal year. Where possible, hospital mergers have been identified and the formula results are expressed for the merged hospital in the 1999/2000 fiscal year.

The model calculates an overall expected cost per equivalent weighted case (ECPEWC) by hospital for the patient activity types identified above.

Data Sources

Data for the 1999/2000 fiscal year, were utilized to generate an expected cost per weighted case for each hospital, including:

• Ontario Cost Distribution Methodology (OCDM) data;

• MIS trial balance submissions;

• Supplementary tables;

• Canadian Institute for Health Information (CIHI) acute inpatient and day surgery discharge abstract data grouped by complexity (Plx 99);

• MDS/RUG-III-weighted patient days provided by the JPPC Complex Continuing Care Technical Working Group;

Small Acute Care Hospitals

Large Acute Care Hospitals

Stand-Alone Chronic Care

Acute Inpatient and DS X XChronic Care X X XRehabilitation XEmergency (Out-pt) XELDCAP X

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• Medical student trainee data collected by the JPPC;

• Level of care mapping to CMG 99; and,

• Northern and rural hospital framework definitions for rural and northern hospitals.

Data Quality Review

A data quality review was conducted to review the data elements required in the calculation of the expected cost per equivalent weighted case. This included a review of the 1999/2000 Ontario Cost Distribution Methodology data, specifically, a review of valid entry codes in functional centres (e.g. if expenses greater than 0 then relevant statistics should be greater than 0).

The results of this review indicated that several facilities reported expenses but no, or poor-quality, activity statistics, or, activity statistics but no expenses. Exclusions and/or assumptions were made case by case to correct the data set. It is important to note that no corrective action was necessary where expenses were incorrectly allocated from small hospitals as the approach used for small hospitals, already corrects for this. The only exception to this was in the case where a hospital reported ELDCAP expenses but no activity. In these cases, the ELDCAP expenses were added to chronic care expenses. This was done to more accurately calculate the weighted case equivalency for chronic care.

Finally, a number of facilities were excluded from both the rate and volume model because they are specialty facilities that don’t have activity measure or private facilities that do not report financial data. Stand-alone chronic care facilities are not included in the volume model since the volume model only applies to acute and day surgery cases.

Methodological Steps

Step 1: Calculation of Actual Cost per Equivalent Weighted Case

The MOHLTC calculates an actual cost per weighted case (ACPWC) using the OCDM. This ratio however, only pertains to acute inpatient and day surgery activity whereas the proposed model includes various types of activity. Therefore, a new measurement of unit cost, known as the actual cost per equivalent weighted case (ACPEWC) is calculated using the OCDM data to include the relevant patient activity data depending upon the hospital type for which the calculation is being made. For small hospitals, acute, chronic, rehabilitation, ELDCAP and outpatient emergency costs and activity are included in the model. For large/community acute facilities, acute and chronic care expenses and activity are included. For stand-alone chronic care facilities, only chronic care expenses and activity are included.

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The next several paragraphs detail how the various patient types are incorporated into the calculation of a new ACPEWC.

The OCDM allocates departmental hospital expenses to patient areas, including:

• Acute inpatient and day surgery (expenses, weighted cases);

• Chronic care (expenses, RUG-III-weighted patient days);

• Rehabilitation (expenses, patient days); and,

• Emergency (expenses, visits) and other outpatient expenses

The costs and activity are summarized by patient area by hospital and, a unit cost is derived by patient area by hospital. Exhibit 2 below, details the ratios calculated for each hospital.

Exhibit 2: Unit Cost Ratios Calculated by Type of Hospital

To calculate a new ACPEWC that encompasses all of the relevant patient areas, chronic care and other patient areas must be integrated into one cost per equivalent weighted case. This is done by establishing a common denominator, or an equivalent weighted case (EWC). An EWC is calculated for each patient area by comparing the average cost per unit for each patient area to the average full cost of an acute weighted case. Exhibit 3 provides an example of the calculation using emergency data:

Exhibit 3: Calculation of an Emergency Equivalent Weighed Case

( )

=

CaseWeightedperCost

AcuteFullAverageVisitEmergperCostFull

CaseWeighted

Equivalent

Emergency

The equivalent weighted case calculation was applied to 1999/2000 data. Weighted mean unit costs were calculated for all patient types and were trimmed at the 10th and 90th percentiles. Exhibit 4 provides detail on the equivalencies by patient type. The exhibit shows that, for example, the average full cost of a small hospital emergency department (outpatient visit) is $139 and the average full cost of an acute weighted case is $2,796. Therefore, one emergency visit is equivalent to $139/$2,796 or 0.050 equivalent weighted cases for small acute care facilities.

Small Acute Care Hospitals Large Acute Care HospitalsStand-Alone Chronic Care

HospitalsAcute Inpatient and DS Cost per Weighted Case Cost per Weighted CaseChronic Care Cost per RUG-Weighted Pt Day Cost per RUG-Weighted Pt Day Cost per RUG-Weighted Pt DayRehabilitation Cost per Patient DayEmergency (Out-pt) Cost per VisitELDCAP Cost per Patient Day

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Exhibit 4: Weighted Case Equivalencies by Patient Type

Units of Activity Average Cost per Unit Weighted Case Equivalency

Acute weighted cases 2796.40

Chronic patient days 283.03 0.1012

Emergency outpatient visits 138.75 0.0496

Rehabilitation patient days 492.19 0.1760

ELDCAP patient days 176.80 0.0632

The weighted case equivalencies are then applied to hospital-specific data to calculate the total equivalent weighted cases for each hospital. The total number of equivalent weighted cases, by hospital type, is equal to:

• Small acute care hospitals

CasesdWt

AcuteTotal

DaysPatient

ELDCAP

CasesdWtEquivalent

DaysPatient

hab

DaysPatient

dWtChronic

Visits

Emergency

Cases

WeightedEquivalent

'

*0632.0

'

Re

*1760.0'

*1012.0*0496.0 ++++=

• Large/community acute care hospitals

CasesdWt

Acute

Total

DaysPatient

dWtChronic

Cases

Weighted

Equivalent

'

'*1012.0 +=

• Stand-alone chronic care hospitals

Days Patient d Wt Chronic

Cases Weighted Equivalent

' * 1012 . 0 =

It is important to note that the approach for small hospitals includes all patient activity since small hospitals have more difficulty allocating their departmental costs across patient types. A typical example is that a small hospital may staff one nurse for both a nursing unit and the emergency department. As a result, the hours and dollars associated with that nurse are more difficult to allocate appropriately to each functional centre.

The cost allocation problem may also be true, to a lesser extent for larger acute hospitals. However, application of an equivalent weighted case methodology for rehabilitation and emergency care has not been attempted for large/community hospitals since median costs cannot be applied in areas such as emergency and rehabilitation until resource intensity weights are available. As an example, the cost

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of an emergency visit in a teaching facility with a trauma unit will be much higher than the cost of an emergency visit in a community hospital without trauma. Applying a median emergency cost per visit across all large/community acute hospitals would disadvantage more tertiary emergency activity and advantage less tertiary emergency activity.

The calculation of an ACPEWC is therefore equal to the sum of expenses (as per the OCDM) for the relevant patient areas divided by the sum of equivalent weighted cases for a particular hospital. For small hospitals this will include all activity (not including ambulatory care). For community and teaching hospitals, the ACPEWC ratio will pertain to acute and chronic care activity. For stand-alone chronic care hospitals, the ratio will pertain to chronic care only. Appendix 14 provides detail on the breakdown of equivalent weighted cases by hospital by patient area. Appendix 5 details the actual equivalent weighted cases for each hospital.

Step 2: Calculation of Adjustment Factors

The JPPC identified several factors to be included in the integrated model. The rationale for including these factors is discussed elsewhere in this report. These factors were defined as:

• Size adjustment;

- Inverse of equivalent weighted cases

• Tertiary adjustments;

- (Per cent) Non-neonate tertiary factor

= (Non-neonate tertiary weighted cases multiplied by 100) divided by total equivalent weighted cases;

- (Per cent) Newborn and Neonate tertiary factor

= (Newborn/neonate tertiary weighted cases multiplied by 100) divided by total equivalent weighted cases.

• Teaching adjustment;

- Medical student days divided by the sum of acute patient census days, chronic (unweighted) census patient days and day surgery cases;

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• Isolation adjustment; and,

- Percentage of equivalent weighted cases in isolated site(s) as defined by the Rural and Northern hospital framework9

• Stand-alone chronic care hospital flag

- Equal to one for stand-alone chronic care facilities, otherwise equal to zero.

The above factors are calculated for each hospital and then applied and tested in the regression model. Exhibit 5 details the factors included in the regression model by hospital type:

Exhibit 5: Adjustment Factors by Hospital Type

Step 3: Calibration and Evaluation of Model

A weighted least squares regression model is used to test the statistical significance of these factors in predicting cost per weighted case and to estimate the size of the required adjustment. The regression model predicts, based on the factors identified, hospital-specific expected cost per equivalent weighted case (ECPEWC). The model is defined as:

Expected = Base + Size + Neonatal & Non-Neonatal + Teaching + Isolation + Chronic Stand-Alone CPEWC Rate Adjustment Adjustments Adjustment Adjustment Flag

Three iterations of the regression model were applied to identify outlier hospitals. All iterations were weighted by equivalent weighted cases. In the first iteration, observations with a studentized residual outside of three standard deviations were identified as outliers and removed. The second weighted least squares regression model was performed excluding the outliers identified in the first model.

9 Rural and Northern Health: Parameters and Benchmarks: Report of the Joint Committee of the Ministry of Health and the Ontario Hospital Association, July 1998, Appendix 5. For the majority of rural and northern facilities, the isolation adjustment was 100%. However, for a multi -site organization in which one or more of its sites were defined as being isolated, the percentage applied was based upon the weighted average of activity from the isolated site(s).

Total Equivalent Weighted Cases Total Costs

Percent Tertiary

Neonate Factor

Percent Tertiary Non- neonate Factor

Teaching Factor

Percent Isolated

Size Adjustment

Chronic Care Flag

Large Acute Facilities Acute Inpt and DS,

Chronic Acute Inpt and DS,

Chronic Yes Yes Yes Yes Yes 0

Small Acute Facilities

Acute Inpt and DS, Chronic, Rehab,

Emergency

Acute Inpt and DS, Chronic, Rehab,

Emergency No No No Yes Yes 0

Chronic Stand-Alone Facilities Chronic Care Chronic Care No No Yes

Yes Yes 1

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Observations with a studentized residual outside of three standard deviations were again identified as outliers for the third regression. The third regression model excluded outlier hospitals identified by the first two models. Exhibit 6 below identifies those outlier hospitals identified after applying all three iterations of the weighted regression model.

Exhibit 6: Outlier Hospitals

Hospital No. of standard deviations

Sarnia St. Joseph’s 5.76

Kingston Hotel Dieu 3.56

Thunder Bay Hogarth-Westmount 3.50

Sunnybrook and Women’s 3.45

St. Michael’s 3.20

Mount Sinai -3.26

The results of the model indicate that the factors: size, tertiary-ness, teaching, and stand-alone chronic care flag are all significant at p=0.05. The isolation flag was found not to be significant at p=0.05 but was not dropped to maintain model stability. The r-squared of this regression model was 70.5%. The coefficients for the regression model are presented in Exhibit 7 below. Appendix 6 provides the adjustment factor estimates for all hospitals. Appendix 7 provides the actual and expected cost per equivalent weighted case for all hospitals.

Exhibit 7: Adjustment Factor Coefficients

Parameter

Base Rate 2231.27

Size Adjustment 1,152,708.20

Non-Neonate Tertiary Adjustment 15.49

Neonate Tertiary Adjustment 58.01

Teaching Adjustment 1,244.59

Isolation Adjustment 150.59

Chronic Care Flag Adjustment 363.96

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Step 4: Application of the Model for Recently Merged Facilities

During the 1999/2000 fiscal year, several hospitals were in the process of mergers and/or amalgamations. These mergers may or may not have been finalized during the 1999/2000 fiscal year. However, they were recognized by the MOHLTC to have occurred during that year. Where hospitals reported separately for 1999/2000, merging facilities were treated as separate data elements in the calculation of the expected cost per equivalent weighted case. For example, if multi-site hospitals submitted separate trial balances then site-specific actual and expected cost per equivalent weighted case were calculated. Expected and actual cost per equivalent weighted case of the merger facility was then rolled-up to the merged facility in the final presentation of the model results.

The expected cost per weighted case for a merged facility that submitted separate trial balances is therefore, calculated as follows:

• Expected CPEWC results of the regression model is calculated by site;

• Adjustment factors for the individual sites are recalculated as a merged facility;

− Non-neonate tertiary factorMerged = weighted average of non-neonate tertiary factors for merging facilities

− Neonate tertiary factorMerged = weighted average of neonate tertiary factors for merging facilities

− Teaching factorMerged = weighted average of teaching factors for merging facilities

− Size adjustmentMerged = weighted average of size adjustments for merging facilities

− Isolation adjustment = Only applicable where separate patient discharge abstract data sets are provided by site (calculated as percentage of total activity isolated)

− Stand-alone chronic care flagMerged = weighted average of chronic flag(s) for merging facilities

• A new expected CPEWC is derived by taking the weighted average ECPEWC of the individual sites; and,

• A new actual CPEWC is derived by taking the weighted average ACPEWC of the individual sites.

Appendix 8 provides detail on the calculation of the actual and expected cost per equivalent weighted case for recently merged facilities.

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1999/2000 Model Application

Based upon the 1999/2000 data, the model was applied to a total of 157 facilities including mergers. This included 53 small facilities, 78 community facilities, 11 teaching facilities and 15 stand-alone chronic care facilities. Stand-alone rehabilitation facilities and specialty facilities were excluded from the analysis based on the application of the model. Appendix 7 provides hospital-specific results of the model.

Model and Data Enhancements

Resource Intensity Weights (RIWs)

Previous JPPC funding models have used Ontario Case Weight (OCW) data as the basis of measurement for acute and day surgery weighted cases. Last year, the JPPC received feedback that using OCWs was confusing and difficult; hospitals tend to be far more familiar with RIW data, and have easy access to it. RIW data is also the data set that most hospitals use for their internal analyses. Hence, the JPPC Hospital Funding Committee recommended to the MOHLTC that the Ontario Cost Distribution Methodology and JPPC funding models, including this application of the rate model using 1999/2000 data, should be based on RIW data.

Small Hospitals

The methodology used to calculate the emergency outpatient equivalency has been enhanced to include additional expenses such as diagnostic and therapeutic expenses. This refinement was made to better estimate the relative cost of an emergency visit compared to an acute care weighted case for small hospitals.

Tertiary acute care activity reported by small hospitals is included in this application of the rate model. Teaching activity, however, is not included for small hospitals. The Rate Sub-Committee felt that since further analysis is required regarding the teaching factor, no changes would be introduced at this time. The JPPC will continue to collect teaching data from small hospitals for further research.

Adjustment Factors that are on the Rate Sub-Committee Work Plan

Teaching Factor

The Rate Sub-Committee has started to re-examine the specifications and scope of the teaching factor. An expert panel of statisticians/researchers and hospital administrators has been convened to review the recent literature, examine and recommend changes to the specifications of the teaching factor.

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The impact of teaching on hospital operating costs will be examined within the context of different hospital types (e.g., stand-alone chronic care, small and large community, and large affiliated teaching hospitals). As well, the appropriateness of including both undergraduate and graduate medical education will be investigated.

Isolation Factor

Isolation is presently represented in the rate model as a non-continuous factor. Preliminary work has begun to develop a continuous adjustment for isolation. Mileage (i.e., minimum distance, in kilometers, to the nearest facility) as a proxy for isolation was explored but found not to be statistically valid. Future work in this area will continue to explore various approaches to improving this factor.

Chronic Care Factor

When chronic care data were first introduced into the model, it became apparent that an adjustment was needed for the stand-alone chronic care facilities. Without any adjustment, these facilities appeared to be systematically disadvantaged by the rate model. This made intuitive sense since it has been previously demonstrated that these facilities tend to have higher chronic care unit costs than do mixed facilities that have both acute and chronic care activity.

However, it may be the case that some mixed facilities with large chronic care programs may also be disadvantaged by the current specification of the rate model. Hence, further work is being done to examine this issue and to refine the way in which chronic care activity is integrated within the rate model.

Aboriginal Status/Immigrant Population

The hypothesis for including percent aboriginal status and recent immigrant population percent as an adjustment factor is that in addition to the general lower socio-economic status of aboriginal peoples, there are additional costs to providing services to these individuals.

The data on aboriginal status and recent immigrant population was not at a stage where the Rate Sub-Committee felt comfortable analyzing it. Therefore, this adjustment was deferred to the next phase of analysis.

Multi-Site

Hypothesis: Running a 500-bed hospital on one site would incur less cost per weighted case than running it on multiple sites. This could be due to duplication of some services and extended administrative travel time.

It was generally agreed that there were three models in operation in Ontario. The first is operating multiple hospitals on multiple sites. It was suggested that this

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would be the most expensive model of hospital operations. The second model is operating one hospital on multiple sites. It was suggested that this would be the mid-range model with respect to the cost of hospital operations per weighted case. The third model is operating one hospital on one site. It was felt that this would be the most efficient model of operating a hospital.

The hospitals that are operating on multiple sites, particularly when there is such a distance between sites that sharing of services is difficult or time consuming, hypothesized that extra cost would be incurred over the expense of operating a hospital on a single site. The data for investigating this perceived phenomenon was not available within the time frame of this phase of the project. Therefore, the investigation of this possible adjustment factor was deferred for future analysis.

Socio-Economic Status

Hypothesis: A person with lower socio-economic status would incur more cost per weighted case than a person with higher economic status. This could be due to the fact that people with poorer nutrition, lower education, and less home support tend to stay longer in the hospital.

Preliminary analysis using income as a proxy for socio-economic status was done and it was shown that the lower the income of the individual, the longer the length of stay. This suggests that for these patients, the cost of providing care is higher, even with the same admission, treatment planning and discharge planning systems.

There was no time to further investigate and understand this effect. It was decided to defer this adjustment factor for another year until more study had been completed.

Availability of Community Resources

Hypothesis: Lack of community resources would increase length of stay at a hospital, as there are no non-hospital alternatives to support a shorter length of stay. It was found in the Volumes Sub-Committee work that level of community resources did not impact the number of admissions to a hospital. It was felt that there might be an impact on the length of stay of individuals if there were lower levels of community resources.

The availability of community resources would also include availability of physicians both within and without the hospital.

It was decided to defer the investigation of this factor for future analysis.

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VOLUME METHODOLOGY

Overview of the Recommended Volume Equity Model

The purpose of a population-based formula is to distribute volumes of health services to communities equitably, taking into account the factors that legitimately affect utilization of health services. These factors may be population factors such as health and socioeconomic status, or they may be related to the supply of alternatives to hospital care. The methodological goal of the JPPC Volume Sub-Committee was to develop a model to predict the volumes of services that would be used by a community with given size, demographics, population health status indicators, and the availability of alternatives. The terms of reference of the Volume Sub-Committee are in Appendix 5. The members of the Volume Sub-Committee are listed in Appendix 6.

The JPPC Volume Sub-Committee developed and recommended a population-based formula predicting the expected volume of inpatient and day surgery weighted cases for a population with given population characteristics at the average Ontario rate of utilization. Population characteristics used in predicting weighted cases include demographics, income, mortality, aboriginal population, fertility and the incidence of low birth-weight newborns.

Predictions based on this population-based formula can be used to equitably distribute available hospital resources among populations or communities. Equity among communities implies that the funding for hospital services should be proportional to each population’s expected volumes given the referral population’s unique characteristics. The model does not specify the absolute needs of populations

The methodology allocates weighted case volumes to hospitals in two distinct steps:

• First, hospital volumes are allocated to specific Ontario communities (defined at the census division and subdivision level) through population-based community allocations; and

• Second, community-specific volumes are allocated to individual hospital providers through hospital allocations.

Each step is described in detail below.

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Allocation of Volumes to Communities

The objective of this step is to predict the volume of inpatient and day surgery weighted cases for a community with given characteristics at the average Ontario rate of utilization for 1999/2000.10

Three models were developed. These three models are used in combination to predict expected weighted case volumes for each community. Each of the three models was calibrated and tested using:

• five years (1995/96-1999/2000) of Ontario hospital utilization data; and

• an estimate of the relative needs of each community based on each community’s individual characteristics.

The three models are described below:

• Medical and surgical case mix volumes are allocated to each community based on the Ontario experience taking into account population size, age and sex, relative mortality, and low income, aboriginal and rural percentages;

• Pregnancy and childbirth case mix volumes are allocated to each community taking into account female population size and age profile, and their fertility rate relative to the provincial average; and

• Newborn and neonate case mix volumes are allocated to each community based on the size and age profile of the female population, their relative fertility rate and the community-specific percentage of low birth-weight newborns and neonates.

For each model, community-specific expected volumes are calculated in two steps:

1. Community-specific expected volumes are calculated adjusting only for a population’s age and sex distribution.

2. Through regression analysis, an “index” is calculated for each community, taking into account the other population adjustment factors (in the case of the medical and surgical case mix model, the other population adjustment factors are excess mortality, income, aboriginal and rural geography). The age- and sex-adjusted volumes are multiplied by the “index” factor to arrive at expected community-specific volumes.

10 Note: The volumes equity formula is a “pie-sharing” exercise, seeking to equitably distribute existing Ontario weighted case volumes to individual providers. No attempt is made to determine the absolute number of hospital weighted cases that should exist for the province.

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The expected growth in weighted cases between 1999/2000 and 2001/2002 is estimated for each community by applying the 1999/2000 expected per capita utilization rates for each age group and gender cohort (e.g., males 5-9 years, females 60-64 years, etc.) to the change in population size. Growth in medical and surgical case mix is calculated separately for tertiary and non-tertiary activity. This distinction is required to support a repatriation of primary and secondary medical and surgical growth volumes.

Allocation of Community-Specific Volumes (Base Year and Growth) to Hospitals

Community-specific expected weighted cases are allocated to individual hospital providers in proportion to each hospital’s 1999/2000-market share profile for that specific community. This is done for each of the three groups of case mix (medical and surgical, pregnancy and childbirth, and newborn and neonates).

Growth is calculated based upon Ministry of Finance growth projections. This growth is allocated to hospitals in two ways depending on the case mix:

• Growth in primary and secondary medical and surgical weighted case is allocated to hospitals in the same census division as the volume growth of the resident population. This assumes that all primary and secondary medical and surgical growth is repatriated to local hospitals, regardless of what previous market share patterns may have been.

• Growth in tertiary medical and surgical weighted cases, as well as growth in pregnancy and childbirth and newborn and neonate weighted cases, is allocated to individual hospital providers in proportion to 1999/2000 market share profiles for each of these three groups of case mix. This assumes that growth in tertiary services (or pregnancy and childbirth services or newborn and neonate services) will continue to flow to those hospitals, whether local or distant, currently providing that type of care.

Overall expected volumes for each hospital are obtained by summing the base year and growth allocations for each of the three groups of case mix. Comparing this value to hospitals’ actual acute inpatient and day surgery volume for Ontario residents provides a measure of relative volume equity. Hospitals with actual volumes well below expected are considered to be serving relatively under-serviced communities while hospitals with volumes well above expected are considered to be serving relatively over-serviced communities.

The following sections of the report describe:

• the data sources used in the development of the population-based volumes equity model;

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• the definition of “weighted cases” as the unit of measurement in the volumes equity model;

• the steps taken to build the volumes equity formula;

• methodologies used in the development and application of the recommended model to calculate hospital-specific expected volumes.

Data Sources

Data sources used in the development of the volume equity model are outlined below:

• Ontario Ministry of Finance Population Estimates and Projections (1996-2002) for all census sub-divisions in Ontario, provided by 5-year age and gender cohorts, prepared by Statistics Canada, obtained from Ministry of Finance;

• Census (1996) data from Statistics Canada containing data on;

• average household income (grouped into population quintiles);

• aboriginal percentage of population; and

• Population density (land area in square kilometers and population).

• Canadian Institute for Health Information (CIHI) acute inpatient and day surgery discharge abstract data for all Ontario hospitals grouped by complexity (Plx 99) for fiscal years 1995/96 to 1999/2000. CIHI data was also used to provide the number of hospital-related births and deaths for all Ontario.11 Live birth data was used to calculate community-specific fertility rates. Mortality data was used to calculate hospital-related excess mortality rates.

Data regarding Ontario resident utilization of out-of-province hospital services were not available to the JPPC during the development of the Volumes Equity Formula. The Volumes Equity Formula is applied to volumes for Ontario residents for hospital care received in Ontario. As such, actual utilization is understated for certain border communities with a substantial out-of-province flow rate. For example, an unknown (but substantial) fraction of Kenora residents receive hospital services in Winnipeg. In future implementations of the Volumes Equity 11 While the model originally proposed using vital statistics data to count live births and deaths, analysis revealed that geographic units of residence were often misrepresented in larger urban areas (e.g., residence would be listed as “Toronto” instead of a more specific region of “East York” or “North York”). This led to some subdivisions, such as Toronto, being attributed with a very high fertility (or death) rate and other neighbouring subdivisions, such as East York, with surprisingly low fertility (or death) rates. To correct for this, CIHI hospital births (and deaths) were used as a proxy for all live births and (deaths), where postal code data could more accurately pinpoint the actual census subdivision in which a patient resided.

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Formula, the JPPC will work with the Ministry of Health and Long-Term Care to obtain discharge abstracts for all Ontario residents regardless of province where service was received.

Definition, Measurement and Allocation of Hospital Volumes

Weighted Cases as the Unit of Volumes Measurement

Patient volumes were measured using “weighted cases” (also known as Resource Intensity Weights or RIWs). Weighted cases were obtained from the CIHI inpatient and day surgery discharge abstract data grouped by complexity (Plx 99) for the fiscal years 1995/96 through to 1999/200. CIHI RIW is the currency of hospital service volumes in all analysis.

Measurement and Allocation of Hospital Volumes

Five discrete steps were taken in the process of calculating expected weighted case volumes by individual hospitals. They are:

1. Measurement of Community-Specific Weighted Cases. As a first step, 1999/2000 inpatient and day surgery weighted cases are allocated to individual geographic communities in Ontario.

2. Measurement and Summary of the Population Adjustment Factors. Analysis was undertaken to determine which demographic, socio-economic and other factors legitimately influenced hospital utilization volumes. In this step, the selected population factors are described. Trend and variation results are provided at the geographic community level.

3. Analysis and Calibration of the Community-Based Model. This step entails a discussion of the results of regression analyses calculating the impact of each population adjustment factor on the expected volume of weighted cases for individual geographic communities in Ontario.

4. Growth Adjustment. Because the most recent data available for analysis was 1999/2000 data, and it was desired to apply the model to the year 2001/02, a methodology was incorporated to account for anticipated volume changes due to population growth and aging.

5. Allocation of Volumes to Individual Hospital Providers. In this step, community-specific expected weighted case volumes are allocated to individual hospitals. The result is the development of hospital-specific expected weighted case volumes that can be compared to hospital-specific actual volumes.

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Exhibit 8 below depicts the steps in the order they occur. Each of these five steps is described in detail.

Exhibit 8: Application of Volumes Model

Step 1: Measurement of Community-Specific Weighted Cases

Linkage of Patient Volumes to Census Sub-Divisions

To calculate community-specific volume rates, patient-level data must first be linked to population estimates based on a common unit of geography. Unfortunately, a common unit of geography does not exist among the various datasets:

• CIHI abstract data is used to gather patient-level data. This data contains two geographic codes: a residence code (comprised of a combination of a patient’s county and municipality codes) and patient residence postal code.

• Population estimates are obtained from the 1996 Census, where the geographic codes used are census division (CD), census sub-division (CSD) and forward sortation area (FSA or the first three digits of the postal code).

While a one-to-one link exists between the residence code contained in the patient data and the CSD in the population data, several issues arise when attempting this linkage:

Identify Characteristics Of Regions

Define Level of Geography

Calculate Regional Volumes

Allocate Volumes to Providers

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• First, the recording of the residence code on the patient's abstract is not always accurate. For example, when a patient is asked where he/she lives, the patient may respond with a generalized location such as Ottawa, rather than the specific municipality of residence, such as Nepean or Orleans.

• Second, from year-to-year, the definitions of these levels of geography can change. For example, as municipalities grow, they may split and become their own entities. Conversely, through amalgamation, as seen in Metropolitan Toronto, previously defined municipalities become coded into single large urban areas. This amalgamation results in the inability to discriminate between significant population characteristics in the previously defined municipalities.

These issues suggest that the patient's postal geography should be used to provide mapping to the population data.

Although the postal code mapping is a good alternative to using the residence code, it is not always possible to achieve a one-to-one match between postal code and census sub-division. This match is required to link patient-level abstract data with population volumes. Consequently, the exact census sub-division of a patient may not be known with certainty.

Statistics Canada has developed a set of tools designed to assist in the task of linking postal codes to census subdivisions. A table called the Postal Code Conversion File (PCCF) lists the postal codes and matching census Enumeration Areas (EA). However, when rolling up to the broader CSD, many postal codes do not provide one-to-one links. As a result, a computerized linking routine (PCCF+) was developed to solve this issue. The Health Division of Statistics Canada maintains the PCCF+. The routine assigns the patient’s census sub-division based on a series of criteria.

Analysis of the uniqueness of postal links to census subdivisions suggested that the uncertainty of a postal link is greatest in northern and rural Ontario. However, certain urban geographies were also shown to contain poor one-to-one links. Therefore, wherever possible, these links were reviewed for face validity. For patient postal codes that did not match exactly in the PCCF+, the first two or three characters of the postal code were used to assign partial geographic identifiers to the extent possible. Patient data that remained unlinked to CSD, following the automated process, were assigned manually utilizing the residence code on the abstract.

Definition of Communities for Volumes Model Development

A regression model to predict patient volumes would achieve greater statistical power if base populations for the analysis could be made as homogeneous as possible. For example, if a population is heterogeneous with respect to socio-economic status, then greater discrimination is achieved by dividing these populations into smaller sub-sets of homogeneous populations. Ideally, as in

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Alberta, Ontario would have a comprehensive database with individual population utilization and health status indicators. However, if dividing a population into smaller sub-divisions introduces measurement errors, for example in assigning weighted cases to communities, then the increased inexactness of geographic allocation will cancel the advantage of having more homogeneous populations. In all cases, the extent to which populations can be divided into smaller units is limited by the availability of geographic data in the various data sources (e.g., CIHI or Census data).

In numerous instances, municipal restructuring and differences in database community definitions have made it impossible to divide census divisions into smaller units of census subdivision.

For the purposes of the volumes equity model, the following population definitions were used as the unit of analysis:

• For medical and surgical volumes, communities were defined as census divisions with the exception of the larger communities of Ottawa, Toronto, York, Halton, Peel, Durham, and Hamilton, where the unit of geography was defined at the census sub-division level.12

• For pregnancy and childbirth volumes and newborn and neonate volumes, communities were defined as census divisions.

• Overall volumes results for each community are summarized at the census division level. In total, 105 communities in Ontario were defined for the volumes equity model.

Given the difficulty in obtaining accurate population estimates for Indian reserves and settlements, these communities are excluded from the analysis. Indian reserve and settlement populations and weighted cases are both excluded in the calculation of population utilization rates, births and deaths. Other population factors are calculated excluding the influence of these populations. Consequently, the volume model does not assess the whole of Ontario resident populations. By excluding both reserve and settlement volumes and population from the analysis, providers serving reserves and settlements are neither advantaged nor disadvantaged in the formula. After the expected weighted cases are calculated for each hospital, the reserve and settlement volumes are added back to both the actual and expected weighted cases. Hence, these volumes are included in the comparison of actual and expected volumes for the hospitals serving these communities.

12 Note: for the purposes of the volume equity model, Rockcliffe Park was integrated with Ottawa.

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Step 2: Measurement and Summary of the Population Adjustment Factors

The most important predictors of population utilization of hospital services are age and sex. In addition to demographics, other important factors have been demonstrated to be important in predicting the relative utilization of hospital services. They are: mortality, aboriginal population, rural geography, socio-economic status (measured by income), fertility rates, and low birth weight newborns.

The JPPC Volumes Sub-committee developed a long list of factors to consider in the development of the volumes equity model. This long-list was tested and refined to include only statistically significant factors in the model.

Factors Used for Medical and Surgical Case Mix

Population demographics (e.g., population age and sex distributions) have been shown to be the most important predictors of a community’s expected volume of hospital services utilization. Five-year age group and sex cohorts were used as the basis of regression analysis in the volumes equity model.

The recommended medical and surgical volumes model also predicts population volumes using the following factors:

• Excess mortality: measured in deaths per 1,000 over the provincial average mortality by five-year age group and sex cohorts in the age 0 - 79 year population;

• Percent Population Lowest Income Quintile: based on percentage of the community that resides within Enumeration Areas (EAs) with an average household income in the lowest income quintile;

• Rural Geography: based on the percentage of the population living in census divisions and sub-divisions with population density less than 25 persons per square kilometer; and,

• Aboriginal: percentage of the population made up of aboriginal inhabitants.

Each of the above factors is measured relative to the provincial average for that particular factor. Community-specific rates are provided in Appendix 7. These factors are discussed in detail below.

Excess Mortality

Mortality rates are typically calculated by age and sex cohorts (e.g., males 15-19 years old, females 40-44 years old) to account for the natural increase in mortality rates with increasing age and the differences in age-specific mortality rates

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between the sexes. Over time, mortality rate either remained stable or moderately declined for both males and females. Greater than 60% of communities have mortality rates ranging from -0.4 to 0.4 excess deaths per 1,000 population, relative to the provincial average.

Aboriginal

Data containing the percent of community population that is aboriginal was obtained from 1996 Census data. It is important to note that any aboriginal populations residing on Indian Reserves have been excluded from this analysis as described earlier. Most populations have a very low percentage of aboriginals in their population. However, approximately ten populations have a significant proportion of aboriginals. It has been demonstrated that those populations with a higher percentage of aboriginals will utilize more hospital resources than those populations with relatively few aboriginals.

Rural Geography

The model also includes a factor for rural geography. Rural geography was defined as population density less than 25 persons/sq km. This cut-off figure approximately represents the 10th percentile of census subdivision population density, so that roughly 10% of the Ontario population is accounted for in the rural adjustment.

The provincial mean percent rural is approximately 14.5%, while the provincial median is 0%. Wide variation exists with more than half of the communities having less than 4.5 fewer percent than the provincial mean percent rural population (i.e. less than 10% rural population). Only 10 communities have more than 35.5% above the provincial mean (i.e. greater than 50% rural population). It is expected that these rural populations have less access to alternatives to hospital care and therefore, have higher utilization rates.

Income

Average household income, based on 1996 Statistics Canada census data was used as a measure of socio-economic status for each community. Analysis studying the impact of household income on hospital utilization revealed that only those populations in the lowest income quintile demonstrated statistically higher hospital utilization rates. In other words, very low income was shown to be an indicator of increased hospital utilization. The regression model ultimately proposed for the volumes equity formula therefore considers only the lowest income quintile as a criterion to increase expected hospital volumes. The percentage of the community that resides within Enumeration Areas (EAs) with an average area-adjusted household income in the lowest income quintile was calculated. The area adjustment takes into account the variation in cost of living among communities within Ontario.

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Factors used for Pregnancy, Childbirth, Newborns and Neonates

Fertility Rates

Fertility rate is used to predict volumes for case mix relating to pregnancy and childbirth and to newborns and neonates. Fertility rates are measured by linking CIHI data on live births13 by age of mother, to the female population count for each community. The number of births per female of childbearing age is compared to the provincial average, by five-year age groups for female populations between10-54 years.

Excess fertility rates (based on a comparison of actual to expected birth rates by mother’s age) were calculated for each community and five-year age group across 1995-2000 data. Community- and age group-specific excess fertility rates for 1999/2000 were calculated by averaging community- and age group–specific excess fertility rates over the past five years. Estimates of excess fertility rates are provided in Appendix 8.

Incidence of Low Birth Weight Newborns

The incidence of low birth-weight (less than 2500 grams) newborns is used as a factor in predicting newborn and neonate volumes for communities. A higher incidence of low birth-weight newborns and neonates is expected to result in higher weighted case volumes for the same number of deliveries.

For most communities, the variation in community incidence of low birth-weight newborns falls within the range of 5.5% to 7.5%. Variation in the incidence of low birth-weight newborns has shown to be statistically significant among communities. Individual community ratios are available in Appendix 9.

Step 3: Analysis and Calibration of the Population-based Model

The population-based models for allocating volumes to communities are based on regression models that link population volumes (measured in Step 1) to the population adjustment factors (measured in Step 2). Regression analysis tests the statistical significance of the various population factors in predicting population volumes and develops a weighting (or coefficient) for each population factor included in the regression equation. The regression equation calculates the expected hospital volumes (by weighted cases) for each community.

13 While the model originally proposed using vital statistics data to count live births, analysis revealed that geographic units of residence were often misrepresented in larger urban areas (e.g., residence would be listed as “Toronto” instead of a more specific region of “East York” or “North York”). This led to some subdivisions, such as Toronto, being attributed with a very high fertility rate and other neighbouring subdivisions, such as East York, with surprisingly low fertility rates. To correct for this, CIHI hospital births were used as a proxy for all live births, where postal code data could more accurately pinpoint the actual census subdivision in which a female patient resided.

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In this section we summarize the methodology and results of the regression analyses and discuss the interpretation of the coefficients.

Medical and Surgical Case Mix

A population-weighted least squares regression model was used to test and analyze the relationship of the medical and surgical population factors to population utilization data from 95/96 to 99/00. In this model, the dependent variable is the number of weighted cases per 1000 population for each age group, sex, community and fiscal year. Community-specific volume predictions for the medical and surgical model are available in Appendix 10.

As discussed in Step 2, the recommended model includes the following adjustment factors: age, sex, excess mortality, percentage lowest income quintile population, percentage rural population, and percentage aboriginal population. Because age- and sex-specific per capita hospital volume rates have been declining over the past several years, the effect of age and sex variables was calculated for individual fiscal years. By contrast, the estimated adjustment factors for mortality, income, rural and aboriginal were based on averages across the five years of calibrating data.

The medical and surgical model was calculated in two steps:

1. Community-specific volumes are calculated adjusting only for population age and sex.

2. Through regression analysis, a MARI index was calculated for each community, taking into account the other population adjustment factors of excess mortality, income, aboriginal and rural geography. The age and sex adjusted volumes are multiplied by the MARI index factor to arrive at expected community-specific volumes.

This two-step methodology results in an easier-to-understand model that retains the statistical power of more complex specifications.

Base Rates for Age and Sex

In general, weighted cases per 1000 population are higher for males from birth until the early teens and once beyond age 50. From teenage years to age 50, females have higher per capita medical and surgical weighted cases.

Calculating expected community-specific weighted case volumes adjusting only for age and sex accounts for greater than 98% of the variation in weighted cases on a regional basis. This underscores the fundamental link between age and gender and hospital utilization.

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A “MARI index” was developed to account for additional variation in weighted cases. The variables used in the development of the needs index are: excess mortality, percent aboriginal population, percent rural population and percent lowest income quintile population. The MARI (mortality-aboriginal-rural-income) index equation is shown below in Exhibit 9.

Exhibit 9: Calculation of MARI Index

Communities ranged in the MARI index values from 0.66 to 1.49. Individual community indexes are available in Appendix 7. A detailed discussion of each of the adjustment factors follows below. The range of values is illustrated in Exhibit 10 below.

Exhibit 10: Distribution of Medical and Surgical Model Needs Index by Community, 99/00

Excess Mortality Adjustment Coefficients

Excess mortality, in addition to age and sex, was statistically significant and an important predictor of patient volumes for age groups below age 80. A unit increase in excess deaths per 1000 increases the MARI index by 26.9.

MARI Index = 100 +

26.9*(Excess mortality/1000) + 2.19*(% aboriginal) +

0.18*(% rural) + 0.25*(% lowest income quintile)

where 100 is the base that accounts for age and gender adjusted volumes.

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0.65 to 0.80 0.80 to 0.95 0.95 to 1.10 1.10 to 1.25 1.25 to 1.40 1.40 to 1.55

Needs Index

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Aboriginal Percentage Coefficient

The effect on the MARI index of an additional unit increase in the aboriginal percentage of the population is an increase of 2.19 when controlling for age and sex. This suggests that aboriginal populations have higher volumes per 1,000 population than the provincial average. The maximum adjustment given to a population is approximately 20 for a population with approximately 9% aboriginal population.

Rural Geography Percentage Coefficient

Analysis of the effect of rurality of hospital volumes estimates that every 1% of the population in census sub-divisions with fewer than 25 persons per square kilometer increases the MARI index by a factor of 0.18, controlling for age and sex.

Population Lowest Income Quintile Percentage Coefficient

All other things being equal, populations with higher socio-economic status have lower weighted cases per 1000 population. In-depth analysis into income quintiles revealed that only the lowest income quintile was a predictor of increased hospital volumes. Therefore, the volume equity model includes only the bottom income quintile as an upward adjustment factor to expected hospital medical/surgical volumes. Based on the MARI index equation above, it is seen that every 1% of the population from the lowest income quintile increases the needs index by 0.25.

Calculation of Expected Community-Specific Volumes

In order to arrive at total expected community-specific weighted case volumes, expected age- and sex-adjusted community-specific volumes are multiplied by the needs index. The needs index, as described above, incorporates the effects of additional population adjustment factors on hospital volumes utilization. In other words:

Pregnancy and Childbirth Case Mix

A population-weighted least squares regression model was used to test and analyze the relationship between pregnancy and childbirth weighted cases per 1000 population and female age and fertility using 1995/96 to 1999/2000 data. The dependent variable in these models is the number of weighted cases per 1000 population for each age group, sex, community and fiscal year. Both female age

Total Expected Community-Specific Volumes = Community-Specific Volumes (age- and sex-adjusted only) * MARI Index

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and excess fertility rates were highly significant predictors of weighted cases per 1000 population. These factors are described in detail below.

Community-specific predictions for the pregnancy and childbirth model are available in Appendix 9.

Female Age Base Rates

The estimated number of weighted cases per 1,000 females is declining among females less than 34 years of age and increasing moderately for females in the 35-39 age group. This trend is consistent with the provincial trends in fertility demonstrated earlier.

Expected pregnancy and childbirth-weighted cases are calculated as follows:

The expected pregnancy and childbirth-weighted cases for each age group can be summed to achieve the total expected pregnancy and childbirth weighted cases for a community. However, this equation does not account for differences in fertility rates across communities.

Excess Fertility Coefficient

Similar to the MARI index developed for the medical surgical model, a “fertility index” was developed to predict the impact of higher fertility rates on hospital pregnancy and childbirth volumes.

Multiplying the community-specific fertility index by the expected pregnancy and childbirth-weighted cases (not accounting for differences in fertility rates) leads to the calculation of total pregnancy and childbirth volumes expected for individual communities. In other words:

Fertility Index = 100 + 4.35 *(Excess fertility rate of 10-19 year-olds) + 2.33 * (Excess fertility rate of 20-39 year-olds) + 4.97 * (Excess fertility rate of women 40 years plus)

Age-Specific Expected Pregnancy and Childbirth Weighted Cases =

Age-Specific Weighted Cases per 1000 Population * Age-Specific Population

Total Community-Specific Expected Pregnancy and Childbirth Weighted Cases =

Fertility Index *

Total Expected Pregnancy and Childbirth Weighted Cases (age-adjusted only)

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Newborn and Neonate Case Mix

The adjustment for low birth-weight newborns is based on a regression model relating newborn and neonate case mix index to the incidence of low birth-weight newborns. The estimated equation is as follows:

In a hypothetical community with no low birth-weight newborns, the expected case mix index (or average RIW per case) is approximately 0.36. On the other hand, for a hypothetical community with all low birth-weight newborns, the expected case mix index is approximately 0.36+3.17=3.53.

Expected community-specific newborn and neonate volume is obtained by multiplying the case mix index with the expected number of births from the analysis of each community’s female population and relative fertility rates.

Expected newborn and neonate-weighted cases are available in Appendix 10.

MoHLTC Normalization of Case Mix

After the JPPC developed the Funding Formula, the MoHLTC completed additional computations for funding purposes. For each of the three case mixes mentioned above, the expected volume for each community was separately normalized to ensure that the sum of all provincial expected weighted cases was equivalent to the sum of all actual provincial weighted cases. This was achieved by multiplying each expected value by the sum of all actual weighted cases divided by the sum of all expected weighted cases. The case mix normalization factors are listed below.

Exhibit 11: Case Mix - Normalization Factor Table (Pre-Growth)

Case Mix Normalization Factor

Medical and Surgical 0.949

Pregnancy and Childbirth 1.003

Newborn and Neonate 1.000

CASE MIX INDEX = AVERAGE RIW PER CASE =

0.36 + 3.17 * (Incidence of Low Birth-weight)

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Step 4: Growth Adjustment – Estimating the Impact of Demographic Growth and Aging to 2000/2001

Historically, funding tools for population growth have been used to allocate separate pools of growth funding to communities with higher than average population growth and aging. However, these models do not evaluate the relative equity of historical population volumes. As a result, high growth populations with high historical volumes are compensated at the same rate as high growth populations with low historical volumes. The use of a single population-based formula allows policy makers to evaluate the impacts of population growth and aging along with the relative equity of existing population volumes.

The population-based models calibrated in Step 3 are based on the most currently available utilization and population data. It is necessary to estimate the impact of population growth on hospital volumes between the time for which data was available (1999/2000) and the intended year of application of the model (2000/2001). This section details the methods used to estimate the two-year expected growth in weighted cases for medical and surgical, pregnancy and childbirth, and newborn and neonate weighted case volumes by community.

Growth adjustments help ensure that population-weighted case allocations are responsive to changes in population size and demographics. No attempt has been made to forecast changes in per capita rates. To the extent that per-capita rates for hospital services continue to decline, these estimates may overstate actual growth.

The estimated growth adjustments are based on application of the population-based models from 1999/2000 to the changes in community populations, by age group and gender, since that time.

Medical and surgical weighted case growth is estimated by application of the medical and surgical volume model for 1999/2000 to the estimated two-year changes in population by age group and sex. To support a repatriation of primary and secondary medical and surgical weighted cases, it is necessary to distinguish between tertiary and non-tertiary weighted case growth. Non-tertiary weighted case growth is repatriated to local hospitals (i.e., within the same census division or subdivision) while tertiary weighted case growth is allocated according to existing market share patterns. (For details on the assignment of growth volumes to hospital providers, please refer to Step 5).

Growth allocation of both tertiary and non-tertiary weighted cases is conducted on a community-by-community basis, and by population age and sex cohort. The estimated medical and surgical weighted case impact of the two-year demographic growth by community is presented in Appendix 10 along with tertiary and non-tertiary allocations.

Pregnancy and childbirth and newborn and neonate growth volumes are estimated by applying these population-based models to the change in female population of

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childbearing over this two-year period by age group and by community. Growth estimates for these programs are available in Appendix 10.

Normalization of each community growth estimate was performed to ensure that for each program the sum of the expected growth volumes for the province is equivalent to the sum of the provincial growth volumes adjusted only for age and sex. This is achieved by multiplying each community growth estimate by the sum of age- and sex-adjusted weighted cases divided by the sum of all expected weighted cases. The case mix normalization factors are listed below.

Exhibit 12: Case Mix-Normalization Factor (Post-Growth)

Case Mix Normalization Factor

Primary/Secondary Growth

Tertiary Growth Medical and Surgical

0.978 0.987

Pregnancy and Childbirth 1.506

Newborn and Neonate 1.000

Step 5: Hospital Allocations (Base Year and Growth)

The process of allocating community-specific weighted cases in 1999/00 to individual hospital providers is based on each provider’s program market share in 1999/2000. For example, if Hospital X had 25% of weighted cases for Community A, then it was allocated with 25% of that community's population-based expected weighted case allocation. In this way, hospitals that serve communities whose actual volumes are higher than expected are allocated fewer weighted cases than have historically been discharged from these communities. On the other hand, hospitals that serve communities whose actual volumes are below expected will tend to be allocated more weighted cases.

Pregnancy and childbirth and newborn and neonate growth is also allocated to hospitals based on 1999/2000 market share profiles, as was tertiary medical and surgical weighted case growth. Non-tertiary medical and surgical growth (i.e. primary, secondary and day surgery weighted cases) is allocated to hospitals based on the market share of the providers in the community’s census division, thereby allowing for repatriation.

Where mergers and amalgamations have occurred, the historical figures included all the legacy organizations. As an example, St. Michael’s Hospital includes estimated volumes for St. Michael’s Hospital, Wellesley Hospital and Central Hospital for the 1995/96 to 1999/2000 fiscal years, even though the merger was not finalized in 1995/96. This allows for year-over-year comparisons.

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Overall expected volumes for each hospital are obtained by first summing the base year and growth allocations over the three groups of case mix. Second, each hospital’s total expected volumes is normalized to ensure that the sum of all the expected weighted cases for the province is equal to the sum of all the actual weighted cases. This is achieved by multiplying each hospital’s expected value by the sum of all actual weighted cases divided by the sum of all expected weighted cases. The hospital volume normalization factor used is 0.959.

Comparing hospital-specific expected weighted case volumes to hospital-specific actual acute inpatient and day surgery volume for Ontario residents provides a measure of relative volume equity. Hospitals with actual volumes well below expected are considered to be serving relatively under-serviced communities. Hospitals with volumes well above expected are considered to be serving relatively over-serviced communities.

The results of the volume model indicate that a large degree of variation between actual and expected weighted cases exists across the province and within each hospital type. Variance was calculated as follows:

Without the application of the hospital normalization factor, the overall variance for the province between 99/00 and 01/02 is calculated to be negative 4.1%. If normalization is applied, a greater percentage of hospitals will exhibit positive variance. A positive variance indicates that a hospital’s actual volumes are higher than expected volumes; conversely, a negative variance indicates that a hospital’s actual volumes are less than expected volumes. This approach would be consistent with previous growth funding formulae.

The model was applied to a total of 139 facilities including mergers. This included 52 small facilities, 74 community facilities, 11 teaching facilities and two specialty hospitals. Stand-alone rehabilitation and chronic care facilities were excluded from the analysis based on the application of the model. Appendices 11 and 12 provide detail on actual and expected hospital base year and growth allocations by case mix and Appendix 12 summarizes overall hospital-specific results.

Variance = (Actual Volumes in 99/00 – Expected Volumes [in 99/00 or 00/01])

Expected Volumes [in 99/00 or 00/01]

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VOLUMES WORK PLAN

The following deliverables were prioritized for the next year:

1. Cross-validation of the model – retrospective analysis with multi-year data to compare actual and expected growth.

2. Proximity model for growth allocation – begin developing new approaches to replace the existing approach, i.e., using geo-political boundaries to determine local market share to be used to allocate primary and secondary growth to local hospitals.

3. Introduction of chronic care volumes – begin to examine the hypotheses regarding chronic care volumes and investigate data availability.

4. Data quality and availability improvements – (e.g., on-reserve aboriginal and mortality data) will be incorporated in the model as soon as possible.

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CONCLUSION

This document has provided a technical overview of the methodologies employed to generate both an expected unit cost and an expected volume.

The methodology to calculate the expected rate was based upon a regression model that predicts the expected cost per weighted case of acute inpatient and day surgery, as well as chronic care activity. For small hospitals, the model also includes outpatient emergency, rehabilitation and ELDCAP activity. The model integrates the small and large/community acute care formula as well as introduces chronic care unit costs into the methodology. The model estimates a hospital’s cost per weighted case given the size of the facility, the amount of tertiary and teaching activity, the location of the facility (i.e. isolation) and the type of facility (i.e. stand-alone chronic care facility). The model can be used to measure a hospital’s relative cost performance or to approximate appropriate funding levels.

The volume methodology first estimates population volumes and then allocates these volumes to hospitals. The model predicts the number of inpatient and day surgery (medical and surgical) weighted cases that would be used by a population with given population characteristics at the average Ontario rate of utilization. Population characteristics used in predicting weighted cases include age and sex of the population, income, mortality, aboriginal population, and rural-ness. These volumes are then allocated to hospitals based on historical market share. Growth volumes are also predicted for a population and then allocated to hospitals. Separate methodologies were derived for the allocation of tertiary and local growth. The hospital predictions can be used as the basis for evaluating a hospital’s relative utilization or it can be used to approximate funding.

This document does not discuss implementation of these models. The models can stand-alone and provide information on overall hospital cost performance and utilization or the models can be integrated to calculate hospital-specific expected funding levels. Next steps should focus on evaluating the advantages and disadvantages of various implementation strategies.

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LIST OF APPENDICES

Appendix 1 Volume Sub-committee Terms of Reference

Appendix 2 Volume Sub-committee Membership List

Appendix 3 Rate Sub-committee Terms of Reference

Appendix 4 Rate Sub-committee Membership List

Appendix 5 1999/2000 Equivalent Weighted Cases for Rates Model

Appendix 6 Adjustment Factor Estimates

Appendix 7 Actual and Expected Cost Per Equivalent Weighted Case

Appendix 8 Calculation of Model Details for Merged Facilities

Appendix 9 Community MARI Index

Appendix 10 Community Expected Medical/Surgical Volumes Calculation

Appendix 11 Community Fertility Index

Appendix 12 Community Expected Pregnancy and Childbirth Volumes Calculation

Appendix 13 Newborn and Neonate Case Mix Index

Appendix 14 Community Expected Newborn and Neonate Volumes Calculation

Appendix 15 Hospital Expected Pregnancy and Childbirth, Newborn and Neonate Weighted Cases

Appendix 16 Hospital Expected Medical and Surgical Weighted Cases

Appendix 17 Hospital Total Expected Weighted Cases

Appendix 18 Integration and Implementation Committee Terms of Reference

Appendix 19 Integration and Implementation Committee Membership List

Appendix 20 Funding Committee Terms of Reference

Appendix 21 Funding Committee Membership List

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LIST OF APPENDICES

Appendix 1 Volume Sub-committee Terms of Reference

Appendix 2 Volume Sub-committee Membership List

Appendix 3 Rate Sub-committee Terms of Reference

Appendix 4 Rate Sub-committee Membership List

Appendix 5 1999/2000 Equivalent Weighted Cases for Rates Model

Appendix 6 Adjustment Factor Estimates

Appendix 7 Actual and Expected Cost Per Equivalent Weighted Case

Appendix 8 Calculation of Model Details for Merged Facilities

Appendix 9 Community MARI Index

Appendix 10 Community Expected Medical/Surgical Volumes Calculation

Appendix 11 Community Fertility Index

Appendix 12 Community Expected Pregnancy and Childbirth Volumes Calculation

Appendix 13 Newborn and Neonate Case Mix Index

Appendix 14 Community Expected Newborn and Neonate Volumes Calculation

Appendix 15 Hospital Expected Pregnancy and Childbirth, Newborn and Neonate Weighted Cases

Appendix 16 Hospital Expected Medical and Surgical Weighted Cases

Appendix 17 Hospital Total Expected Weighted Cases

Appendix 18 Integration and Implementation Committee Terms of Reference

Appendix 19 Integration and Implementation Committee Membership List

Appendix 20 Funding Committee Terms of Reference

Appendix 21 Funding Committee Membership List

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APPENDIX 1 VOLUME SUB-COMMITTEE

TERMS OF REFERENCE

Background

Recognizing the rapid rate of change that has been stimulated by the recommendations of the Health Services Restructuring Commission (HSRC), the JPPC Hospital Funding Committee (HFC) has recommended that the Ministry of Health determine hospital allocations for HSRC reviewed hospitals separately in order to accommodate funding requirements as hospitals implement the directives of the HSRC. This period of individual negotiation is expected to last for at least two years beginning in 1998/99.

After the HSRC has completed its work, a formula based funding methodology will again be needed. Using other provinces and jurisdictions as comparisons, the HFC initiated a 2 year work plan to develop a population needs-based funding methodology that the Ministry of Health could decide to use in the post -restructured system (i.e., post-HSRC). Two sub-committees of the HFC will develop this methodology. The committees are called Rate and Volume Sub-Committees of the HFC.

Mandate

By July 1, 1999, to contribute to a provincial funding methodology that, on a regional or district level, predicts the anticipated volume of hospital activity.

Objectives

• To work with the Rates Sub-Committee to determine appropriate volumes of service to which rates may be applied

• To identify the volume of activity associated with population distributions

Frequency of Meeting

The Volumes Sub-Committee will meet monthly or at the discretion of the Chair.

Membership

Representation from hospitals as per OHA/MoH determination.

Reporting Relationship

The Volumes Sub-Committee reports to the Hospital Funding Committee

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APPENDIX 2 VOLUME SUB-COMMITTEE MEMBERSHIP LIST

Frank Lussing, Chair York Central Hospital

Antoni Basinski ThiiNC Information Management Inc.

Catherine Cornell Niagara-on-the-Lake General Hospital

Kevin Empey University Health Network, Toronto General

Shawn Gilhuly Norfolk General Hospital

Murray Glendinning Ministry of Health and Long-Term Care

Paul Huras Thames Valley District Health Council

Alan Iskiw Ministry of Health and Long-Term Care

Maureen Judge Ministry of Health and Long-Term Care

Joe Mapa Mount Sinai Hospital

Frank Markel Joint Policy and Planning Committee

John Marshall Kingston General Hospital

Gerlinde Mueller Ministry of Health and Long-Term Care

Doug Murray Ministry of Health and Long-Term Care

George Pink University of Toronto

Colin Preyra Ministry of Health and Long-Term Care

Lou Reidel Ontario Hospital Association

Paul Sandor Ministry of Health and Long-Term Care

Luc Seguin Hawkesbury & District General Hospital

John Wegener St. Michael’s Hospital

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APPENDIX 3 RATE SUB-COMMITTEE TERMS OF REFERENCE

Background

Recognizing the rapid rate of change that has been stimulated by the recommendations of the Health Services Restructuring Commission (HSRC), the JPPC Hospital Funding Committee (HFC) has recommended that the Ministry of Health determine hospital allocations for HSRC reviewed hospitals separately in order to accommodate funding requirements as hospitals implement the directives of the HSRC. This period of individual negotiation is expected to last for at least two years beginning in 1998/99.

After the HSRC has completed its work, a formula based funding methodology will again be needed. Using other provinces and jurisdictions as comparisons, the HFC initiated a 2 year work plan to develop a population needs based funding allocation methodology that the Ministry of Health could decide to use in the post-restructured system (i.e., post-HSRC). Two sub-committees of the HFC will develop this methodology. The committees are called Rate and Volume Sub-Committees of the HFC.

Mandate

To contribute to the development of a single comprehensive hospital funding methodology. To calculate a standard rate so that it may be applied to a standard volume of patients served by hospitals.

Objectives

• To work with the JPPC Volume sub-committee in the development of a population needs based funding methodology

• To identify the costs associated with facility specific indicators affecting costs in hospitals.

• To ensure that funding allocations resulting from the methodology developed can be reconciled

• To ensure that application of the methodology promotes equal access for equal need

• To examine the pros and cons associated with a prospective payment mechanism to hospitals by the Ministry of Health

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• To ensure that the application of the funding methodology includes incentives toward efficient practice

Frequency of Meetings

The Rate sub-committee will meet monthly or at the discretion of the Chairperson. The Chairperson is also required to attend scheduled meetings and provide monthly updates to the Hospital Funding Committee.


The Rate sub-committee will report directly to the Hospital Funding Committee

Resources

The JPPC Secretariat will support the Rate sub-committee. Members are entitled to have approved expenses incurred while conducting JPPC activity reimbursed. Guidelines for travel, mileage and accommodation are available from the JPPC Secretariat.

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APPENDIX 4 RATE SUB-COMMITTEE MEMBERSHIP LIST

Norman Maciver, Chair West Parry Sound Health Centre

Ricardo Amres Ministry of Health and Long-Term Care

Randy Belair Lake of the Woods District Hospital

Chuck Botz London Health Sciences Centre

Nan Brooks Joint Policy and Planning Committee

Bobby Crichton Ministry of Health and Long-Term Care

William Croson William S. Croson & Associates Ltd.

Ron Dennis Royal Victoria Hospital

Chris Ferrao William Osler Health Centre, Brampton

Murray Glendinning MoHLTC

Chris Helyar Hay Health Care Consulting Group

Dan Hill Riverdale Hospital

Sherry Kennedy Quinte Healthcare Corporation, Belleville

Karim Mamdani University Health Network


Ian McKillop Wilfrid Laurier University

Patrick O’Malley Lambton Hospitals Group, Sarnia

Archie Outar Ministry of Health and Long-Term Care

Colin Preyra Ministry of Health and Long-Term Care

Mirna Rahal Ministry of Health and Long-Term Care


Ellen Schraa Joint Policy and Planning Committee

Joan Sproul Mount Sinai Hospital

John Sutherland Huron Perth Hospitals Partnership

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Bruce Sutton Nipigon District Memorial Hospital

Mary Lou Toop Lakeridge Health Corporation, Oshawa

Richard Wilson The Ottawa Hospital, Riverside Campus

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Appendix 5: 1999/2000 Equivalent Weighted Cases for Rates Model

Facility # Facility NameAcute

Weighted Cases

Chronic Weighted

Days

Chronic EWC

ER outpatient visits

ER EWCRehab Patient Days

Rehab EWCELDCAP Patient Days

Eldcap EWCTotal EWC

592 NAPANEE Lennox & Addington 1791 2517 255 28291 1404 0 0 0 0 3450593 NEWBURY Four Counties 749 2964 300 8302 412 0 0 0 0 1461596 ALLISTON Stevenson Memorial 2905 0 0 25123 1247 0 0 0 0 4152597 ALMONTE General 1051 9817 994 9405 467 0 0 0 0 2511599 ARNPRIOR & District Memorial 1736 4507 456 20105 998 0 0 0 0 3190600 ATIKOKAN General 540 1431 145 5907 293 0 0 7978 504 1482606 BARRIE Roval Victoria 19859 15172 1536 0 - 0 - 0 - 21395611 BLIND RIVER St Joseph's 954 3286 333 15064 747 0 0 3631 230 2264613 TORONTO West Park 0 59637 6036 0 - 0 - 0 - 6036614 BRACEBRIDGE S Muskoka Memorial 3530 4227 428 0 - 0 - 0 - 3957617 BRANTFORD General 15995 0 0 0 - 0 - 0 - 15995618 BRANTFORD St Joseph's 1683 21817 2208 0 - 0 - 0 - 3891619 BROCKVILLE General 6878 0 0 0 - 0 - 0 - 6878620 BROCKVILLE St Vincent de Paul 0 12967 1312 0 - 0 - 0 - 1312624 CAMPBELLFORD Memorial 1842 2030 205 18304 908 0 0 0 0 2955626 CARLETON PLACE & District Memorial 1073 0 0 19006 943 0 0 0 0 2016627 CHAPLEAU General 266 1299 131 2917 145 0 0 8875 561 1104628 CHATHAM Public General 7648 8136 823 0 - 0 - 0 - 8471629 CHATHAM St Joseph's 3515 0 0 0 - 0 - 0 - 3515632 TORONTO North York General 37776 0 0 0 - 0 - 0 - 37776633 CLINTON Public 1207 134 14 16907 839 0 0 0 0 2059638 COCHRANE Lady Minto 802 1684 170 0 0 0 0 0 0 973640 COLLINGWOOD General and Marine 4227 0 0 0 - 0 - 0 - 4227643 CORNWALL General 5154 0 0 0 - 0 - 0 - 5154644 CORNWALL Hotel Dieu 6661 16928 1713 0 - 0 - 0 - 8374646 DEEP RIVER and District 586 0 0 7676 381 0 0 0 0 967647 DRYDEN District General 2111 3420 346 16757 831 0 0 7284 461 3749648 DUNNVILLE Haldimand War Memorial 1298 4017 407 18229 904 0 0 0 0 2609650 ELLIOT LAKE St Joseph's 2723 1811 183 0 - 0 - 0 - 2907653 ENGLEHART & District 709 3459 350 5676 282 0 0 0 0 1341654 ESPANOLA General 989 1805 183 15782 783 0 0 10870 687 2642655 EXETER South Huron 818 531 54 18104 898 0 0 0 0 1770656 FERGUS Groves Memorial Comm 2347 5210 527 0 - 0 - 0 - 2874661 CAMBRIDGE Memorial 13495 28971 2932 0 - 0 - 0 - 16427662 GERALDTON District Hospital 913 2243 227 13451 667 0 0 6940 439 2246663 GODERICH Alexandra Marine & General 3109 2547 258 26067 1293 0 0 0 0 4661664 GRIMSBY West Lincoln Memorial 3055 5674 574 0 - 0 - 0 - 3629665 GUELPH General 10211 0 0 0 - 0 - 0 - 10211666 GUELPH St Joseph's Hospital 5493 28865 2921 0 - 0 - 0 - 8414674 HAMILTON St Joseph's 33853 9470 959 50560 - 936 - 0 - 34812675 HAMILTON St Peter's 0 93871 9501 0 - 0 - 0 - 9501676 HANOVER & District 1767 8314 841 18533 920 0 0 0 0 3528681 HEARST Notre Dame 947 6323 640 21187 1051 0 0 0 0 2638682 HORNEPAYNE Community 163 0 0 2333 116 0 0 3216 203 482684 INGERSOLL Alexandra 1613 1261 128 23861 1184 0 0 0 0 2925685 IROQUOIS FALLS Anson General 721 4339 439 6205 308 0 0 0 0 1468686 WAWA North Algoma 577 4839 490 7901 392 0 0 0 0 1459687 KAPUSKASING Sensenbrenner 2009 3596 364 24938 1237 0 0 0 0 3610692 KINGSTON Hotel Dieu 2928 0 0 35515 - 0 - 0 - 2928693 KINGSTON General 35124 0 0 52529 - 0 - 0 - 35124695 KINGSTON St Mary's-of-the-Lake 0 48742 4933 0 - 0 - 0 - 4933


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Weighted Cases

Chronic Weighted

Days

Chronic EWC




Eldcap EWCTotal EWC

696 KIRKLAND & District 2249 3323 336 0 - 0 - 0 - 2585699 KITCHENER St Mary's 12910 0 0 0 - 0 - 0 - 12910701 RICHMOND HILL York Central 18174 6942 703 0 - 0 - 0 - 18877704 LEAMINGTON District Memorial 4102 7224 731 0 - 0 - 0 - 4833707 LINDSAY Ross Memorial 8398 16597 1680 0 - 0 - 0 - 10078709 LISTOWEL Memorial 1467 8349 845 14561 722 0 0 0 0 3034714 LONDON St Joseph's 26818 91605 9271 33729 - 26498 - 0 - 36090718 BURLINGTON Joseph Brant Memorial 19056 9890 1001 0 - 0 - 0 - 20057719 MANITOUWADGE General 198 0 0 3305 164 0 0 2948 186 548721 MARATHON Wilson Memorial 386 1465 148 5013 249 0 0 0 0 783723 MATHESON Bingham Memorial 391 1259 127 6215 308 0 0 7058 446 1273724 MATTAWA General 504 260 26 7008 348 0 0 0 0 878726 MIDLAND Huronia 4711 0 0 0 - 0 - 0 - 4711731 MISSISSAUGA Credit Valley 22548 15388 1557 0 - 0 - 0 - 24106732 KEMPTVILLE District 892 5286 535 17292 858 0 0 0 0 2285733 MOUNT FOREST Louise Marshall 906 0 0 13535 672 0 0 0 0 1577734 HALDIMAND West Haldimand General 1047 5172 523 17734 880 0 0 0 0 2451736 NEWMARKET Southlake Regio-l Health Centre 20691 7085 717 0 - 0 - 0 - 21408739 NIPIGON District Memorial 683 1991 202 5358 266 0 0 5414 342 1492745 ORILLIA Soldiers' Memorial 11745 12697 1285 0 - 0 - 0 - 13030753 OTTAWA Montfort 11426 1761 178 0 - 0 - 0 - 11605759 PALMERSTON & District 1036 351 36 9530 473 0 0 0 0 1544760 PARIS - The Willett 289 10244 1037 9814 487 0 0 0 0 1812763 PEMBROKE General 6964 8464 857 0 - 0 - 0 - 7821766 PENETANGUISHENE General 191 12220 1237 0 - 0 - 0 - 1428768 BARRY'S BAY St Francis Memorial 593 4521 458 9458 469 0 0 0 0 1520771 PETERBOROUGH Civic 22557 17819 1803 0 - 0 - 0 - 24361773 TORONTO Providence 0 81303 8229 0 - 0 - 0 - 8229776 PETROLIA Charlotte Eleanor Englehart 1397 6180 626 19808 983 0 0 0 0 3006777 NEPEAN Queensway-Carleton 14701 0 0 0 - 0 - 0 - 14701784 LITTLE CURRENT Manitoulin 1673 0 0 21298 1057 0 0 0 0 2730788 RENFREW Victoria 2026 6794 688 0 - 0 - 0 - 2714790 ST CATHARINES Hotel Dieu 10663 0 0 0 - 0 - 0 - 10663792 ST MARY'S Memorial 878 707 72 9705 482 0 0 0 0 1431793 ST THOMAS Elgin General 9266 24120 2441 0 - 0 - 0 - 11707795 SARNIA St. Joseph's 596 27275 2760 0 - 0 - 0 - 3356796 SARNIA General 13822 0 0 0 - 0 - 0 - 13822797 SAULT STE MARIE General 17879 11895 1204 0 - 0 - 0 - 19082800 HAWKESBURY & District General 3337 6973 706 0 - 0 - 0 - 4043801 SEAFORTH Community 742 1669 169 7990 396 0 0 0 0 1307802 ALEXANDRIA Glengarry Memorial 890 5111 517 19031 944 0 0 0 0 2351804 SIMCOE Norfolk General 6084 14770 1495 0 - 0 - 0 - 7579805 SIOUX LOOKOUT District 885 1131 115 10206 506 0 0 7160 453 1958809 SMOOTH ROCK FALLS 281 816 83 3367 167 0 0 7123 450 981813 STRATFORD General 7753 11242 1138 0 - 0 - 0 - 8890814 STRATHROY Middlesex General 3192 10576 1070 0 - 0 - 0 - 4263819 TERRACE BAY McCausland 322 4311 436 3440 171 0 0 0 0 929824 TILLSONBURG District Memorial 2898 9263 938 0 - 0 - 0 - 3835826 KENORA Lake-of-the-Woods District 3357 11408 1155 0 - 0 - 0 - 4512827 TORONTO Baycrest 0 94560 9570 0 - 0 - 0 - 9570842 TORONTO Mount Si-i 29484 0 0 31231 - 0 - 0 - 29484


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Weighted Cases

Chronic Weighted

Days

Chronic EWC




Eldcap EWCTotal EWC

849 TORONTO Riverdale 0 145012 14677 0 - 0 - 0 - 14677850 TORONTO Runnymede 0 31327 3171 0 - 0 - 0 - 3171852 TORONTO St Michael's 51174 0 0 67560 - 0 - 0 - 51174854 TORONTO SA Grace 0 38903 3937 0 - 0 - 0 - 3937858 TORONTO East General 29314 0 0 0 - 0 - 0 - 29314870 WALLACEBURG Sydenham 1754 1569 159 22560 1119 0 0 0 0 3033881 STURGEON FALLS West Nipissing 1650 5173 524 22677 1125 0 0 0 0 3298882 WINCHESTER District Memorial 2724 8629 873 0 - 0 - 0 - 3597888 NEW LISKEARD Temiskaming 3541 3411 345 0 - 0 - 0 - 3886889 WINGHAM & District 1617 2898 293 20772 1031 1051 185 0 0 3126890 WOODSTOCK General 6587 8995 910 0 - 0 - 0 - 7497895 THUNDER BAY Hogarth-Westmount 0 11687 1183 0 - 0 - 0 - 1183896 RED LAKE Marg Cochenour Memorial 584 1563 158 0 0 0 0 0 0 742898 TORONTO St Joseph's 26300 0 0 0 - 0 - 0 - 26300900 FORT FRANCES Riverside Health Care 3075 9884 1000 0 - 0 - 0 - 4075903 HUNTSVILLE District Memorial 3481 6052 613 0 - 0 - 0 - 4093905 MARKHAM Stouffville 13437 11230 1137 0 - 0 - 0 - 14574906 NORTH BAY General 13284 1624 164 0 - 0 - 0 - 13448907 TIMMINS & District General 9792 10404 1053 0 - 0 - 0 - 10845916 ORANGEVILLE Dufferin-Caledon 6383 7702 780 0 - 0 - 0 - 7162927 WINDSOR Hotel Dieu Grace 27961 0 0 0 - 0 - 0 - 27961928 SMITHS FALLS Perth & Smiths Falls 5764 6236 631 0 - 0 - 0 - 6395930 KITCHENER Grand River 22958 75598 7651 0 - 0 - 0 - 30609931 PARRY SOUND West Parry Sound 2742 21461 2172 0 - 0 - 0 - 4914932 OTTAWA Sisters of Charity 0 169097 17114 0 - 0 - 0 - 17114933 WINDSOR Regional 21685 24624 2492 0 - 0 - 0 - 24177935 THUNDER BAY Regional 26836 0 0 0 - 0 - 0 - 26836936 LONDON Health Sciences 67228 0 0 106551 - 6170 - 0 - 67228938 MINDEN Haliburton Highlands 554 60 6 28863 1432 0 0 0 0 1992940 COBOURG Northumberland 4133 11219 1136 0 - 0 - 0 - 5268941 TORONTO Humber River Regional 43118 0 0 0 - 0 - 0 - 43118942 HAMILTON Health Sciences Centre 82763 58635 5935 97829 - 33510 - 0 - 88697946 KINCARDINE S Bruce Grey Hlth Ctr 4610 4056 411 0 - 0 - 0 - 5021947 TORONTO University Health Network 86561 0 0 67236 - 0 - 0 - 86561949 MISSISSAUGA Trillium Health Centre 40328 75010 7592 0 - 0 - 0 - 47920950 OAKVILLE Halton Heatlhcare Services Corporation 19742 21521 2178 0 - 0 - 0 - 21920951 BRAMPTON William Osler 50872 28546 2889 0 - 0 - 0 - 53761952 OSHAWA Lakeridge Health Corporation 36845 51574 5220 0 - 0 - 0 - 42065953 TORONTO Sunnybrook & Women's 57797 107067 10836 63781 - 0 - 70974 - 68634954 TORONTO Rouge Valley Health System 33930 28196 2854 0 - 0 - 0 - 36784955 OWEN SOUND Grey Bruce Health Services 16173 17208 1742 0 - 0 - 0 - 17914956 TORONTO Rehabilitation Institute 0 99764 10097 0 - 0 - 0 - 10097957 BELLEVILLE Quinte Health Care Corporation 17036 17576 1779 0 - 0 - 0 - 18815958 OTTAWA The Ottawa Hospital 97406 0 0 139243 - 0 - 0 - 97406959 SUDBURY Hopital Regional de Sudbury Regional Hospital 35200 20091 2033 0 - 0 - 0 - 37233943 Thunder Bay St. Joseph's 0 65836 6663 0 - - 0 - 6663960 TORONTO The Scarborough Hospital 50717 3481 352 0 - 0 - 0 - 51069962 ST. CATHARINES Niagara Health System 42854 113368 11474 0 - 0 - 0 - 54328


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Appendix 6: Adjustment Factor Estimates

Component Estimates Base 2,231.27 1,152,708.20 1,244.59 150.59 15.49 58.01 363.96

Facility No.

Hospital NameHospital

TypeActual 99/00

CPEWCSize Teaching Isolation

Non-neonate tertiary

Neonate tertiary

Standalone chronic flag

Size Teaching IsolationNon-

neonate tertiary

Neonate tertiary


Expected 99/00

CPEWC592 NAPANEE Lennox & Addington smll $2,721 0.000290 0.0000 0 0.78 0.00 0 334.13 0.00 0.00 12.14 0.00 0.00 $2,578593 NEWBURY Four Counties smll $3,241 0.000685 0.0000 0 1.15 0.00 0 789.24 0.00 0.00 17.77 0.00 0.00 $3,038596 ALLISTON Stevenson Memorial smll $2,192 0.000241 0.0000 0 2.85 0.11 0 277.63 0.00 0.00 44.20 6.25 0.00 $2,559597 ALMONTE General smll $2,443 0.000398 0.0000 0 0.19 0.00 0 459.02 0.00 0.00 2.98 0.00 0.00 $2,693599 ARNPRIOR & District Memorial smll $2,551 0.000313 0.0000 0 1.25 0.00 0 361.33 0.00 0.00 19.29 0.00 0.00 $2,612600 ATIKOKAN General smll $2,533 0.000675 0.0000 1 10.92 0.00 0 777.83 0.00 150.59 169.18 0.00 0.00 $3,329606 BARRIE Roval Victoria ctty $2,265 0.000047 0.0057 0 14.88 0.84 0 53.88 7.04 0.00 230.44 48.98 0.00 $2,572611 BLIND RIVER St Joseph's smll $2,460 0.000442 0.0000 1 2.75 0.41 0 509.22 0.00 150.59 42.63 23.77 0.00 $2,957613 TORONTO West Park chrn $3,364 0.000166 0.0099 0 0.00 0.00 1 190.97 12.32 0.00 0.00 0.00 363.96 $2,799614 BRACEBRIDGE S Muskoka Memorial ctty $2,737 0.000253 0.0000 0 4.36 0.00 0 291.28 0.00 0.00 67.54 0.00 0.00 $2,590617 BRANTFORD General ctty $2,343 0.000063 0.0185 0 16.28 0.42 0 72.07 23.02 0.00 252.15 24.33 0.00 $2,603618 BRANTFORD St Joseph's ctty $2,881 0.000257 0.0175 0 10.34 0.00 0 296.22 21.76 0.00 160.22 0.00 0.00 $2,709619 BROCKVILLE General ctty $2,506 0.000145 0.0020 0 8.93 0.02 0 167.59 2.43 0.00 138.39 1.04 0.00 $2,541620 BROCKVILLE St Vincent de Paul chrn $4,619 0.000762 0.0000 0 0.00 0.00 1 878.33 0.00 0.00 0.00 0.00 363.96 $3,474624 CAMPBELLFORD Memorial smll $2,866 0.000338 0.0000 0 4.61 0.00 0 390.04 0.00 0.00 71.46 0.00 0.00 $2,693626 CARLETON PLACE & District Memorial smll $2,207 0.000496 0.0000 0 0.72 0.00 0 571.73 0.00 0.00 11.16 0.00 0.00 $2,814627 CHAPLEAU General smll $3,598 0.000906 0.0000 1 0.00 0.00 0 1,044.39 0.00 150.59 0.00 0.00 0.00 $3,426628 CHATHAM Public General ctty $2,744 0.000118 0.0000 0 5.09 0.40 0 136.07 0.00 0.00 78.89 23.19 0.00 $2,469629 CHATHAM St Joseph's ctty $4,199 0.000284 0.0000 0 21.23 0.00 0 327.93 0.00 0.00 328.80 0.00 0.00 $2,888632 TORONTO North York General ctty $2,825 0.000026 0.0710 0 15.82 0.77 0 30.51 88.43 0.00 245.01 44.68 0.00 $2,640633 CLINTON Public smll $2,601 0.000486 0.0000 0 1.47 0.00 0 559.80 0.00 0.00 22.83 0.00 0.00 $2,814638 COCHRANE Lady Minto smll $4,204 0.001028 0.0000 1 0.13 0.00 0 1,185.28 0.00 150.59 2.02 0.00 0.00 $3,569640 COLLINGWOOD General and Marine ctty $2,451 0.000237 0.0470 0 5.40 0.22 0 272.68 58.45 0.00 83.67 12.73 0.00 $2,659643 CORNWALL General ctty $2,669 0.000194 0.0113 0 14.63 0.00 0 223.64 14.03 0.00 226.56 0.00 0.00 $2,696644 CORNWALL Hotel Dieu ctty $2,652 0.000119 0.0019 0 9.96 0.04 0 137.65 2.41 0.00 154.34 2.48 0.00 $2,528646 DEEP RIVER and District smll $4,221 0.001034 0.0000 0 3.49 0.00 0 1,191.79 0.00 0.00 54.04 0.00 0.00 $3,477647 DRYDEN District General smll $2,538 0.000267 0.0000 1 2.43 0.00 0 307.44 0.00 150.59 37.71 0.00 0.00 $2,727648 DUNNVILLE Haldimand War Memorial smll $2,645 0.000383 0.0000 0 0.88 0.00 0 441.87 0.00 0.00 13.66 0.00 0.00 $2,687650 ELLIOT LAKE St Joseph's ctty $3,125 0.000344 0.0364 1 6.47 0.00 0 396.56 45.26 150.59 100.24 0.00 0.00 $2,924653 ENGLEHART & District smll $2,389 0.000746 0.0000 1 4.29 0.00 0 859.69 0.00 150.59 66.46 0.00 0.00 $3,308654 ESPANOLA General smll $2,317 0.000379 0.0000 0 3.88 0.00 0 436.33 0.00 0.00 60.06 0.00 0.00 $2,728655 EXETER South Huron smll $2,637 0.000565 0.0000 0 1.08 0.00 0 651.38 0.00 0.00 16.74 0.00 0.00 $2,899656 FERGUS Groves Memorial Comm ctty $2,395 0.000348 0.0068 0 2.74 0.02 0 401.05 8.42 0.00 42.50 1.01 0.00 $2,684661 CAMBRIDGE Memorial ctty $2,457 0.000061 0.0027 0 9.57 0.32 0 70.17 3.38 0.00 148.30 18.57 0.00 $2,472662 GERALDTON District Hospital smll $2,403 0.000445 0.0000 1 1.49 0.00 0 513.23 0.00 150.59 23.07 0.00 0.00 $2,918663 GODERICH Alexandra Marine & General smll $2,576 0.000215 0.0000 0 6.54 0.00 0 247.34 0.00 0.00 101.27 0.00 0.00 $2,580664 GRIMSBY West Lincoln Memorial ctty $2,377 0.000276 0.0523 0 2.33 0.00 0 317.62 65.09 0.00 36.12 0.00 0.00 $2,650665 GUELPH General ctty $2,306 0.000098 0.0068 0 15.06 0.34 0 112.89 8.48 0.00 233.26 19.93 0.00 $2,606666 GUELPH St Joseph's Hospital ctty $2,692 0.000119 0.0015 0 13.62 0.00 0 136.99 1.89 0.00 210.99 0.00 0.00 $2,581674 HAMILTON St Joseph's tchg $2,835 0.000029 0.2377 0 27.68 1.07 0 33.11 295.89 0.00 428.69 62.36 0.00 $3,051675 HAMILTON St Peter's chrn $2,414 0.000105 0.0000 0 0.00 0.00 1 121.33 0.00 0.00 0.00 0.00 363.96 $2,717676 HANOVER & District smll $2,324 0.000283 0.0000 0 1.75 0.00 0 326.71 0.00 0.00 27.15 0.00 0.00 $2,585681 HEARST Notre Dame smll $3,278 0.000379 0.0000 1 0.46 0.17 0 436.91 0.00 150.59 7.06 9.84 0.00 $2,836682 HORNEPAYNE Community smll $5,588 0.002073 0.0000 1 0.00 0.00 0 2,389.61 0.00 150.59 0.00 0.00 0.00 $4,771684 INGERSOLL Alexandra smll $2,880 0.000342 0.0000 0 2.23 0.00 0 394.16 0.00 0.00 34.47 0.00 0.00 $2,660685 IROQUOIS FALLS Anson General smll $3,235 0.000681 0.0000 0 4.03 0.00 0 785.19 0.00 0.00 62.39 0.00 0.00 $3,079686 WAWA North Algoma smll $2,655 0.000685 0.0000 1 0.55 0.00 0 790.09 0.00 150.59 8.53 0.00 0.00 $3,180687 KAPUSKASING Sensenbrenner smll $2,813 0.000277 0.0000 1 0.75 0.00 0 319.32 0.00 150.59 11.67 0.00 0.00 $2,713692 KINGSTON Hotel Dieu tchg $4,980 0.000342 0.2782 0 1.18 0.00 0 393.73 346.24 0.00 18.23 0.00 0.00 $2,989693 KINGSTON General tchg $3,392 0.000028 0.4061 0 44.03 2.94 0 32.82 505.38 0.00 682.02 170.69 0.00 $3,622695 KINGSTON St Mary's-of-the-Lake chrn $3,340 0.000203 0.0516 0 0.00 0.00 1 233.66 64.22 0.00 0.00 0.00 363.96 $2,893696 KIRKLAND & District ctty $3,425 0.000387 0.0111 1 5.78 0.00 0 445.88 13.80 150.59 89.46 0.00 0.00 $2,931699 KITCHENER St Mary's ctty $2,609 0.000077 0.0000 0 16.34 0.00 0 89.29 0.00 0.00 253.05 0.00 0.00 $2,574701 RICHMOND HILL York Central ctty $2,268 0.000053 0.0000 0 18.94 0.07 0 61.07 0.00 0.00 293.42 4.04 0.00 $2,590704 LEAMINGTON District Memorial ctty $2,112 0.000207 0.0000 0 3.37 0.03 0 238.50 0.00 0.00 52.28 1.69 0.00 $2,524

ADJUSTMENT FACTORS


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Facility No.


TypeActual 99/00



Neonate tertiary



neonate tertiary

Neonate tertiary


Expected 99/00

CPEWC

ADJUSTMENT FACTORS

707 LINDSAY Ross Memorial ctty $2,270 0.000099 0.0046 0 8.50 0.01 0 114.38 5.73 0.00 131.73 0.79 0.00 $2,484709 LISTOWEL Memorial smll $2,394 0.000330 0.0000 0 2.64 0.00 0 379.91 0.00 0.00 40.93 0.00 0.00 $2,652714 LONDON St Joseph's tchg $3,142 0.000028 0.1932 0 14.59 5.09 0 31.94 240.45 0.00 225.95 295.15 0.00 $3,025718 BURLINGTON Joseph Brant Memorial ctty $2,258 0.000050 0.0203 0 18.41 0.05 0 57.47 25.25 0.00 285.17 3.08 0.00 $2,602719 MANITOUWADGE General smll $5,186 0.001824 0.0000 1 0.43 0.00 0 2,102.03 0.00 150.59 6.73 0.00 0.00 $4,491721 MARATHON Wilson Memorial smll $3,206 0.001277 0.0000 1 0.45 0.00 0 1,472.40 0.00 150.59 7.01 0.00 0.00 $3,861723 MATHESON Bingham Memorial smll $3,049 0.000786 0.0000 0 0.21 0.00 0 905.48 0.00 0.00 3.18 0.00 0.00 $3,140724 MATTAWA General smll $3,836 0.001139 0.0000 0 0.63 0.00 0 1,313.46 0.00 0.00 9.78 0.00 0.00 $3,555726 MIDLAND Huronia ctty $2,674 0.000212 0.0124 0 2.55 0.02 0 244.67 15.40 0.00 39.50 1.27 0.00 $2,532731 MISSISSAUGA Credit Valley ctty $2,412 0.000041 0.0218 0 12.00 1.33 0 47.82 27.19 0.00 185.91 77.06 0.00 $2,569732 KEMPTVILLE District smll $2,696 0.000438 0.0000 0 1.07 0.00 0 504.42 0.00 0.00 16.53 0.00 0.00 $2,752733 MOUNT FOREST Louise Marshall smll $3,130 0.000634 0.0000 0 1.37 0.00 0 730.75 0.00 0.00 21.26 0.00 0.00 $2,983734 HALDIMAND West Haldimand General smll $2,788 0.000408 0.0000 0 2.27 0.00 0 470.36 0.00 0.00 35.17 0.00 0.00 $2,737736 NEWMARKET Southlake Regional Health Centrectty $2,479 0.000047 0.0067 0 16.19 0.55 0 53.85 8.30 0.00 250.74 32.09 0.00 $2,576739 NIPIGON District Memorial smll $3,156 0.000670 0.0000 1 1.29 0.00 0 772.34 0.00 150.59 19.94 0.00 0.00 $3,174745 ORILLIA Soldiers' Memorial ctty $2,020 0.000077 0.0133 0 14.81 0.54 0 88.46 16.52 0.00 229.36 31.55 0.00 $2,597753 OTTAWA Montfort ctty $2,448 0.000086 0.0768 0 10.69 0.00 0 99.33 95.56 0.00 165.50 0.18 0.00 $2,592759 PALMERSTON & District smll $3,240 0.000647 0.0000 0 0.93 0.02 0 746.33 0.00 0.00 14.46 1.37 0.00 $2,993760 PARIS - The Willett smll $3,688 0.000552 0.0000 0 0.00 0.00 0 636.04 0.00 0.00 0.00 0.00 0.00 $2,867763 PEMBROKE General ctty $2,318 0.000128 0.0003 0 3.72 0.12 0 147.39 0.42 0.00 57.63 6.80 0.00 $2,444766 PENETANGUISHENE General chrn $2,766 0.000700 0.0000 0 0.00 0.00 1 807.35 0.00 0.00 0.00 0.00 363.96 $3,403768 BARRY'S BAY St Francis Memorial smll $3,611 0.000658 0.0000 1 1.15 0.00 0 758.35 0.00 150.59 17.85 0.00 0.00 $3,158771 PETERBOROUGH Civic ctty $2,710 0.000041 0.0061 0 17.77 0.31 0 47.32 7.54 0.00 275.25 18.18 0.00 $2,580773 TORONTO Providence chrn $2,648 0.000122 0.0031 0 0.00 0.00 1 140.08 3.90 0.00 0.00 0.00 363.96 $2,739776 PETROLIA Charlotte Eleanor Englehart smll $2,545 0.000333 0.0000 0 2.03 0.00 0 383.53 0.00 0.00 31.49 0.00 0.00 $2,646777 NEPEAN Queensway-Carleton ctty $2,504 0.000068 0.0027 0 21.72 0.00 0 78.41 3.35 0.00 336.37 0.00 0.00 $2,649784 LITTLE CURRENT Manitoulin smll $2,931 0.000366 0.0000 1 2.50 0.00 0 422.26 0.00 150.59 38.70 0.00 0.00 $2,843788 RENFREW Victoria ctty $2,371 0.000369 0.0012 0 8.39 0.00 0 424.78 1.52 0.00 129.88 0.00 0.00 $2,787790 ST CATHARINES Hotel Dieu ctty $2,707 0.000094 0.0155 0 21.08 0.00 0 108.11 19.31 0.00 326.44 0.00 0.00 $2,685792 ST MARY'S Memorial smll $3,129 0.000699 0.0000 0 2.97 0.00 0 805.49 0.00 0.00 45.95 0.00 0.00 $3,083793 ST THOMAS Elgin General ctty $2,663 0.000085 0.0127 0 12.75 0.49 0 98.46 15.86 0.00 197.45 28.27 0.00 $2,571795 SARNIA St. Joseph's ctty $6,204 0.000298 0.0000 0 0.29 0.00 0 343.47 0.00 0.00 4.53 0.00 0.00 $2,579796 SARNIA General ctty $2,593 0.000072 0.0000 0 13.73 0.26 0 83.40 0.00 0.00 212.73 15.10 0.00 $2,543797 SAULT STE MARIE General ctty $2,784 0.000052 0.0213 1 12.84 0.50 0 60.41 26.45 150.59 198.89 29.23 0.00 $2,697800 HAWKESBURY & District General ctty $2,562 0.000247 0.0000 0 4.11 0.00 0 285.10 0.00 0.00 63.69 0.00 0.00 $2,580801 SEAFORTH Community smll $3,274 0.000765 0.0000 0 0.83 0.00 0 881.78 0.00 0.00 12.81 0.00 0.00 $3,126802 ALEXANDRIA Glengarry Memorial smll $2,296 0.000425 0.0000 0 0.27 0.00 0 490.22 0.00 0.00 4.23 0.00 0.00 $2,726804 SIMCOE Norfolk General ctty $2,378 0.000132 0.0000 0 9.36 0.07 0 152.09 0.00 0.00 144.97 3.83 0.00 $2,532805 SIOUX LOOKOUT District smll $2,978 0.000511 0.0000 1 3.75 0.00 0 588.61 0.00 150.59 58.13 0.00 0.00 $3,029809 SMOOTH ROCK FALLS smll $3,946 0.001019 0.0000 1 0.46 0.00 0 1,175.06 0.00 150.59 7.16 0.00 0.00 $3,564813 STRATFORD General ctty $2,584 0.000112 0.0474 0 12.82 0.15 0 129.66 59.01 0.00 198.58 8.48 0.00 $2,627814 STRATHROY Middlesex General ctty $2,410 0.000235 0.0846 0 2.46 0.00 0 270.41 105.31 0.00 38.16 0.00 0.00 $2,645819 TERRACE BAY McCausland smll $4,004 0.001076 0.0000 1 2.12 0.00 0 1,240.59 0.00 150.59 32.88 0.00 0.00 $3,655824 TILLSONBURG District Memorial ctty $2,779 0.000261 0.0000 0 1.40 0.00 0 300.56 0.00 0.00 21.71 0.00 0.00 $2,554826 KENORA Lake-of-the-Woods District ctty $2,971 0.000222 0.0354 1 5.17 0.00 0 255.47 44.12 150.59 80.14 0.00 0.00 $2,762827 TORONTO Baycrest chrn $2,565 0.000104 0.0444 0 0.00 0.00 1 120.44 55.28 0.00 0.00 0.00 363.96 $2,771842 TORONTO Mount Sinai tchg $3,265 0.000034 0.5546 0 28.15 9.64 0 39.10 690.26 0.00 436.05 559.39 0.00 $3,956849 TORONTO Riverdale chrn $2,355 0.000068 0.0000 0 0.00 0.00 1 78.54 0.00 0.00 0.00 0.00 363.96 $2,674850 TORONTO Runnymede chrn $2,895 0.000315 0.0000 0 0.00 0.00 1 363.56 0.00 0.00 0.00 0.00 363.96 $2,959852 TORONTO St Michael's tchg $3,831 0.000020 0.3747 0 43.16 0.03 0 22.53 466.36 0.00 668.53 1.84 0.00 $3,391854 TORONTO SA Grace chrn $2,425 0.000254 0.0000 0 0.00 0.00 1 292.76 0.00 0.00 0.00 0.00 363.96 $2,888858 TORONTO East General ctty $2,668 0.000034 0.0907 0 23.13 0.95 0 39.32 112.90 0.00 358.24 55.36 0.00 $2,797870 WALLACEBURG Sydenham smll $3,216 0.000330 0.0000 0 2.61 0.00 0 380.11 0.00 0.00 40.43 0.00 0.00 $2,652881 STURGEON FALLS West Nipissing smll $3,394 0.000303 0.0000 0 3.69 0.00 0 349.47 0.00 0.00 57.12 0.00 0.00 $2,638882 WINCHESTER District Memorial ctty $2,625 0.000278 0.0155 0 3.15 0.00 0 320.42 19.33 0.00 48.83 0.00 0.00 $2,620


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Facility No.


TypeActual 99/00



Neonate tertiary



neonate tertiary

Neonate tertiary


Expected 99/00

CPEWC

ADJUSTMENT FACTORS

888 NEW LISKEARD Temiskaming ctty $2,707 0.000257 0.0161 1 5.56 0.01 0 296.63 20.04 150.59 86.11 0.52 0.00 $2,785889 WINGHAM & District smll $2,835 0.000320 0.0000 0 2.95 0.00 0 368.72 0.00 0.00 45.66 0.00 0.00 $2,646890 WOODSTOCK General ctty $2,559 0.000133 0.0094 0 11.16 0.01 0 153.75 11.66 0.00 172.88 0.39 0.00 $2,570895 THUNDER BAY Hogarth-Westmount chrn $7,338 0.000845 0.0000 0 0.00 0.00 1 974.52 0.00 0.00 0.00 0.00 363.96 $3,570896 RED LAKE Marg Cochenour Memorial smll $4,455 0.001347 0.0000 1 3.15 0.00 0 1,552.64 0.00 150.59 48.86 0.00 0.00 $3,983898 TORONTO St Joseph's ctty $2,597 0.000038 0.1186 0 20.79 0.90 0 43.83 147.66 0.00 322.06 52.43 0.00 $2,797900 FORT FRANCES Riverside Health Care ctty $2,845 0.000245 0.0293 1 4.33 0.23 0 282.85 36.47 150.59 67.10 13.20 0.00 $2,781903 HUNTSVILLE District Memorial ctty $2,408 0.000244 0.0079 0 5.40 0.01 0 281.60 9.89 0.00 83.66 0.71 0.00 $2,607905 MARKHAM Stouffville ctty $2,466 0.000069 0.0044 0 12.60 0.53 0 79.09 5.48 0.00 195.20 30.83 0.00 $2,542906 NORTH BAY General ctty $2,990 0.000074 0.0000 0 11.82 0.45 0 85.71 0.00 0.00 183.10 25.95 0.00 $2,526907 TIMMINS & District General ctty $2,692 0.000092 0.0289 0 19.42 0.06 0 106.29 36.00 0.00 300.81 3.44 0.00 $2,678916 ORANGEVILLE Dufferin-Caledon ctty $2,201 0.000140 0.0075 0 10.87 0.00 0 160.94 9.39 0.00 168.44 0.28 0.00 $2,570927 WINDSOR Hotel Dieu Grace ctty $2,890 0.000036 0.0032 0 24.82 2.12 0 41.23 3.92 0.00 384.49 123.08 0.00 $2,784928 SMITHS FALLS Perth & Smiths Falls ctty $2,731 0.000156 0.0046 0 11.64 0.01 0 180.26 5.75 0.00 180.30 0.33 0.00 $2,598930 KITCHENER Grand River ctty $2,517 0.000033 0.0085 0 15.96 0.77 0 37.66 10.63 0.00 247.14 44.51 0.00 $2,571931 PARRY SOUND West Parry Sound ctty $2,496 0.000204 0.0000 0 3.98 0.00 0 234.59 0.00 0.00 61.63 0.00 0.00 $2,527932 OTTAWA Sisters of Charity chrn $2,858 0.000058 0.0205 0 0.00 0.00 1 67.35 25.48 0.00 0.00 0.00 363.96 $2,688933 WINDSOR Regional ctty $2,905 0.000041 0.0014 0 12.30 0.09 0 47.68 1.76 0.00 190.50 5.22 0.00 $2,476935 THUNDER BAY Regional ctty $2,692 0.000037 0.0448 0 24.94 0.81 0 42.95 55.73 0.00 386.23 46.95 0.00 $2,763936 LONDON Health Sciences tchg $3,642 0.000015 0.4709 0 51.74 0.33 0 17.15 586.06 0.00 801.36 19.19 0.00 $3,655938 MINDEN Haliburton Highlands smll $1,606 0.000502 0.0000 1 0.30 0.00 0 578.62 0.00 150.59 4.68 0.00 0.00 $2,965940 COBOURG Northumberland ctty $2,632 0.000190 0.0074 0 5.95 0.03 0 218.81 9.23 0.00 92.20 1.64 0.00 $2,553941 TORONTO Humber River Regional ctty $2,426 0.000023 0.0074 0 19.03 0.43 0 26.73 9.27 0.00 294.69 24.68 0.00 $2,587942 HAMILTON Health Sciences Centre tchg $3,342 0.000011 0.2919 0 42.22 2.45 0 13.00 363.27 0.00 653.97 141.92 0.00 $3,403943 Thunder Bay St. Joseph's (781) chrn $2,845 0.000150 0.0000 0 0.00 0.00 1 172.99 0.00 0.00 0.00 0.00 363.96 $2,768946 KINCARDINE S Bruce Grey Hlth Ctr ctty $2,690 0.000199 0.0000 0 3.00 0.00 0 229.59 0.00 0.00 46.44 0.00 0.00 $2,507947 TORONTO University Health Network tchg $3,687 0.000012 0.3478 0 58.07 0.23 0 13.32 432.86 0.00 899.49 13.19 0.00 $3,590949 MISSISSAUGA Trillium Health Centre ctty $2,584 0.000021 0.0023 0 18.10 0.17 0 24.05 2.85 0.00 280.43 10.00 0.00 $2,549950 OAKVILLE Halton Heatlhcare Services Corporationctty $2,447 0.000046 0.0059 0 10.57 0.29 0 52.59 7.31 0.00 163.72 16.86 0.00 $2,472951 BRAMPTON William Osler ctty $2,435 0.000019 0.0062 0 13.90 0.55 0 21.44 7.74 0.00 215.29 31.92 0.00 $2,508952 OSHAWA Lakeridge Health Corporation ctty $2,810 0.000024 0.0163 0 14.07 0.28 0 27.40 20.26 0.00 217.92 16.38 0.00 $2,513953 TORONTO Sunnybrook & Women's tchg $3,626 0.000015 0.2368 0 38.16 3.12 0 16.80 294.74 0.00 591.01 180.95 0.00 $3,315954 TORONTO Rouge Valley Health System ctty $2,721 0.000027 0.0053 0 15.18 0.63 0 31.34 6.59 0.00 235.05 36.81 0.00 $2,541955 OWEN SOUND Grey Bruce Health Servicesctty $2,989 0.000056 0.0044 0 11.31 0.15 0 64.35 5.52 0.00 175.20 8.69 0.00 $2,485956 TORONTO Rehabilitation Institute chrn $3,081 0.000099 0.0050 0 0.00 0.00 1 114.16 6.22 0.00 0.00 0.00 363.96 $2,716957 BELLEVILLE Quinte Health Care Corporationctty $2,924 0.000053 0.0253 0 7.58 0.09 0 61.27 31.48 0.00 117.42 5.24 0.00 $2,447958 OTTAWA The Ottawa Hospital tchg $3,461 0.000010 0.2770 0 38.47 2.05 0 11.83 344.73 0.00 595.85 118.65 0.00 $3,302959 SUDBURY Hopital Regional de Sudbury Regional Hospitalctty $3,085 0.000027 0.0224 0 27.32 1.06 0 30.96 27.93 0.00 423.18 61.48 0.00 $2,775


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Appendix 7: Actual and Expected Cost Per Equivalent Weighted Case

Facility No.


Type

Total 99/00 Equivalent Weighted

Cases

Actual 99/00 CPEWC

Expected 99/00

CPEWC

Over/Under 99/00 ECPEWC

% Over/Under 99/00

ECPEWC

592 NAPANEE Lennox & Addington smll 3,450 $2,721 $2,578 $144 5.57%593 NEWBURY Four Counties smll 1,461 $3,241 $3,038 $203 6.67%596 ALLISTON Stevenson Memorial smll 4,152 $2,192 $2,559 -$367 -14.35%597 ALMONTE General smll 2,511 $2,443 $2,693 -$250 -9.29%599 ARNPRIOR & District Memorial smll 3,190 $2,551 $2,612 -$61 -2.35%600 ATIKOKAN General smll 1,482 $2,533 $3,329 -$796 -23.92%606 BARRIE Roval Victoria ctty 21,395 $2,265 $2,572 -$307 -11.94%611 BLIND RIVER St Joseph's smll 2,264 $2,460 $2,957 -$498 -16.83%613 TORONTO West Park chrn 6,036 $3,364 $2,799 $566 20.22%614 BRACEBRIDGE S Muskoka Memorial ctty 3,957 $2,737 $2,590 $147 5.67%617 BRANTFORD General ctty 15,995 $2,343 $2,603 -$260 -9.99%618 BRANTFORD St Joseph's ctty 3,891 $2,881 $2,709 $172 6.33%619 BROCKVILLE General ctty 6,878 $2,506 $2,541 -$35 -1.36%620 BROCKVILLE St Vincent de Paul chrn 1,312 $4,619 $3,474 $1,145 32.97%624 CAMPBELLFORD Memorial smll 2,955 $2,866 $2,693 $173 6.42%626 CARLETON PLACE & District Memorial smll 2,016 $2,207 $2,814 -$607 -21.57%627 CHAPLEAU General smll 1,104 $3,598 $3,426 $172 5.01%628 CHATHAM Public General ctty 8,471 $2,744 $2,469 $275 11.14%629 CHATHAM St Joseph's ctty 3,515 $4,199 $2,888 $1,311 45.40%632 TORONTO North York General ctty 37,776 $2,825 $2,640 $185 7.01%633 CLINTON Public smll 2,059 $2,601 $2,814 -$213 -7.58%638 COCHRANE Lady Minto smll 973 $4,204 $3,569 $634 17.78%640 COLLINGWOOD General and Marine ctty 4,227 $2,451 $2,659 -$208 -7.83%643 CORNWALL General ctty 5,154 $2,669 $2,696 -$26 -0.98%644 CORNWALL Hotel Dieu ctty 8,374 $2,652 $2,528 $124 4.91%646 DEEP RIVER and District smll 967 $4,221 $3,477 $744 21.40%647 DRYDEN District General smll 3,749 $2,538 $2,727 -$189 -6.94%648 DUNNVILLE Haldimand War Memorial smll 2,609 $2,645 $2,687 -$42 -1.54%650 ELLIOT LAKE St Joseph's ctty 2,907 $3,125 $2,924 $201 6.88%653 ENGLEHART & District smll 1,341 $2,389 $3,308 -$919 -27.78%654 ESPANOLA General smll 2,642 $2,317 $2,728 -$411 -15.07%655 EXETER South Huron smll 1,770 $2,637 $2,899 -$263 -9.07%656 FERGUS Groves Memorial Comm ctty 2,874 $2,395 $2,684 -$290 -10.79%661 CAMBRIDGE Memorial ctty 16,427 $2,457 $2,472 -$15 -0.60%662 GERALDTON District Hospital smll 2,246 $2,403 $2,918 -$515 -17.65%663 GODERICH Alexandra Marine & General smll 4,661 $2,576 $2,580 -$4 -0.16%


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Facility No.


Type


Cases

Actual 99/00 CPEWC

Expected 99/00

CPEWC


% Over/Under 99/00

ECPEWC

664 GRIMSBY West Lincoln Memorial ctty 3,629 $2,377 $2,650 -$273 -10.31%665 GUELPH General ctty 10,211 $2,306 $2,606 -$300 -11.51%666 GUELPH St Joseph's Hospital ctty 8,414 $2,692 $2,581 $111 4.31%674 HAMILTON St Joseph's tchg 34,812 $2,835 $3,051 -$216 -7.09%675 HAMILTON St Peter's chrn 9,501 $2,414 $2,717 -$302 -11.13%676 HANOVER & District smll 3,528 $2,324 $2,585 -$261 -10.11%681 HEARST Notre Dame smll 2,638 $3,278 $2,836 $443 15.61%682 HORNEPAYNE Community smll 482 $5,588 $4,771 $817 17.12%684 INGERSOLL Alexandra smll 2,925 $2,880 $2,660 $220 8.28%685 IROQUOIS FALLS Anson General smll 1,468 $3,235 $3,079 $156 5.06%686 WAWA North Algoma smll 1,459 $2,655 $3,180 -$525 -16.52%687 KAPUSKASING Sensenbrenner smll 3,610 $2,813 $2,713 $101 3.71%692 KINGSTON Hotel Dieu tchg 2,928 $4,980 $2,989 $1,990 66.58%693 KINGSTON General tchg 35,124 $3,392 $3,622 -$230 -6.35%695 KINGSTON St Mary's-of-the-Lake chrn 4,933 $3,340 $2,893 $447 15.44%696 KIRKLAND & District ctty 2,585 $3,425 $2,931 $494 16.84%699 KITCHENER St Mary's ctty 12,910 $2,609 $2,574 $36 1.38%701 RICHMOND HILL York Central ctty 18,877 $2,268 $2,590 -$322 -12.42%704 LEAMINGTON District Memorial ctty 4,833 $2,112 $2,524 -$411 -16.30%707 LINDSAY Ross Memorial ctty 10,078 $2,270 $2,484 -$213 -8.60%709 LISTOWEL Memorial smll 3,034 $2,394 $2,652 -$259 -9.75%714 LONDON St Joseph's tchg 36,090 $3,142 $3,025 $117 3.86%718 BURLINGTON Joseph Brant Memorial ctty 20,057 $2,258 $2,602 -$344 -13.21%719 MANITOUWADGE General smll 548 $5,186 $4,491 $695 15.49%721 MARATHON Wilson Memorial smll 783 $3,206 $3,861 -$655 -16.97%723 MATHESON Bingham Memorial smll 1,273 $3,049 $3,140 -$91 -2.91%724 MATTAWA General smll 878 $3,836 $3,555 $282 7.92%726 MIDLAND Huronia ctty 4,711 $2,674 $2,532 $141 5.58%731 MISSISSAUGA Credit Valley ctty 24,106 $2,412 $2,569 -$157 -6.11%732 KEMPTVILLE District smll 2,285 $2,696 $2,752 -$57 -2.06%733 MOUNT FOREST Louise Marshall smll 1,577 $3,130 $2,983 $147 4.92%734 HALDIMAND West Haldimand General smll 2,451 $2,788 $2,737 $51 1.87%736 NEWMARKET Southlake Regional Health Centre ctty 21,408 $2,479 $2,576 -$97 -3.76%739 NIPIGON District Memorial smll 1,492 $3,156 $3,174 -$18 -0.57%745 ORILLIA Soldiers' Memorial ctty 13,030 $2,020 $2,597 -$577 -22.24%753 OTTAWA Montfort ctty 11,605 $2,448 $2,592 -$144 -5.55%


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Facility No.


Type


Cases

Actual 99/00 CPEWC

Expected 99/00

CPEWC


% Over/Under 99/00

ECPEWC

759 PALMERSTON & District smll 1,544 $3,240 $2,993 $246 8.22%760 PARIS - The Willett smll 1,812 $3,688 $2,867 $821 28.64%763 PEMBROKE General ctty 7,821 $2,318 $2,444 -$126 -5.15%766 PENETANGUISHENE General chrn 1,428 $2,766 $3,403 -$637 -18.71%768 BARRY'S BAY St Francis Memorial smll 1,520 $3,611 $3,158 $453 14.34%771 PETERBOROUGH Civic ctty 24,361 $2,710 $2,580 $130 5.04%773 TORONTO Providence chrn 8,229 $2,648 $2,739 -$91 -3.31%776 PETROLIA Charlotte Eleanor Englehart smll 3,006 $2,545 $2,646 -$101 -3.83%777 NEPEAN Queensway-Carleton ctty 14,701 $2,504 $2,649 -$146 -5.49%784 LITTLE CURRENT Manitoulin smll 2,730 $2,931 $2,843 $88 3.09%788 RENFREW Victoria ctty 2,714 $2,371 $2,787 -$416 -14.93%790 ST CATHARINES Hotel Dieu ctty 10,663 $2,707 $2,685 $22 0.83%792 ST MARY'S Memorial smll 1,431 $3,129 $3,083 $46 1.49%793 ST THOMAS Elgin General ctty 11,707 $2,663 $2,571 $92 3.56%795 SARNIA St. Joseph's ctty 3,356 $6,204 $2,579 $3,625 140.55%796 SARNIA General ctty 13,822 $2,593 $2,543 $50 1.97%797 SAULT STE MARIE General ctty 19,082 $2,784 $2,697 $88 3.25%800 HAWKESBURY & District General ctty 4,043 $2,562 $2,580 -$18 -0.69%801 SEAFORTH Community smll 1,307 $3,274 $3,126 $148 4.74%802 ALEXANDRIA Glengarry Memorial smll 2,351 $2,296 $2,726 -$430 -15.78%804 SIMCOE Norfolk General ctty 7,579 $2,378 $2,532 -$154 -6.09%805 SIOUX LOOKOUT District smll 1,958 $2,978 $3,029 -$50 -1.66%809 SMOOTH ROCK FALLS smll 981 $3,946 $3,564 $382 10.72%813 STRATFORD General ctty 8,890 $2,584 $2,627 -$43 -1.64%814 STRATHROY Middlesex General ctty 4,263 $2,410 $2,645 -$236 -8.90%819 TERRACE BAY McCausland smll 929 $4,004 $3,655 $348 9.53%824 TILLSONBURG District Memorial ctty 3,835 $2,779 $2,554 $225 8.83%826 KENORA Lake-of-the-Woods District ctty 4,512 $2,971 $2,762 $209 7.57%827 TORONTO Baycrest chrn 9,570 $2,565 $2,771 -$206 -7.42%842 TORONTO Mount Sinai tchg 29,484 $3,265 $3,956 -$691 -17.48%849 TORONTO Riverdale chrn 14,677 $2,355 $2,674 -$318 -11.91%850 TORONTO Runnymede chrn 3,171 $2,895 $2,959 -$64 -2.17%852 TORONTO St Michael's tchg 51,174 $3,831 $3,391 $440 12.99%854 TORONTO SA Grace chrn 3,937 $2,425 $2,888 -$463 -16.02%858 TORONTO East General ctty 29,314 $2,668 $2,797 -$129 -4.60%870 WALLACEBURG Sydenham smll 3,033 $3,216 $2,652 $564 21.27%


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Facility No.


Type


Cases

Actual 99/00 CPEWC

Expected 99/00

CPEWC


% Over/Under 99/00

ECPEWC

881 STURGEON FALLS West Nipissing smll 3,298 $3,394 $2,638 $756 28.66%882 WINCHESTER District Memorial ctty 3,597 $2,625 $2,620 $5 0.20%888 NEW LISKEARD Temiskaming ctty 3,886 $2,707 $2,785 -$79 -2.82%889 WINGHAM & District smll 3,126 $2,835 $2,646 $189 7.15%890 WOODSTOCK General ctty 7,497 $2,559 $2,570 -$11 -0.43%895 THUNDER BAY Hogarth-Westmount chrn 1,183 $7,338 $3,570 $3,768 105.55%896 RED LAKE Marg Cochenour Memorial smll 742 $4,455 $3,983 $471 11.83%898 TORONTO St Joseph's ctty 26,300 $2,597 $2,797 -$200 -7.15%900 FORT FRANCES Riverside Health Care ctty 4,075 $2,845 $2,781 $64 2.28%903 HUNTSVILLE District Memorial ctty 4,093 $2,408 $2,607 -$199 -7.64%905 MARKHAM Stouffville ctty 14,574 $2,466 $2,542 -$76 -2.99%906 NORTH BAY General ctty 13,448 $2,990 $2,526 $464 18.36%907 TIMMINS & District General ctty 10,845 $2,692 $2,678 $15 0.55%916 ORANGEVILLE Dufferin-Caledon ctty 7,162 $2,201 $2,570 -$369 -14.38%927 WINDSOR Hotel Dieu Grace ctty 27,961 $2,890 $2,784 $106 3.81%928 SMITHS FALLS Perth & Smiths Falls ctty 6,395 $2,731 $2,598 $134 5.14%930 KITCHENER Grand River ctty 30,609 $2,517 $2,571 -$54 -2.10%931 PARRY SOUND West Parry Sound ctty 4,914 $2,496 $2,527 -$31 -1.25%932 OTTAWA Sisters of Charity chrn 17,114 $2,858 $2,688 $170 6.32%933 WINDSOR Regional ctty 24,177 $2,905 $2,476 $428 17.29%935 THUNDER BAY Regional ctty 26,836 $2,692 $2,763 -$71 -2.57%936 LONDON Health Sciences tchg 67,228 $3,642 $3,655 -$13 -0.36%938 MINDEN Haliburton Highlands smll 1,992 $1,606 $2,965 -$1,359 -45.84%940 COBOURG Northumberland ctty 5,268 $2,632 $2,553 $79 3.10%941 TORONTO Humber River Regional ctty 43,118 $2,426 $2,587 -$161 -6.22%942 HAMILTON Health Sciences Centre tchg 88,697 $3,342 $3,403 -$62 -1.81%943 Thunder Bay St. Joseph's (781) chrn 6,663 $2,845 $2,768 $77 2.77%946 KINCARDINE S Bruce Grey Hlth Ctr ctty 5,021 $2,690 $2,507 $183 7.29%947 TORONTO University Health Network tchg 86,561 $3,687 $3,590 $96 2.69%949 MISSISSAUGA Trillium Health Centre ctty 47,920 $2,584 $2,549 $35 1.39%950 OAKVILLE Halton Heatlhcare Services Corporation ctty 21,920 $2,447 $2,472 -$25 -1.01%951 BRAMPTON William Osler ctty 53,761 $2,435 $2,508 -$73 -2.90%952 OSHAWA Lakeridge Health Corporation ctty 42,065 $2,810 $2,513 $297 11.81%953 TORONTO Sunnybrook & Women's tchg 68,634 $3,626 $3,315 $311 9.39%954 TORONTO Rouge Valley Health System ctty 36,784 $2,721 $2,541 $180 7.10%955 OWEN SOUND Grey Bruce Health Services ctty 17,914 $2,989 $2,485 $504 20.28%


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Facility No.


Type


Cases

Actual 99/00 CPEWC

Expected 99/00

CPEWC


% Over/Under 99/00

ECPEWC

956 TORONTO Rehabilitation Institute chrn 10,097 $3,081 $2,716 $366 13.47%957 BELLEVILLE Quinte Health Care Corporation ctty 18,815 $2,924 $2,447 $477 19.50%958 OTTAWA The Ottawa Hospital tchg 97,406 $3,461 $3,302 $159 4.82%959 SUDBURY Hopital Regional de Sudbury Regional Hospital ctty 37,233 $3,085 $2,775 $310 11.18%

Minimum -45.84%25th Percentile -7.22%Median 0.02%75th Percentile 7.11%Maximum 140.55%


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Appendix 8: Calculation of Model Details for Merged Facilities

Facility No. Hospital NameHospital Type

Total 99/00 Equivalent

Weighted Cases size teaching isolationnon-neonate

tertiaryneonate tertiary

stand-alone chronic flag

Actual 99/00

CPEWC

Expected 99/00

CPEWC

Over/Under 99/00

ECPEWC

% Over/Under

99/00 ECPEWC

623 ST CATHARINES Shaver chrn 3,464 0.000289 0.0000 0 0.00 0.00 1 $2,628 $2,928 -$300658 FORT ERIE Douglas Memorial ctty 2,849 0.000351 0.0000 0 1.60 0.00 0 $2,642 $2,661 -$19737 NIAGARA-ON-THE-LAKE General smll 884 0.001131 0.0000 0 0.00 0.00 0 $2,750 $3,535 -$785738 NIAGARA FALLS Greater Niagara ctty 15,000 0.000067 0.0017 0 10.39 0.11 0 $2,516 $2,477 $39782 PORT COLBORNE General ctty 2,692 0.000371 0.0000 0 2.92 0.00 0 $2,748 $2,705 $43791 ST CATHARINES GENERAL ctty 15,738 0.000064 0.0055 0 12.41 0.60 0 $2,527 $2,539 -$12873 WELLAND County General ctty 13,700 0.000073 0.0013 0 17.79 0.14 0 $2,516 $2,601 -$85962 ST CATHERINES Niagara Health System ccty 54,328 0.000129 0.0024 0 11.18 0.24 0.06377 $2,548 $2,593 -$45 -1.73%

787 TORONTO Scarborough SA Grace ctty 18,076 0.000055 0.0147 0 19.70 0.73 0 $2,367 $2,661 -$294799 TORONTO Scarborough General ctty 32,994 0.000030 0.0360 0 27.56 0.75 0 $2,402 $2,781 -$380960 TORONTO The Scarborough Hospital ccty 51,069 0.000039 0.0285 0 24.77705 0.74005 0 $2,389 $2,739 -$349 -12.76%

ADJUSTMENT FACTORS


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Appendix 9: Community MARI Index

Community Description Excess Mortality

Percentage Population Off-

Reserve Aboriginal

Percentage RuralPercentage

Population Lowest Income Quintile

MARI Index

STORMONT, DUNDAS AND GLENGARRY UNITED COUNTIES 0.77 -0.21 24.79 19.70 1.2961PRESCOTT AND RUSSELL UNITED COUNTIES 0.05 -0.32 8.54 15.35 1.0614OSGOODE -0.67 -0.31 -14.52 -0.15 0.7854CUMBERLAND -0.26 -0.30 -14.52 -0.15 0.8961GLOUCESTER -0.23 -0.07 -14.52 7.54 0.9279VANIER 0.45 2.75 -14.52 66.81 1.3211NEPEAN -0.42 -0.41 -14.52 7.86 0.8704OTTAWA/ROCK -0.18 -0.13 -14.52 29.37 0.9963RIDEAU -0.73 -0.91 -14.52 -0.15 0.7560GOULBOURN -0.61 -0.83 -14.52 -0.15 0.7895KANATA -0.37 -0.62 -14.52 -0.15 0.8602WEST CARLETON -0.37 -0.29 -14.52 -0.15 0.8664LEEDS AND GRENVILLE UNITED COUNTIES 0.17 -0.54 31.01 18.00 1.1367LANARK COUNTY 0.23 -0.38 37.12 13.27 1.1548FRONTENAC COUNTY -0.17 -0.14 2.90 22.89 1.0142LENNOX AND ADDINGTON COUNTY -0.15 0.32 25.31 25.89 1.0779HASTINGS COUNTY -0.02 0.72 8.21 34.18 1.1119PRINCE EDWARD COUNTY 0.20 0.64 35.08 20.85 1.1856NORTHUMBERLAND COUNTY -0.25 -0.12 15.92 18.84 1.0059PETERBOROUGH COUNTY -0.46 0.35 11.07 23.29 0.9616VICTORIA COUNTY -0.23 -0.60 30.69 22.46 1.0365PICKERING -0.17 -0.75 -14.52 -0.15 0.9120AJAX -0.01 -0.61 -14.52 2.57 0.9648WHITBY 0.17 -0.66 -14.52 6.14 1.0187OSHAWA 0.49 -0.22 -14.52 33.13 1.1838CLARINGTON 0.21 -0.43 -14.52 7.99 1.0408SCUGOG 0.32 -0.98 -14.52 -0.15 1.0378UXBRIDGE -0.30 -0.88 -14.52 -0.15 0.8723BROCK 0.14 -0.77 -14.52 16.66 1.0347VAUGHAN -0.51 -1.09 -14.52 0.66 0.8147MARKHAM -0.52 -1.09 -14.52 3.80 0.8204RICHMOND HILL -0.40 -1.00 -14.52 3.65 0.8525WHITCHURCH-STOUFFVILLE -0.25 -0.92 -14.52 -0.15 0.8859AURORA -0.04 -0.93 -14.52 -0.15 0.9407NEWMARKET 0.32 -0.76 -14.52 0.37 1.0427KING -0.67 -0.75 -14.52 2.66 0.7830EAST GWILLIMBURY 0.09 -0.81 -14.52 -0.15 0.9782GEORGINA 0.58 0.30 -14.52 10.09 1.1608SCARBOROUGH -0.03 -0.83 -14.52 28.21 1.0181


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Reserve Aboriginal



MARI Index

TORONTO 0.29 -0.54 -14.52 31.51 1.1189EAST YORK 0.11 -0.83 -14.52 32.45 1.0652NORTH YORK -0.35 -0.97 -14.52 32.14 0.9374YORK 0.30 -0.61 -14.52 50.61 1.1668ETOBICOKE -0.03 -0.88 -14.52 25.48 1.0108MISSISSAUGA -0.04 -0.93 -14.52 11.98 0.9722BRAMPTON 0.11 -0.84 -14.52 5.46 0.9981CALEDON -0.40 -1.02 -14.52 -0.15 0.8425DUFFERIN COUNTY 0.03 -0.88 30.09 7.53 1.0635WELLINGTON COUNTY -0.19 -0.70 -2.79 16.51 0.9706OAKVILLE -0.24 -0.87 -14.52 2.10 0.8953BURLINGTON -0.25 -0.81 -14.52 3.07 0.8950MILTON 0.19 -0.46 -14.52 2.08 1.0209HALTON HILLS 0.18 -0.86 -14.52 -0.15 1.0025STONEY CREEK -0.24 -0.62 -14.52 5.42 0.9079GLANBROOK -0.40 -0.67 -14.52 -0.15 0.8503ANCASTER -0.88 -0.96 -14.52 -0.15 0.7158HAMILTON 0.42 0.09 -14.52 36.06 1.1775DUNDAS -0.04 -0.74 -14.52 2.01 0.9513FLAMBOROUGH -0.64 -0.72 -14.52 -0.15 0.7843FORT ERIE 0.62 1.23 -14.52 30.32 1.2421PORT COLBORNE 1.05 0.57 -14.52 22.51 1.3253WAINFLEET -0.90 -0.39 -14.52 -0.15 0.7234WEST LINCOLN 0.06 -0.76 -14.52 -0.15 0.9730PELHAM -1.06 -1.02 -14.52 -0.15 0.6641WELLAND 0.70 0.15 -14.52 26.30 1.2320THOROLD 0.36 0.01 -14.52 2.98 1.0770NIAGARA FALLS 0.41 -0.41 -14.52 26.72 1.1420NIAGARA-ON-THE-LAKE -0.45 -0.93 -14.52 -0.15 0.8309ST. CATHARINES 0.28 -0.22 -14.52 21.51 1.0990LINCOLN -0.28 -0.50 -14.52 -0.15 0.8865GRIMSBY -0.11 -0.66 -14.52 3.09 0.9378HALDIMAND-NORFOLK REGIONAL MUNICIPALITY 0.22 0.18 -2.25 12.31 1.0896BRANT COUNTY -0.06 0.93 -7.97 18.24 1.0363NORTH DUMFRIES -0.68 -0.87 -14.52 -0.15 0.7705CAMBRIDGE 0.26 -0.82 -14.52 20.93 1.0770KITCHENER 0.07 -0.46 -14.52 24.26 1.0420WATERLOO -0.27 -0.60 -14.52 15.66 0.9267WILMOT -0.27 -0.54 -14.52 -0.15 0.8885


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Reserve Aboriginal



MARI Index

WELLESLEY -0.35 -1.19 -14.52 9.84 0.8784WOOLWICH -0.76 -0.70 -14.52 -0.15 0.7527PERTH COUNTY -0.76 -0.85 22.11 11.61 0.8450OXFORD COUNTY 0.08 -0.68 21.15 10.38 1.0703ELGIN COUNTY 0.24 -0.44 15.15 12.24 1.1135KENT COUNTY 0.54 -0.32 16.56 17.70 1.2141ESSEX COUNTY 0.28 -0.43 -13.93 18.69 1.0873LAMBTON COUNTY 0.44 0.03 5.21 16.73 1.1711MIDDLESEX COUNTY -0.07 -0.13 -7.42 19.64 1.0152HURON COUNTY -0.22 -0.73 43.12 18.89 1.0507BRUCE COUNTY 0.25 -0.19 34.13 21.05 1.1789GREY COUNTY -0.17 -0.33 33.57 27.87 1.0784SIMCOE COUNTY 0.18 0.20 -5.25 15.57 1.0811MUSKOKA DISTRICT MUNICIPALITY -0.16 0.29 85.48 26.92 1.1870HALIBURTON COUNTY -0.96 -0.87 85.48 46.23 0.9947RENFREW COUNTY 0.32 0.31 22.35 28.81 1.2050NIPISSING DISTRICT 0.72 2.85 9.34 35.16 1.3618PARRY SOUND DISTRICT -0.02 0.61 47.46 45.53 1.2094MANITOULIN DISTRICT 0.56 4.01 56.77 34.66 1.4300SUDBURY DISTRICT 0.94 3.37 44.98 30.83 1.4872SUDBURY REGIONAL MUNICIPALITY 0.78 1.53 -2.70 20.47 1.2898TIMISKAMING DISTRICT 1.14 0.82 22.54 30.81 1.4433COCHRANE DISTRICT 0.78 4.13 62.81 16.35 1.4558ALGOMA DISTRICT 0.96 3.49 16.94 24.17 1.4259THUNDER BAY DISTRICT 0.65 4.98 4.75 17.35 1.3363RAINY RIVER DISTRICT 0.38 5.75 39.82 12.15 1.3329KENORA DISTRICT 0.21 9.01 35.69 9.73 1.3441


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Appendix 10: Community Expected Medical/Surgical Volumes Calculation

Expected Age & Sex Adjusted MARI Indexed Expected MoHLTC Normalized MARI Indexed

Expected On-Reserve Aboriginal

MoHLTC Normalized MARI Indexed Expected

Community Description

Actual 1999/2000 Weighted

Cases

1999/2000 Weighted

Cases

Primary and Secondary Growth to 2001/2002

Tertiary Growth to 2001/2002

MARI Index1999/2000 Weighted

Cases



1999/2000 Weighted

Cases

MARI Primary and Secondary Growth to 2001/2002

MARI Tertiary

Growth to 2001/2002

1999/2000 Weighted

Cases

Growth to 2001/2002

Actual 1999/2000 Weighted Cases*

1999/2000 Weighted Cases*

Growth to 2001/2002*

Total Expected

2001/2002 Medical & Surgical

Weighted Cases*

0.948856 0.97807083 0.98666772

A B C D E F=B*E G=C*E H=D*E I=F*0.949 J=G*0.978 K=H*0.987 L M N=A+L O=I+L P=J+K+M R=O+P

* (Including On-Reserve Aboriginal Weighted Cases) STORMONT, DUNDAS AND GLENGARRY UNITED COUNTIES18,701 16,433 251 75 1.2961 21,299 325 97 20,210 318 95 141 6 18,842 20,351 419 20,770PRESCOTT AND RUSSELL UNITED COUNTIES8,396 9,330 282 125 1.0614 9,903 299 133 9,397 293 131 8,396 9,397 424 9,820OSGOODE 1,225 1,929 92 44 0.7854 1,515 72 34 1,437 71 34 1,225 1,437 105 1,542CUMBERLAND 3,546 4,883 462 203 0.8961 4,376 414 182 4,152 405 179 3,546 4,152 584 4,736GLOUCESTER 9,953 11,600 229 164 0.9279 10,764 212 152 10,213 208 150 9,953 10,213 358 10,571VANIER 2,825 2,457 56 19 1.3211 3,246 74 25 3,080 72 25 2,825 3,080 97 3,177NEPEAN 12,725 14,505 519 233 0.8704 12,625 452 203 11,979 442 200 12,725 11,979 642 12,621OTTAWA/ROCK 46,766 49,199 989 282 0.9963 49,018 986 281 46,511 964 277 46,766 46,511 1,242 47,753RIDEAU 1,499 1,573 69 31 0.7560 1,189 52 23 1,128 51 23 1,499 1,128 74 1,202GOULBOURN 2,102 2,582 170 63 0.7895 2,038 134 50 1,934 131 49 2,102 1,934 180 2,114KANATA 4,136 5,396 377 171 0.8602 4,641 324 147 4,404 317 145 4,136 4,404 462 4,866WEST CARLETON 1,622 1,986 90 44 0.8664 1,721 78 38 1,633 76 38 1,622 1,633 114 1,746LEEDS AND GRENVILLE UNITED COUNTIES14,344 14,782 254 74 1.1367 16,803 289 84 15,944 283 83 14,344 15,944 365 16,309LANARK COUNTY 9,920 8,942 223 71 1.1548 10,326 258 82 9,798 252 81 9,920 9,798 334 10,132FRONTENAC COUNTY 19,629 19,432 273 62 1.0142 19,708 277 63 18,700 271 62 19,629 18,700 333 19,033LENNOX AND ADDINGTON COUNTY 5,559 5,596 101 33 1.0779 6,033 109 36 5,724 107 35 5,559 5,724 142 5,866HASTINGS COUNTY 17,617 17,784 436 122 1.1119 19,775 485 135 18,763 474 134 217 23 17,834 18,980 631 19,611PRINCE EDWARD COUNTY 4,157 4,327 158 35 1.1856 5,130 187 42 4,867 183 41 4,157 4,867 224 5,091NORTHUMBERLAND COUNTY 11,462 13,019 477 122 1.0059 13,096 480 122 12,426 469 121 11,462 12,426 590 13,016PETERBOROUGH COUNTY 20,050 20,147 566 137 0.9616 19,373 544 132 18,382 532 130 93 4 20,143 18,475 666 19,141VICTORIA COUNTY 13,088 11,687 329 72 1.0365 12,113 341 75 11,493 333 74 13,088 11,493 408 11,901PICKERING 8,046 8,787 555 247 0.9120 8,014 506 226 7,604 495 223 8,046 7,604 718 8,322AJAX 6,762 6,887 320 144 0.9648 6,644 308 139 6,304 302 137 6,762 6,304 438 6,743WHITBY 8,204 8,950 490 208 1.0187 9,117 499 212 8,651 488 209 8,204 8,651 697 9,348OSHAWA 18,927 17,263 486 204 1.1838 20,436 576 242 19,391 563 238 18,927 19,391 801 20,192CLARINGTON 8,348 7,639 391 165 1.0408 7,951 407 171 7,544 399 169 8,348 7,544 568 8,112SCUGOG 2,719 2,518 87 37 1.0378 2,614 91 38 2,480 89 38 2,719 2,480 126 2,606UXBRIDGE 2,160 2,230 87 40 0.8723 1,945 76 35 1,845 75 34 2,160 1,845 109 1,954BROCK 1,803 1,858 30 10 1.0347 1,922 31 10 1,824 31 10 1,803 1,824 40 1,864VAUGHAN 13,608 17,003 1,179 514 0.8147 13,852 961 419 13,144 940 413 13,608 13,144 1,353 14,497MARKHAM 16,077 22,922 1,245 573 0.8204 18,805 1,021 470 17,843 999 464 16,077 17,843 1,463 19,305RICHMOND HILL 10,406 14,012 830 355 0.8525 11,945 708 303 11,334 692 299 10,406 11,334 991 12,326WHITCHURCH-STOUFFVILLE 2,397 2,808 112 55 0.8859 2,488 99 49 2,360 97 48 2,397 2,360 145 2,506AURORA 3,777 4,359 271 121 0.9407 4,101 255 114 3,891 249 112 3,777 3,891 361 4,253NEWMARKET 7,650 7,325 451 197 1.0427 7,637 470 206 7,247 460 203 7,650 7,247 663 7,910KING 1,779 2,467 110 52 0.7830 1,932 86 41 1,833 84 40 1,779 1,833 125 1,958EAST GWILLIMBURY 2,287 2,315 131 65 0.9782 2,265 128 64 2,149 125 63 2,287 2,149 188 2,337GEORGINA 4,870 4,724 272 109 1.1608 5,484 316 127 5,203 309 125 4,870 5,203 434 5,638SCARBOROUGH 70,278 76,542 3,080 1,105 1.0181 77,930 3,136 1,125 73,944 3,067 1,110 70,278 73,944 4,178 78,122TORONTO 93,661 86,013 3,020 1,234 1.1189 96,242 3,379 1,381 91,320 3,305 1,363 93,661 91,320 4,667 95,988EAST YORK 16,093 16,008 609 206 1.0652 17,052 649 219 16,180 635 216 16,093 16,180 851 17,031NORTH YORK 80,394 88,694 2,913 883 0.9374 83,139 2,731 828 78,887 2,671 817 80,394 78,887 3,488 82,375YORK 21,344 19,870 807 281 1.1668 23,185 941 327 21,999 921 323 21,344 21,999 1,244 23,243ETOBICOKE 46,134 49,273 1,938 589 1.0108 49,805 1,959 596 47,258 1,916 588 46,134 47,258 2,504 49,762MISSISSAUGA 53,351 66,164 4,904 2,105 0.9722 64,325 4,768 2,046 61,035 4,663 2,019 53,351 61,035 6,682 67,718BRAMPTON 27,930 29,728 2,140 954 0.9981 29,672 2,136 952 28,154 2,089 939 27,930 28,154 3,028 31,183CALEDON 4,241 5,022 358 166 0.8425 4,231 302 139 4,014 295 138 4,241 4,014 433 4,447DUFFERIN COUNTY 6,444 5,578 243 111 1.0635 5,932 259 118 5,628 253 117 6,444 5,628 369 5,998WELLINGTON COUNTY 22,016 23,618 763 300 0.9706 22,925 741 292 21,752 724 288 22,016 21,752 1,012 22,764OAKVILLE 15,345 17,265 926 393 0.8953 15,457 829 352 14,667 811 348 15,345 14,667 1,159 15,826BURLINGTON 19,978 20,244 702 270 0.8950 18,118 629 242 17,191 615 239 19,978 17,191 853 18,044MILTON 4,223 3,995 102 55 1.0209 4,079 104 56 3,870 102 55 4,223 3,870 157 4,027HALTON HILLS 5,009 5,368 375 156 1.0025 5,382 376 156 5,106 368 154 5,009 5,106 522 5,629STONEY CREEK 8,041 7,528 273 98 0.9079 6,835 248 89 6,485 242 88 8,041 6,485 331 6,816GLANBROOK 1,542 1,530 65 23 0.8503 1,301 56 20 1,235 54 19 1,542 1,235 74 1,309ANCASTER 2,775 3,382 95 36 0.7158 2,421 68 26 2,297 66 26 2,775 2,297 92 2,389HAMILTON 58,274 47,087 1,218 322 1.1775 55,443 1,435 380 52,607 1,403 375 58,274 52,607 1,778 54,385DUNDAS 4,467 3,996 1 7 0.9513 3,802 1 7 3,607 1 7 4,467 3,607 8 3,615FLAMBOROUGH 3,106 4,373 256 100 0.7843 3,430 201 78 3,255 196 77 3,106 3,255 273 3,528FORT ERIE 4,433 4,402 143 38 1.2421 5,468 178 47 5,188 174 47 4,433 5,188 221 5,409PORT COLBORNE 3,635 3,095 58 10 1.3253 4,101 77 14 3,892 75 14 3,635 3,892 89 3,980


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Appendix 10: Community Expected Medical/Surgical Volumes Calculation



Cases

1999/2000 Weighted

Cases



MARI Index1999/2000 Weighted

Cases



1999/2000 Weighted

Cases

MARI Primary and Secondary Growth to 2001/2002

MARI Tertiary

Growth to 2001/2002

1999/2000 Weighted

Cases

Growth to 2001/2002




Total Expected

2001/2002 Medical & Surgical

Weighted Cases*

0.948856 0.97807083 0.98666772

A B C D E F=B*E G=C*E H=D*E I=F*0.949 J=G*0.978 K=H*0.987 L M N=A+L O=I+L P=J+K+M R=O+P WAINFLEET 624 800 34 13 0.7234 579 25 10 549 24 9 624 549 34 583WEST LINCOLN 1,336 1,317 44 20 0.9730 1,282 42 19 1,216 42 19 1,336 1,216 60 1,277PELHAM 1,696 2,151 100 35 0.6641 1,429 66 24 1,355 65 23 1,696 1,355 88 1,443WELLAND 9,841 7,464 152 35 1.2320 9,196 188 43 8,725 184 43 9,841 8,725 226 8,952THOROLD 2,414 2,449 78 24 1.0770 2,638 84 26 2,503 82 26 2,414 2,503 108 2,611NIAGARA FALLS 13,171 11,918 261 65 1.1420 13,610 298 74 12,914 292 73 13,171 12,914 364 13,279NIAGARA-ON-THE-LAKE 1,947 2,457 62 16 0.8309 2,042 51 13 1,938 50 13 1,947 1,938 63 2,001ST. CATHARINES 20,648 20,726 455 116 1.0990 22,777 500 127 21,612 489 126 20,648 21,612 615 22,227LINCOLN 2,235 3,006 79 26 0.8865 2,665 70 23 2,529 68 23 2,235 2,529 91 2,620GRIMSBY 2,297 2,942 53 26 0.9378 2,759 50 25 2,618 49 24 2,297 2,618 73 2,692HALDIMAND-NORFOLK REGIONAL MUNICIPALITY15,771 14,687 541 183 1.0896 16,004 590 200 15,185 577 197 884 92 16,655 16,069 866 16,935BRANT COUNTY 18,556 16,393 367 108 1.0363 16,988 380 112 16,120 372 110 18,556 16,120 482 16,601NORTH DUMFRIES 600 963 68 28 0.7705 742 52 22 704 51 22 600 704 72 777CAMBRIDGE 14,404 13,201 483 197 1.0770 14,218 520 212 13,491 509 210 14,404 13,491 718 14,209KITCHENER 21,381 23,084 742 298 1.0420 24,053 773 310 22,823 756 306 21,381 22,823 1,062 23,885WATERLOO 8,760 10,043 452 171 0.9267 9,307 419 158 8,831 410 156 8,760 8,831 566 9,397WILMOT 1,527 1,919 53 20 0.8885 1,705 47 18 1,618 46 17 1,527 1,618 63 1,681WELLESLEY 663 917 25 10 0.8784 805 22 9 764 21 8 663 764 30 794WOOLWICH 1,698 2,454 47 23 0.7527 1,847 36 17 1,753 35 17 1,698 1,753 52 1,805PERTH COUNTY 9,585 10,448 172 51 0.8450 8,829 145 43 8,377 142 42 9,585 8,377 184 8,562OXFORD COUNTY 14,300 14,012 377 104 1.0703 14,997 403 111 14,230 394 110 14,300 14,230 504 14,734ELGIN COUNTY 11,816 11,080 339 112 1.1135 12,338 377 125 11,707 369 123 11,816 11,707 492 12,199KENT COUNTY 16,459 15,368 323 95 1.2141 18,658 392 115 17,704 384 114 6 0 16,465 17,710 497 18,207ESSEX COUNTY 51,175 48,724 1,341 484 1.0873 52,977 1,458 527 50,268 1,426 520 51,175 50,268 1,946 52,213LAMBTON COUNTY 19,609 18,446 303 86 1.1711 21,602 354 101 20,497 347 99 255 18 19,864 20,752 464 21,216MIDDLESEX COUNTY 47,648 52,691 1,184 405 1.0152 53,492 1,202 411 50,756 1,176 405 7 1 47,655 50,763 1,582 52,344HURON COUNTY 10,336 9,282 170 30 1.0507 9,753 178 31 9,254 174 31 10,336 9,254 205 9,459BRUCE COUNTY 11,649 9,812 151 38 1.1789 11,567 178 45 10,976 174 44 106 5 11,755 11,082 224 11,306GREY COUNTY 15,044 14,145 248 57 1.0784 15,254 267 62 14,474 261 61 15,044 14,474 322 14,796SIMCOE COUNTY 50,135 48,571 2,020 648 1.0811 52,513 2,184 701 49,827 2,136 692 109 7 50,243 49,935 2,834 52,769MUSKOKA DISTRICT MUNICIPALITY 8,385 8,578 224 50 1.1870 10,182 266 60 9,661 260 59 7 -1 8,391 9,667 318 9,986HALIBURTON COUNTY 2,604 3,040 116 26 0.9947 3,024 115 26 2,869 113 26 2,604 2,869 139 3,007RENFREW COUNTY 16,264 14,135 397 119 1.2050 17,033 478 143 16,162 467 141 79 13 16,342 16,241 621 16,862NIPISSING DISTRICT 15,020 11,209 201 68 1.3618 15,264 273 92 14,483 267 91 24 3 15,044 14,508 361 14,869PARRY SOUND DISTRICT 6,874 6,678 168 51 1.2094 8,076 203 61 7,663 198 60 111 5 6,984 7,774 264 8,038MANITOULIN DISTRICT 2,023 1,515 45 13 1.4300 2,167 65 18 2,056 64 18 818 41 2,841 2,874 123 2,997SUDBURY DISTRICT 4,269 3,327 65 28 1.4872 4,947 97 42 4,694 95 42 9 4 4,278 4,703 140 4,843SUDBURY REGIONAL MUNICIPALITY25,055 20,950 450 172 1.2898 27,022 580 221 25,640 568 218 25,055 25,640 786 26,426TIMISKAMING DISTRICT 7,900 5,298 40 25 1.4433 7,647 58 35 7,256 57 35 2 0 7,902 7,257 91 7,349COCHRANE DISTRICT 16,824 10,839 242 107 1.4558 15,780 353 156 14,973 345 154 436 28 17,260 15,409 527 15,936ALGOMA DISTRICT 23,912 17,530 419 130 1.4259 24,995 598 186 23,717 585 183 152 7 24,064 23,869 775 24,644THUNDER BAY DISTRICT 26,080 20,724 265 98 1.3363 27,695 354 132 26,278 347 130 312 42 26,391 26,590 518 27,108RAINY RIVER DISTRICT 4,065 3,098 24 8 1.3329 4,130 32 11 3,918 31 11 226 9 4,291 4,144 51 4,196KENORA DISTRICT 6,685 6,314 81 39 1.3441 8,486 109 53 8,052 106 52 2,737 175 9,422 10,789 333 11,123


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Appendix 11: Community Fertility Index

Excess Fertility Expected Age & Sex Adjusted

Community Description Age 10-19 Age 20-39 Age Over 40 Fertility IndexActual 1999/2000 Weighted Cases

99/2000 Weighted Cases Growth to 2001/2002 Fertility Index

A B C D

STORMONT, DUNDAS AND GLENGARRY UNITED COUNTIES 1.05 -1.77 -0.23 0.9925 961 978 8.1219 0.9925PRESCOTT AND RUSSELL UNITED COUNTIES -0.43 -1.96 -0.31 0.9205 649 740 6.9768 0.9205OSGOODE -1.18 -0.64 0.11 0.9394 159 155 3.2662 0.9394CUMBERLAND -1.20 -1.03 -0.16 0.9158 470 528 68.2272 0.9158GLOUCESTER -0.62 -1.95 -0.01 0.9270 1,040 1,069 -73.8974 0.9270VANIER 3.66 -7.33 0.10 0.9934 180 190 -12.5630 0.9934NEPEAN -0.60 0.75 0.31 1.0064 1,367 1,267 -34.0281 1.0064OTTAWA/ROCK 0.40 -7.60 0.48 0.8639 3,403 3,751 -131.4552 0.8639RIDEAU -1.47 0.41 0.50 0.9707 99 104 2.2967 0.9707GOULBOURN -1.17 9.42 -0.05 1.1663 236 192 16.4907 1.1663KANATA -1.10 3.32 -0.05 1.0273 633 632 20.4046 1.0273WEST CARLETON -1.17 -0.24 0.06 0.9464 153 163 -5.6711 0.9464LEEDS AND GRENVILLE UNITED COUNTIES 0.19 -0.35 -0.27 0.9867 862 848 7.1905 0.9867LANARK COUNTY 0.39 -0.99 0.06 0.9967 517 533 11.2465 0.9967FRONTENAC COUNTY 0.38 -6.98 -0.15 0.8460 1,198 1,349 -3.8841 0.8460LENNOX AND ADDINGTON COUNTY 0.46 -2.71 -0.25 0.9443 343 347 -2.4744 0.9443HASTINGS COUNTY 1.98 -0.76 -0.22 1.0572 1,170 1,084 12.0862 1.0572PRINCE EDWARD COUNTY 0.69 -4.35 -0.19 0.9195 190 197 14.3065 0.9195NORTHUMBERLAND COUNTY -0.02 -4.56 -0.21 0.8827 634 689 25.8318 0.8827PETERBOROUGH COUNTY 0.27 -1.85 -0.14 0.9619 1,005 1,059 51.1966 0.9619VICTORIA COUNTY 0.61 0.57 -0.24 1.0276 579 558 26.8716 1.0276PICKERING -0.76 3.80 0.06 1.0588 944 874 39.1390 1.0588AJAX -0.35 7.46 0.16 1.1667 905 714 -23.3488 1.1667WHITBY -0.87 2.52 -0.04 1.0187 895 836 37.6390 1.0187OSHAWA 1.57 0.95 -0.07 1.0868 1,702 1,387 -30.5168 1.0868CLARINGTON -0.33 4.77 0.02 1.0979 822 728 10.9168 1.0979SCUGOG -0.68 0.63 0.18 0.9944 160 162 1.7402 0.9944UXBRIDGE -0.43 4.72 0.06 1.0945 176 144 7.0423 1.0945BROCK -0.56 2.85 -0.23 1.0305 103 103 1.6520 1.0305VAUGHAN -1.50 3.12 0.24 1.0195 1,851 1,676 121.2018 1.0195MARKHAM -1.54 -4.11 0.22 0.8482 1,616 1,957 103.1547 0.8482RICHMOND HILL -1.36 -1.47 0.41 0.9272 1,225 1,345 31.4888 0.9272WHITCHURCH-STOUFFVILLE -0.98 2.04 0.08 1.0087 184 199 -0.7786 1.0087AURORA -0.93 8.53 0.29 1.1728 488 398 11.2053 1.1728NEWMARKET -0.64 5.32 0.21 1.1069 782 753 34.1364 1.1069KING -1.39 -4.49 0.27 0.8485 123 168 -10.5016 0.8485EAST GWILLIMBURY -1.31 -1.29 0.18 0.9219 213 204 -8.3248 0.9219GEORGINA 0.95 2.65 0.09 1.1077 392 426 -0.8221 1.1077SCARBOROUGH 0.19 0.92 0.47 1.0530 6,703 6,408 -223.1001 1.0530TORONTO 0.09 -11.35 0.85 0.7816 7,030 8,884 -725.9791 0.7816EAST YORK 0.54 1.54 0.80 1.0991 1,401 1,274 -61.0117 1.0991NORTH YORK -0.16 -0.67 0.69 1.0117 6,660 6,616 -219.6714 1.0117YORK 0.81 -0.46 0.59 1.0542 1,991 1,855 -83.8176 1.0542ETOBICOKE -0.15 2.03 0.62 1.0721 3,851 3,611 -132.2123 1.0721MISSISSAUGA -0.64 1.80 0.32 1.0298 6,851 7,151 246.6418 1.0298BRAMPTON -0.12 5.41 0.19 1.1301 4,100 3,578 72.6053 1.1301CALEDON -1.35 5.66 0.19 1.0828 553 420 19.3886 1.0828DUFFERIN COUNTY -0.24 5.58 0.04 1.1216 553 476 1.5239 1.1216WELLINGTON COUNTY -0.01 0.42 0.16 1.0172 1,878 1,889 45.9561 1.0172OAKVILLE -1.15 1.94 0.24 1.0076 1,371 1,343 76.4729 1.0076BURLINGTON -0.85 0.83 0.05 0.9847 1,374 1,360 -33.6536 0.9847MILTON -0.98 -1.15 -0.14 0.9235 241 298 -7.3273 0.9235HALTON HILLS -0.57 5.35 0.20 1.1099 508 488 21.8697 1.1099STONEY CREEK -1.11 -1.02 -0.12 0.9218 513 570 6.1093 0.9218GLANBROOK -0.64 -2.68 -0.33 0.8934 80 96 3.1149 0.8934ANCASTER -1.67 -0.05 -0.10 0.9210 186 174 9.6049 0.9210HAMILTON 1.36 -1.04 0.06 1.0380 3,581 3,450 -75.1329 1.0380DUNDAS -0.90 2.23 0.47 1.0365 217 206 6.5929 1.0365FLAMBOROUGH -1.34 -0.49 -0.10 0.9255 246 363 12.5840 0.9255FORT ERIE 1.28 -2.18 -0.12 0.9990 233 247 4.0436 0.9990


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Appendix 11: Community Fertility Index

Community Description Age 10-19 Age 20-39 Age Over 40 Fertility IndexActual 1999/2000 Weighted Cases

99/2000 Weighted Cases Growth to 2001/2002 Fertility Index

A B C D

PORT COLBORNE 0.77 -1.97 -0.04 0.9858 140 151 -4.7224 0.9858WAINFLEET -1.63 -11.88 -0.21 0.6418 29 53 -1.4668 0.6418WEST LINCOLN -1.00 8.54 0.25 1.1683 145 109 -4.4042 1.1683PELHAM -1.36 -1.93 -0.15 0.8885 124 122 11.8799 0.8885WELLAND 0.68 -2.57 -0.21 0.9593 429 470 -6.1902 0.9593THOROLD 0.53 -2.29 -0.23 0.9583 159 176 -8.1743 0.9583NIAGARA FALLS 0.79 -1.40 -0.22 0.9909 671 757 -20.5289 0.9909NIAGARA-ON-THE-LAKE -1.18 -1.66 0.11 0.9152 89 89 8.2136 0.9152ST. CATHARINES 0.38 -1.66 -0.04 0.9757 1,245 1,284 3.3466 0.9757LINCOLN -0.81 5.84 0.00 1.1007 194 172 13.4132 1.1007GRIMSBY -1.08 2.46 -0.10 1.0055 183 175 4.7580 1.0055HALDIMAND-NORFOLK REGIONAL MUNICIPALITY 0.22 2.59 -0.17 1.0617 1,055 918 48.0554 1.0617BRANT COUNTY 1.45 1.02 -0.13 1.0805 1,106 1,078 6.7413 1.0805NORTH DUMFRIES -1.02 -6.59 -0.13 0.7956 75 86 3.9548 0.7956CAMBRIDGE 1.04 2.21 -0.11 1.0912 1,221 1,139 18.1748 1.0912KITCHENER 0.82 -0.23 0.00 1.0301 2,160 2,076 -27.4254 1.0301WATERLOO -0.15 -4.05 -0.01 0.8986 835 942 29.6525 0.8986WILMOT -1.15 -1.72 -0.36 0.8919 115 126 -0.7428 0.8919WELLESLEY -1.67 8.29 0.05 1.1234 117 81 -1.7640 1.1234WOOLWICH -1.43 -1.68 -0.20 0.8890 142 154 4.2234 0.8890PERTH COUNTY 0.06 4.66 -0.05 1.1084 711 670 12.4226 1.1084OXFORD COUNTY 0.69 4.36 -0.15 1.1243 1,022 916 10.3659 1.1243ELGIN COUNTY 0.94 2.74 -0.10 1.1002 796 771 23.1378 1.1002KENT COUNTY 1.56 1.97 -0.21 1.1036 1,091 1,020 -6.9572 1.1036ESSEX COUNTY 0.66 -0.20 -0.05 1.0213 4,075 3,892 -3.3338 1.0213LAMBTON COUNTY 0.25 0.30 -0.21 1.0074 997 1,082 -4.5882 1.0074MIDDLESEX COUNTY 0.56 -1.51 0.03 0.9907 4,211 4,125 -66.0559 0.9907HURON COUNTY -0.04 3.60 -0.08 1.0778 529 486 7.0463 1.0778BRUCE COUNTY -0.35 -0.36 -0.22 0.9658 440 480 20.4127 0.9658GREY COUNTY 0.21 -2.10 -0.10 0.9550 717 712 17.6343 0.9550SIMCOE COUNTY 0.50 0.88 -0.08 1.0384 3,756 3,454 133.7343 1.0384MUSKOKA DISTRICT MUNICIPALITY 0.13 -0.12 -0.28 0.9886 447 420 21.0127 0.9886HALIBURTON COUNTY 0.73 -2.84 -0.20 0.9553 86 102 9.3574 0.9553RENFREW COUNTY 0.62 -0.23 -0.10 1.0167 857 897 20.0599 1.0167NIPISSING DISTRICT 1.57 -2.53 -0.29 0.9947 790 763 -12.7846 0.9947PARRY SOUND DISTRICT 1.15 -2.14 -0.06 0.9970 328 304 10.3617 0.9970MANITOULIN DISTRICT 1.09 -2.38 -0.13 0.9852 68 67 2.2077 0.9852SUDBURY DISTRICT 1.66 -2.80 -0.27 0.9935 205 211 -2.5365 0.9935SUDBURY REGIONAL MUNICIPALITY 1.14 -3.18 -0.27 0.9621 1,397 1,549 2.2440 0.9621TIMISKAMING DISTRICT 1.88 0.23 -0.28 1.0728 345 309 -2.0096 1.0728COCHRANE DISTRICT 2.00 -2.29 -0.40 1.0138 857 874 -9.7445 1.0138ALGOMA DISTRICT 1.62 -2.89 -0.20 0.9931 1,015 1,051 0.5288 0.9931THUNDER BAY DISTRICT 1.21 -2.43 -0.22 0.9850 1,491 1,474 -28.0319 0.9850RAINY RIVER DISTRICT 1.54 -0.23 -0.23 1.0502 208 186 5.8581 1.0502KENORA DISTRICT 1.98 -1.83 -0.25 1.0310 506 487 -6.0386 1.0310


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Appendix 12: Community Expected Pregnancy and Childbirth Volume Calculation

Expected MoHLTC Normalized Actual MoHLTC Normalized Total ExpectedAge & Sex Adjusted Fertility Indexed Expected Fertility Indexed Expected On-reserve Aboriginal 199/2000 Fertility Indexed Expected 2001/2002



Cases

1999/2000 Weighted

Cases

Growth to 2001/2002

Fertility Index

1999/2000 Weighted

Cases

Growth to 2001/2002

1999/2000 Weighted

Cases

Growth to 2001/2002

1999/2000 Weighted

Cases

Growth to 2001/2002

Weighted Cases*



Pregnancy & Childbirth

Weighted Cases*

* (Including On-Reserve Aboriginal Weighted Cases)A B C D E=B*D F=C*D G=E*1.003 H=F*1.506 I J K=A+I L=G+I M=H+J N=L+M

STORMONT, DUNDAS AND GLENGARRY UNITED COUNTIES961 978 8.1219 0.9925 971 8 974 12 31 0 992 1,005 12 1,017PRESCOTT AND RUSSELL UNITED COUNTIES 649 740 6.9768 0.9205 681 6 683 10 649 683 10 693OSGOODE 159 155 3.2662 0.9394 145 3 146 5 159 146 5 150CUMBERLAND 470 528 68.2272 0.9158 484 62 485 94 470 485 94 579GLOUCESTER 1,040 1,069 -73.8974 0.9270 991 -68 994 -103 1,040 994 -103 891VANIER 180 190 -12.5630 0.9934 189 -12 190 -19 180 190 -19 171NEPEAN 1,367 1,267 -34.0281 1.0064 1,275 -34 1,279 -52 1,367 1,279 -52 1,227OTTAWA/ROCK 3,403 3,751 -131.4552 0.8639 3,240 -114 3,249 -171 3,403 3,249 -171 3,078RIDEAU 99 104 2.2967 0.9707 101 2 102 3 99 102 3 105GOULBOURN 236 192 16.4907 1.1663 224 19 225 29 236 225 29 253KANATA 633 632 20.4046 1.0273 649 21 651 32 633 651 32 682WEST CARLETON 153 163 -5.6711 0.9464 154 -5 154 -8 153 154 -8 146LEEDS AND GRENVILLE UNITED COUNTIES 862 848 7.1905 0.9867 836 7 839 11 862 839 11 849LANARK COUNTY 517 533 11.2465 0.9967 531 11 533 17 517 533 17 549FRONTENAC COUNTY 1,198 1,349 -3.8841 0.8460 1,142 -3 1,145 -5 1,198 1,145 -5 1,140LENNOX AND ADDINGTON COUNTY 343 347 -2.4744 0.9443 327 -2 328 -4 343 328 -4 325HASTINGS COUNTY 1,170 1,084 12.0862 1.0572 1,146 13 1,149 19 21 0 1,191 1,170 19 1,189PRINCE EDWARD COUNTY 190 197 14.3065 0.9195 182 13 182 20 190 182 20 202NORTHUMBERLAND COUNTY 634 689 25.8318 0.8827 608 23 610 34 634 610 34 645PETERBOROUGH COUNTY 1,005 1,059 51.1966 0.9619 1,018 49 1,021 74 7 -1 1,013 1,029 74 1,102VICTORIA COUNTY 579 558 26.8716 1.0276 574 28 575 42 579 575 42 617PICKERING 944 874 39.1390 1.0588 926 41 928 62 944 928 62 991AJAX 905 714 -23.3488 1.1667 833 -27 835 -41 905 835 -41 794WHITBY 895 836 37.6390 1.0187 852 38 854 58 895 854 58 912OSHAWA 1,702 1,387 -30.5168 1.0868 1,508 -33 1,512 -50 1,702 1,512 -50 1,462CLARINGTON 822 728 10.9168 1.0979 799 12 802 18 822 802 18 820SCUGOG 160 162 1.7402 0.9944 162 2 162 3 160 162 3 165UXBRIDGE 176 144 7.0423 1.0945 158 8 159 12 176 159 12 170BROCK 103 103 1.6520 1.0305 107 2 107 3 103 107 3 109VAUGHAN 1,851 1,676 121.2018 1.0195 1,709 124 1,714 186 1,851 1,714 186 1,900MARKHAM 1,616 1,957 103.1547 0.8482 1,660 87 1,664 132 1,616 1,664 132 1,796RICHMOND HILL 1,225 1,345 31.4888 0.9272 1,247 29 1,251 44 1,225 1,251 44 1,295WHITCHURCH-STOUFFVILLE 184 199 -0.7786 1.0087 201 -1 201 -1 184 201 -1 200AURORA 488 398 11.2053 1.1728 466 13 468 20 488 468 20 488NEWMARKET 782 753 34.1364 1.1069 833 38 836 57 782 836 57 893KING 123 168 -10.5016 0.8485 142 -9 143 -13 123 143 -13 129EAST GWILLIMBURY 213 204 -8.3248 0.9219 188 -8 189 -12 213 189 -12 177GEORGINA 392 426 -0.8221 1.1077 471 -1 473 -1 392 473 -1 471SCARBOROUGH 6,703 6,408 -223.1001 1.0530 6,748 -235 6,767 -354 6,703 6,767 -354 6,413TORONTO 7,030 8,884 -725.9791 0.7816 6,944 -567 6,964 -854 7,030 6,964 -854 6,109EAST YORK 1,401 1,274 -61.0117 1.0991 1,400 -67 1,404 -101 1,401 1,404 -101 1,303NORTH YORK 6,660 6,616 -219.6714 1.0117 6,694 -222 6,713 -335 6,660 6,713 -335 6,378YORK 1,991 1,855 -83.8176 1.0542 1,956 -88 1,961 -133 1,991 1,961 -133 1,828ETOBICOKE 3,851 3,611 -132.2123 1.0721 3,872 -142 3,883 -213 3,851 3,883 -213 3,669MISSISSAUGA 6,851 7,151 246.6418 1.0298 7,365 254 7,386 382 6,851 7,386 382 7,768BRAMPTON 4,100 3,578 72.6053 1.1301 4,043 82 4,055 124 4,100 4,055 124 4,178CALEDON 553 420 19.3886 1.0828 455 21 456 32 553 456 32 488DUFFERIN COUNTY 553 476 1.5239 1.1216 533 2 535 3 553 535 3 537WELLINGTON COUNTY 1,878 1,889 45.9561 1.0172 1,921 47 1,927 70 1,878 1,927 70 1,997OAKVILLE 1,371 1,343 76.4729 1.0076 1,353 77 1,357 116 1,371 1,357 116 1,473BURLINGTON 1,374 1,360 -33.6536 0.9847 1,339 -33 1,343 -50 1,374 1,343 -50 1,293MILTON 241 298 -7.3273 0.9235 275 -7 276 -10 241 276 -10 266HALTON HILLS 508 488 21.8697 1.1099 542 24 543 37 508 543 37 580STONEY CREEK 513 570 6.1093 0.9218 525 6 527 8 513 527 8 535GLANBROOK 80 96 3.1149 0.8934 85 3 86 4 80 86 4 90ANCASTER 186 174 9.6049 0.9210 160 9 161 13 186 161 13 174HAMILTON 3,581 3,450 -75.1329 1.0380 3,581 -78 3,591 -117 3,581 3,591 -117 3,474DUNDAS 217 206 6.5929 1.0365 214 7 215 10 217 215 10 225FLAMBOROUGH 246 363 12.5840 0.9255 336 12 337 18 246 337 18 355FORT ERIE 233 247 4.0436 0.9990 247 4 247 6 233 247 6 253PORT COLBORNE 140 151 -4.7224 0.9858 149 -5 150 -7 140 150 -7 143WAINFLEET 29 53 -1.4668 0.6418 34 -1 34 -1 29 34 -1 33WEST LINCOLN 145 109 -4.4042 1.1683 127 -5 128 -8 145 128 -8 120PELHAM 124 122 11.8799 0.8885 108 11 108 16 124 108 16 124WELLAND 429 470 -6.1902 0.9593 451 -6 452 -9 429 452 -9 443THOROLD 159 176 -8.1743 0.9583 169 -8 169 -12 159 169 -12 157NIAGARA FALLS 671 757 -20.5289 0.9909 750 -20 752 -31 671 752 -31 722NIAGARA-ON-THE-LAKE 89 89 8.2136 0.9152 81 8 82 11 89 82 11 93ST. CATHARINES 1,245 1,284 3.3466 0.9757 1,253 3 1,256 5 1,245 1,256 5 1,261LINCOLN 194 172 13.4132 1.1007 189 15 190 22 194 190 22 212


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Appendix 12: Community Expected Pregnancy and Childbirth Volume Calculation



Cases

1999/2000 Weighted

Cases

Growth to 2001/2002

Fertility Index

1999/2000 Weighted

Cases

Growth to 2001/2002

1999/2000 Weighted

Cases

Growth to 2001/2002

1999/2000 Weighted

Cases

Growth to 2001/2002

Weighted Cases*



Pregnancy & Childbirth

Weighted Cases*

* (Including On-Reserve Aboriginal Weighted Cases)A B C D E=B*D F=C*D G=E*1.003 H=F*1.506 I J K=A+I L=G+I M=H+J N=L+M

GRIMSBY 183 175 4.7580 1.0055 176 5 176 7 183 176 7 183HALDIMAND-NORFOLK REGIONAL MUNICIPALITY 1,055 918 48.0554 1.0617 974 51 977 77 89 1 1,144 1,066 77 1,144BRANT COUNTY 1,106 1,078 6.7413 1.0805 1,165 7 1,168 11 1,106 1,168 11 1,179NORTH DUMFRIES 75 86 3.9548 0.7956 68 3 69 5 75 69 5 73CAMBRIDGE 1,221 1,139 18.1748 1.0912 1,243 20 1,247 30 1,221 1,247 30 1,276KITCHENER 2,160 2,076 -27.4254 1.0301 2,138 -28 2,144 -43 2,160 2,144 -43 2,101WATERLOO 835 942 29.6525 0.8986 846 27 849 40 835 849 40 889WILMOT 115 126 -0.7428 0.8919 113 -1 113 -1 115 113 -1 112WELLESLEY 117 81 -1.7640 1.1234 91 -2 92 -3 117 92 -3 89WOOLWICH 142 154 4.2234 0.8890 137 4 137 6 142 137 6 143PERTH COUNTY 711 670 12.4226 1.1084 743 14 745 21 711 745 21 766OXFORD COUNTY 1,022 916 10.3659 1.1243 1,030 12 1,033 18 1,022 1,033 18 1,050ELGIN COUNTY 796 771 23.1378 1.1002 849 25 851 38 796 851 38 889KENT COUNTY 1,091 1,020 -6.9572 1.1036 1,126 -8 1,129 -12 1,091 1,129 -12 1,118ESSEX COUNTY 4,075 3,892 -3.3338 1.0213 3,975 -3 3,986 -5 4,075 3,986 -5 3,981LAMBTON COUNTY 997 1,082 -4.5882 1.0074 1,090 -5 1,093 -7 32 2 1,029 1,125 -5 1,120MIDDLESEX COUNTY 4,211 4,125 -66.0559 0.9907 4,086 -65 4,098 -99 5 0 4,215 4,102 -98 4,004HURON COUNTY 529 486 7.0463 1.0778 524 8 525 11 529 525 11 537BRUCE COUNTY 440 480 20.4127 0.9658 464 20 465 30 7 1 446 472 31 502GREY COUNTY 717 712 17.6343 0.9550 680 17 682 25 717 682 25 707SIMCOE COUNTY 3,756 3,454 133.7343 1.0384 3,587 139 3,597 209 8 0 3,764 3,605 209 3,815MUSKOKA DISTRICT MUNICIPALITY 447 420 21.0127 0.9886 415 21 416 31 0 0 447 417 31 448HALIBURTON COUNTY 86 102 9.3574 0.9553 98 9 98 13 86 98 13 111RENFREW COUNTY 857 897 20.0599 1.0167 912 20 915 31 6 0 863 921 31 952NIPISSING DISTRICT 790 763 -12.7846 0.9947 759 -13 761 -19 0 0 790 761 -19 742PARRY SOUND DISTRICT 328 304 10.3617 0.9970 303 10 304 16 12 1 339 316 16 332MANITOULIN DISTRICT 68 67 2.2077 0.9852 66 2 67 3 77 -1 145 144 3 146SUDBURY DISTRICT 205 211 -2.5365 0.9935 210 -3 211 -4 1 0 205 211 -4 208SUDBURY REGIONAL MUNICIPALITY 1,397 1,549 2.2440 0.9621 1,490 2 1,495 3 1,397 1,495 3 1,498TIMISKAMING DISTRICT 345 309 -2.0096 1.0728 332 -2 333 -3 345 333 -3 329COCHRANE DISTRICT 857 874 -9.7445 1.0138 886 -10 889 -15 35 1 892 924 -14 909ALGOMA DISTRICT 1,015 1,051 0.5288 0.9931 1,043 1 1,046 1 14 0 1,029 1,060 1 1,061THUNDER BAY DISTRICT 1,491 1,474 -28.0319 0.9850 1,452 -28 1,456 -42 30 0 1,521 1,486 -41 1,445RAINY RIVER DISTRICT 208 186 5.8581 1.0502 195 6 196 9 36 2 243 231 12 243KENORA DISTRICT 506 487 -6.0386 1.0310 502 -6 503 -9 357 12 863 860 3 863


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Appendix 13: Newborn and Neonate Case Mix Index

Community DescriptionIncidence Low-

Birth WeightActual 1999/2000 Weighted Cases

Estimated BirthsEstimated Births

Growth Case Mix Index

A B C D

STORMONT, DUNDAS AND GLENGARRY UNITED COUNTIES 7.46% 550 1,056 35 0.6011PRESCOTT AND RUSSELL UNITED COUNTIES 6.85% 346 758 22 0.5816OSGOODE 5.42% 68 169 -1 0.5364CUMBERLAND 5.94% 211 511 62 0.5530GLOUCESTER 5.87% 640 1,148 -88 0.5505VANIER 8.64% 134 195 -21 0.6385NEPEAN 6.26% 802 1,484 -47 0.5631OTTAWA/ROCK 6.65% 1,990 3,706 -100 0.5754RIDEAU 4.86% 73 118 -1 0.5185GOULBOURN 5.37% 157 267 17 0.5347KANATA 5.83% 332 708 10 0.5494WEST CARLETON 7.16% 114 174 -10 0.5914LEEDS AND GRENVILLE UNITED COUNTIES 6.67% 526 961 18 0.5758LANARK COUNTY 6.22% 300 585 17 0.5616FRONTENAC COUNTY 6.18% 778 1,332 -3 0.5604LENNOX AND ADDINGTON COUNTY 5.78% 173 381 4 0.5478HASTINGS COUNTY 7.96% 664 1,258 36 0.6169PRINCE EDWARD COUNTY 7.67% 103 195 19 0.6077NORTHUMBERLAND COUNTY 7.96% 476 678 40 0.6169PETERBOROUGH COUNTY 6.02% 659 1,114 67 0.5552VICTORIA COUNTY 7.25% 345 612 53 0.5943PICKERING 7.51% 659 1,068 28 0.6027AJAX 7.89% 690 1,006 -59 0.6146WHITBY 7.28% 628 969 28 0.5953OSHAWA 7.56% 985 1,664 -20 0.6043CLARINGTON 6.85% 467 886 4 0.5817SCUGOG 5.09% 110 165 0 0.5260UXBRIDGE 7.83% 143 200 4 0.6129BROCK 5.56% 67 130 7 0.5408VAUGHAN 6.15% 1,148 2,125 134 0.5594MARKHAM 7.75% 1,100 1,811 59 0.6103RICHMOND HILL 6.55% 643 1,396 9 0.5723WHITCHURCH-STOUFFVILLE 7.28% 132 224 -7 0.5954AURORA 6.39% 304 564 -1 0.5670NEWMARKET 7.96% 522 893 27 0.6168KING 5.02% 55 139 -14 0.5235EAST GWILLIMBURY 6.70% 120 231 -13 0.5770GEORGINA 8.42% 220 456 10 0.6315SCARBOROUGH 8.48% 4,663 7,364 -235 0.6335TORONTO 7.04% 4,646 7,651 -351 0.5877EAST YORK 7.65% 960 1,515 -56 0.6070NORTH YORK 7.95% 4,517 7,352 -190 0.6166YORK 7.62% 1,304 2,086 -77 0.6062ETOBICOKE 7.84% 2,551 4,283 -132 0.6130


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A B C D

MISSISSAUGA 7.15% 4,784 7,928 262 0.5913BRAMPTON 7.66% 3,048 4,562 84 0.6074CALEDON 7.18% 409 631 11 0.5922DUFFERIN COUNTY 6.66% 416 629 6 0.5758WELLINGTON COUNTY 6.80% 1,234 2,161 55 0.5801OAKVILLE 5.61% 866 1,547 44 0.5422BURLINGTON 7.25% 951 1,567 -63 0.5944MILTON 6.88% 149 268 -7 0.5826HALTON HILLS 5.91% 309 589 19 0.5520STONEY CREEK 7.54% 365 587 1 0.6036GLANBROOK 3.93% 60 90 1 0.4891ANCASTER 6.20% 132 214 0 0.5612HAMILTON 7.87% 2,375 3,932 -94 0.6139DUNDAS 8.27% 137 257 5 0.6266FLAMBOROUGH 5.96% 168 292 2 0.5535FORT ERIE 7.97% 171 249 8 0.6173PORT COLBORNE 7.41% 78 152 -4 0.5993WAINFLEET 5.97% 49 27 -1 0.5539WEST LINCOLN 5.25% 52 156 -4 0.5308PELHAM 6.14% 78 137 11 0.5591WELLAND 7.21% 336 469 -4 0.5930THOROLD 7.02% 122 179 -7 0.5869NIAGARA FALLS 7.15% 487 769 -19 0.5911NIAGARA-ON-THE-LAKE 3.85% 46 107 9 0.4864ST. CATHARINES 6.86% 870 1,353 3 0.5821LINCOLN 6.31% 102 216 17 0.5646GRIMSBY 5.10% 92 189 3 0.5262HALDIMAND-NORFOLK REGIONAL MUNICIPALITY 6.89% 608 1,168 82 0.5829BRANT COUNTY 8.37% 757 1,337 25 0.6300NORTH DUMFRIES 3.64% 38 87 3 0.4799CAMBRIDGE 7.54% 942 1,415 29 0.6036KITCHENER 6.77% 1,479 2,326 -34 0.5792WATERLOO 7.01% 604 925 37 0.5866WILMOT 3.92% 72 131 -1 0.4888WELLESLEY 6.34% 65 135 -2 0.5655WOOLWICH 6.59% 102 174 4 0.5734PERTH COUNTY 6.22% 431 846 31 0.5618OXFORD COUNTY 5.37% 511 1,205 40 0.5347ELGIN COUNTY 7.01% 440 930 41 0.5867KENT COUNTY 6.74% 715 1,293 6 0.5783ESSEX COUNTY 5.92% 2,617 4,402 -6 0.5523LAMBTON COUNTY 6.71% 598 1,102 19 0.5773MIDDLESEX COUNTY 6.36% 2,642 4,475 -70 0.5661HURON COUNTY 5.55% 297 579 18 0.5405


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A B C D

BRUCE COUNTY 4.94% 245 481 34 0.5210GREY COUNTY 6.28% 373 735 34 0.5635SIMCOE COUNTY 6.20% 2,278 4,197 216 0.5609MUSKOKA DISTRICT MUNICIPALITY 6.65% 317 468 33 0.5752HALIBURTON COUNTY 5.90% 50 91 12 0.5514RENFREW COUNTY 5.41% 474 972 33 0.5361NIPISSING DISTRICT 5.19% 511 849 -2 0.5289PARRY SOUND DISTRICT 7.21% 141 336 16 0.5931MANITOULIN DISTRICT 3.64% 20 62 3 0.4799SUDBURY DISTRICT 9.16% 144 224 4 0.6549SUDBURY REGIONAL MUNICIPALITY 6.57% 965 1,581 19 0.5728TIMISKAMING DISTRICT 6.49% 187 368 9 0.5703COCHRANE DISTRICT 7.34% 429 905 4 0.5973ALGOMA DISTRICT 6.22% 696 1,069 20 0.5616THUNDER BAY DISTRICT 5.53% 989 1,647 -24 0.5397RAINY RIVER DISTRICT 3.43% 103 216 11 0.4730KENORA DISTRICT 3.47% 267 546 -1 0.4744


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Appendix 14: Community Expected Newborn and Neonate Volume CalculationNeeds Indexed Expected On-Reserve Aboriginal Needs Indexed Expected

Community DescriptionCase Mix

Index

1999/2000 Weighted

Cases

Growth to 2001/2002

MoHLTC Normalized 1999/2000 Weighted

Cases

1999/2000 Weighted

Cases

Growth to 2001/2002


MoHLTC Normalized 1999/2000 Weighted Cases*


Total Expected 2001/2002 Newborn &

Neonate Weighted Cases*

* Including On-Reserve Aboriginal Weighted CasesD E=B*D F=C*D G=E*0.99997 H I J=A+H K=G+H L=F+I M=K+L

STORMONT, DUNDAS AND GLENGARRY UNITED COUNTIES 0.6011 635 21 635 9 0 559 643 21 664PRESCOTT AND RUSSELL UNITED COUNTIES 0.5816 441 13 441 346 441 13 454OSGOODE 0.5364 91 -1 91 68 91 -1 90CUMBERLAND 0.5530 283 34 283 211 283 34 317GLOUCESTER 0.5505 632 -48 632 640 632 -48 584VANIER 0.6385 125 -14 125 134 125 -14 111NEPEAN 0.5631 835 -26 835 802 835 -26 809OTTAWA/ROCK 0.5754 2,132 -58 2,132 1,990 2,132 -58 2,075RIDEAU 0.5185 61 -1 61 73 61 -1 61GOULBOURN 0.5347 143 9 143 157 143 9 152KANATA 0.5494 389 6 389 332 389 6 395WEST CARLETON 0.5914 103 -6 103 114 103 -6 97LEEDS AND GRENVILLE UNITED COUNTIES 0.5758 553 10 553 526 553 10 564LANARK COUNTY 0.5616 329 10 329 300 329 10 338FRONTENAC COUNTY 0.5604 747 -2 747 778 747 -2 745LENNOX AND ADDINGTON COUNTY 0.5478 209 2 209 173 209 2 211HASTINGS COUNTY 0.6169 776 22 776 12 0 676 788 22 810PRINCE EDWARD COUNTY 0.6077 118 11 118 103 118 11 130NORTHUMBERLAND COUNTY 0.6169 418 25 418 476 418 25 443PETERBOROUGH COUNTY 0.5552 618 37 618 6 0 665 625 37 661VICTORIA COUNTY 0.5943 364 31 364 345 364 31 395PICKERING 0.6027 644 17 644 659 644 17 661AJAX 0.6146 618 -36 618 690 618 -36 582WHITBY 0.5953 577 17 577 628 577 17 593OSHAWA 0.6043 1,005 -12 1,005 985 1,005 -12 993CLARINGTON 0.5817 515 2 515 467 515 2 518SCUGOG 0.5260 87 0 87 110 87 0 87UXBRIDGE 0.6129 123 2 123 143 123 2 125BROCK 0.5408 70 4 70 67 70 4 74VAUGHAN 0.5594 1,189 75 1,189 1,148 1,189 75 1,264MARKHAM 0.6103 1,105 36 1,105 1,100 1,105 36 1,141RICHMOND HILL 0.5723 799 5 799 643 799 5 804WHITCHURCH-STOUFFVILLE 0.5954 133 -4 133 132 133 -4 129AURORA 0.5670 320 0 320 304 320 0 319NEWMARKET 0.6168 551 16 551 522 551 16 568KING 0.5235 73 -8 73 55 73 -8 65EAST GWILLIMBURY 0.5770 133 -8 133 120 133 -8 126GEORGINA 0.6315 288 6 288 220 288 6 294SCARBOROUGH 0.6335 4,665 -149 4,665 4,663 4,665 -149 4,516TORONTO 0.5877 4,496 -206 4,496 4,646 4,496 -206 4,290EAST YORK 0.6070 919 -34 919 960 919 -34 885NORTH YORK 0.6166 4,534 -117 4,534 4,517 4,534 -117 4,416YORK 0.6062 1,264 -47 1,264 1,304 1,264 -47 1,218ETOBICOKE 0.6130 2,625 -81 2,625 2,551 2,625 -81 2,544MISSISSAUGA 0.5913 4,688 155 4,688 4,784 4,688 155 4,843BRAMPTON 0.6074 2,771 51 2,771 3,048 2,771 51 2,822CALEDON 0.5922 374 7 374 409 374 7 380DUFFERIN COUNTY 0.5758 362 3 362 416 362 3 365WELLINGTON COUNTY 0.5801 1,254 32 1,254 1,234 1,254 32 1,285OAKVILLE 0.5422 839 24 839 866 839 24 863


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Appendix 14: Community Expected Newborn and Neonate Volume Calculation


Index

1999/2000 Weighted

Cases

Growth to 2001/2002


Cases

1999/2000 Weighted

Cases

Growth to 2001/2002







BURLINGTON 0.5944 931 -38 931 951 931 -38 893MILTON 0.5826 156 -4 156 149 156 -4 152HALTON HILLS 0.5520 325 11 325 309 325 11 336STONEY CREEK 0.6036 354 1 354 365 354 1 355GLANBROOK 0.4891 44 1 44 60 44 1 45ANCASTER 0.5612 120 0 120 132 120 0 120HAMILTON 0.6139 2,414 -58 2,414 2,375 2,414 -58 2,356DUNDAS 0.6266 161 3 161 137 161 3 164FLAMBOROUGH 0.5535 162 1 162 168 162 1 163FORT ERIE 0.6173 154 5 154 171 154 5 159PORT COLBORNE 0.5993 91 -2 91 78 91 -2 89WAINFLEET 0.5539 15 -1 15 49 15 -1 14WEST LINCOLN 0.5308 83 -2 83 52 83 -2 81PELHAM 0.5591 77 6 77 78 77 6 82WELLAND 0.5930 278 -2 278 336 278 -2 276THOROLD 0.5869 105 -4 105 122 105 -4 101NIAGARA FALLS 0.5911 455 -11 455 487 455 -11 443NIAGARA-ON-THE-LAKE 0.4864 52 5 52 46 52 5 57ST. CATHARINES 0.5821 788 2 788 870 788 2 790LINCOLN 0.5646 122 10 122 102 122 10 132GRIMSBY 0.5262 99 1 99 92 99 1 101HALDIMAND-NORFOLK REGIONAL MUNICIPALITY 0.5829 681 48 681 106 1 715 787 49 836BRANT COUNTY 0.6300 842 16 842 757 842 16 858NORTH DUMFRIES 0.4799 42 1 42 38 42 1 43CAMBRIDGE 0.6036 854 17 854 942 854 17 872KITCHENER 0.5792 1,347 -19 1,347 1,479 1,347 -19 1,328WATERLOO 0.5866 542 22 542 604 542 22 564WILMOT 0.4888 64 -1 64 72 64 -1 63WELLESLEY 0.5655 76 -1 76 65 76 -1 76WOOLWICH 0.5734 100 2 100 102 100 2 102PERTH COUNTY 0.5618 475 17 475 431 475 17 493OXFORD COUNTY 0.5347 644 21 644 511 644 21 666ELGIN COUNTY 0.5867 546 24 546 440 546 24 569KENT COUNTY 0.5783 748 3 748 715 748 3 751ESSEX COUNTY 0.5523 2,431 -4 2,431 2,617 2,431 -4 2,428LAMBTON COUNTY 0.5773 636 11 636 10 2 608 646 13 660MIDDLESEX COUNTY 0.5661 2,533 -39 2,533 5 0 2,647 2,538 -39 2,499HURON COUNTY 0.5405 313 10 313 297 313 10 323BRUCE COUNTY 0.5210 250 18 250 2 1 247 252 18 270GREY COUNTY 0.5635 414 19 414 373 414 19 434SIMCOE COUNTY 0.5609 2,354 121 2,354 4 0 2,282 2,358 121 2,480MUSKOKA DISTRICT MUNICIPALITY 0.5752 269 19 269 317 269 19 288HALIBURTON COUNTY 0.5514 50 6 50 50 50 6 57RENFREW COUNTY 0.5361 521 18 521 3 0 477 524 18 542NIPISSING DISTRICT 0.5289 449 -1 449 511 449 -1 448PARRY SOUND DISTRICT 0.5931 199 9 199 3 1 144 202 10 213MANITOULIN DISTRICT 0.4799 30 1 30 42 0 62 72 1 73SUDBURY DISTRICT 0.6549 147 3 147 0 144 147 3 149SUDBURY REGIONAL MUNICIPALITY 0.5728 906 11 906 965 906 11 916TIMISKAMING DISTRICT 0.5703 210 5 210 187 210 5 215COCHRANE DISTRICT 0.5973 541 2 541 18 1 448 559 3 562


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Appendix 14: Community Expected Newborn and Neonate Volume Calculation


Index

1999/2000 Weighted

Cases

Growth to 2001/2002


Cases

1999/2000 Weighted

Cases

Growth to 2001/2002







ALGOMA DISTRICT 0.5616 601 11 601 5 0 702 606 11 617THUNDER BAY DISTRICT 0.5397 889 -13 889 13 0 1,002 901 -13 889RAINY RIVER DISTRICT 0.4730 102 5 102 12 2 115 114 7 121KENORA DISTRICT 0.4744 259 -1 259 162 10 429 421 9 430


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Appendix 15: Hospital Expected Pregnancy and Childbirth, Newborn and Neonatal Weighted Cases

Pregnancy & Childbirth Weighted Cases Newborn and Neonate Weighted Cases

Facility Number

Hospital Type 2000/2001 Hospital NameActual

1999/2000Expected

1999/2000Expected

2001/2002

MoHLTC Normalized Expected

2001/2002

Actual 1999/2000

Expected 1999/2000

Expected 2001/2002


2001/2002592 Small NAPANEE Lennox & Addington 107 103 103 98 36 43 43 42

593 Small NEWBURY Four Counties 2 2 2 2 1 1 1 1

596 Small ALLISTON Stevenson Memorial 251 240 252 242 90 90 94 90

597 Small ALMONTE General 210 217 224 215 64 69 71 68

599 Small ARNPRIOR & District Memorial 4 4 4 4 0 0 0 0

600 Small ATIKOKAN General 11 11 11 11 4 4 4 4

606 Large Community BARRIE Roval Victoria 1,695 1,624 1,718 1,648 1,019 1,054 1,107 1,062

611 Small BLIND RIVER St Joseph's 3 3 3 3 11 9 9 9

614 Large Community BRACEBRIDGE S Muskoka Memorial 158 147 158 152 53 45 48 46

617 Large Community BRANTFORD General 1,102 1,147 1,164 1,117 634 702 720 691

618 Large Community BRANTFORD St Joseph's 0 0 0 0 0 0 0 0

619 Large Community BROCKVILLE General 375 366 370 355 137 144 147 141

624 Small CAMPBELLFORD Memorial 1 1 1 1 0 0 0 0

626 Small CARLETON PLACE & District Memorial 0 0 0 0 0 0 0 0

627 Small CHAPLEAU General 6 6 6 6 2 2 2 2

628 Large Community CHATHAM Public General 817 845 837 803 463 483 485 466

629 Large Community CHATHAM St Joseph's 7 7 7 7 17 18 18 18

632 Large Community TORONTO North York General 3,915 3,927 3,834 3,679 2,023 2,049 2,021 1,939

633 Small CLINTON Public 90 90 92 88 29 31 32 30

638 Small COCHRANE Lady Minto 47 49 48 46 14 18 18 17

640 Large Community COLLINGWOOD General and Marine 265 254 268 257 90 94 98 94

643 Large Community CORNWALL General 20 20 21 20 0 0 0 0

644 Large Community CORNWALL Hotel Dieu 563 570 577 553 191 219 226 217


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Facility Number


1999/2000Expected

1999/2000Expected

2001/2002


2001/2002

Actual 1999/2000

Expected 1999/2000

Expected 2001/2002


2001/2002646 Small DEEP RIVER and District 0 0 0 0 0 0 0 0

647 Small DRYDEN District General 158 157 154 148 54 52 52 50

648 Small DUNNVILLE Haldimand War Memorial 93 87 92 88 27 31 32 31

650 Large Community ELLIOT LAKE St Joseph's 124 128 127 122 41 36 37 36

653 Small ENGLEHART & District 0 0 0 0 0 0 0 0

654 Small ESPANOLA General 2 2 2 2 1 1 1 1

655 Small EXETER South Huron 0 0 0 0 0 0 0 0

656 Large Community FERGUS Groves Memorial Comm 229 234 243 233 83 84 86 82

661 Large Community CAMBRIDGE Memorial 1,064 1,084 1,109 1,064 664 607 619 594

662 Small GERALDTON District Hospital 29 28 27 26 8 8 8 7

663 Small GODERICH Alexandra Marine & General 90 90 93 89 30 31 32 31

664 Large Community GRIMSBY West Lincoln Memorial 466 448 464 445 157 182 186 179

665 Large Community GUELPH General 1,260 1,293 1,340 1,286 682 689 706 677

666 Large Community GUELPH St Joseph's Hospital 0 0 0 0 0 0 0 0

674 Teaching HAMILTON St Joseph's 2,963 2,968 2,931 2,812 2,019 2,048 2,024 1,942

676 Small HANOVER & District 74 72 75 72 26 29 30 29

681 Small HEARST Notre Dame 68 70 69 66 27 33 34 32

682 Small HORNEPAYNE Community 5 5 5 5 1 1 1 1

684 Small INGERSOLL Alexandra 78 79 80 77 28 35 36 35

685 Small IROQUOIS FALLS Anson General 0 0 0 0 0 0 0 0

686 Small WAWA North Algoma 49 50 50 48 14 12 13 12

687 Small KAPUSKASING Sensenbrenner 102 105 104 99 30 37 38 36

692 Teaching KINGSTON Hotel Dieu 0 0 0 0 0 0 0 0

693 Teaching KINGSTON General 1,917 1,846 1,848 1,773 1,885 1,910 1,935 1,856

696 Large Community KIRKLAND & District 111 108 107 102 35 39 40 39


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Facility Number


1999/2000Expected

1999/2000Expected

2001/2002


2001/2002

Actual 1999/2000

Expected 1999/2000

Expected 2001/2002


2001/2002699 Large Community KITCHENER St Mary's 0 0 0 0 0 0 0 0

701 Large Community RICHMOND HILL York Central 2,036 2,005 2,096 2,011 915 998 1,017 976

704 Large Community LEAMINGTON District Memorial 460 453 452 434 139 131 131 126

707 Large Community LINDSAY Ross Memorial 383 383 410 393 166 175 189 182

709 Small LISTOWEL Memorial 148 151 155 149 52 56 58 56

714 Teaching LONDON St Joseph's 3,343 3,306 3,276 3,143 3,397 3,404 3,419 3,280

718 Large Community BURLINGTON Joseph Brant Memorial 1,277 1,289 1,262 1,211 614 610 594 570

719 Small MANITOUWADGE General 5 5 5 5 3 3 3 3

721 Small MARATHON Wilson Memorial 35 34 33 32 14 13 13 12

723 Small MATHESON Bingham Memorial 1 1 1 1 0 0 0 0

724 Small MATTAWA General 0 0 0 0 1 0 0 0

726 Large Community MIDLAND Huronia 325 311 329 316 92 95 100 96

731 Large Community MISSISSAUGA Credit Valley 2,930 3,105 3,247 3,115 2,001 1,954 2,008 1,927

732 Small KEMPTVILLE District 0 0 0 0 0 0 0 0

733 Small MOUNT FOREST Louise Marshall 28 28 29 28 8 8 9 8

734 Small HALDIMAND West Haldimand General 0 0 0 0 0 0 0 0

736 Large CommunityNEWMARKET Southlake Regional Health Centre

1,817 1,880 1,941 1,863 1,015 1,110 1,132 1,086

739 Small NIPIGON District Memorial 2 2 2 2 0 0 0 0

745 Large Community ORILLIA Soldiers' Memorial 768 738 784 752 519 525 555 533

751 Specialty OTTAWA CHEO 0 0 0 0 1,069 1,149 1,146 1,100

753 Large Community OTTAWA Montfort 735 739 730 701 256 291 291 279

755 Large Community OTTAWA SA Grace 1,023 997 987 947 319 340 337 323

759 Small PALMERSTON & District 64 66 68 65 16 17 17 16

760 Small PARIS - The Willett 1 1 1 1 0 0 0 0

763 Large Community PEMBROKE General 525 559 577 554 191 209 216 208


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Facility Number


1999/2000Expected

1999/2000Expected

2001/2002


2001/2002

Actual 1999/2000

Expected 1999/2000

Expected 2001/2002


2001/2002768 Small BARRY'S BAY St Francis Memorial 1 1 1 1 0 0 0 0

771 Large Community PETERBOROUGH Civic 1,260 1,272 1,359 1,304 740 702 744 714

776 Small PETROLIA Charlotte Eleanor Englehart 41 45 45 43 11 12 12 12

777 Large Community NEPEAN Queensway-Carleton 562 547 543 521 164 173 171 164

784 Small LITTLE CURRENT Manitoulin 51 51 52 50 16 20 20 19

788 Large Community RENFREW Victoria 79 84 87 83 22 24 25 24

790 Large Community ST CATHARINES Hotel Dieu 1 1 1 1 0 0 0 0

792 Small ST MARY'S Memorial 1 2 2 2 0 0 0 0

793 Large Community ST THOMAS Elgin General 556 588 614 589 280 344 359 344

795 Large Community SARNIA St. Joseph's 0 0 0 0 0 0 0 0

796 Large Community SARNIA General 765 836 831 798 339 360 367 352

797 Large Community SAULT STE MARIE General 825 850 851 816 546 472 481 461

800 Large Community HAWKESBURY & District General 181 190 192 185 54 68 70 67

801 Small SEAFORTH Community 3 4 4 3 1 1 1 1

802 Small ALEXANDRIA Glengarry Memorial 0 0 0 0 0 0 0 0

804 Large Community SIMCOE Norfolk General 346 322 346 332 128 143 153 147

805 Small SIOUX LOOKOUT District 97 97 96 92 34 33 33 32

809 Small SMOOTH ROCK FALLS 0 0 0 0 0 0 0 0

813 Large Community STRATFORD General 713 735 753 723 327 358 370 355

814 Large Community STRATHROY Middlesex General 222 222 218 209 81 79 79 76

819 Small TERRACE BAY McCausland 13 13 12 12 3 2 2 2

824 Large Community TILLSONBURG District Memorial 101 101 105 101 31 38 40 38

826 Large Community KENORA Lake-of-the-Woods District 257 256 256 246 85 83 85 81

837 Specialty TORONTO Hospital for Sick Children 1 1 1 1 4,166 4,107 4,087 3,921

842 Teaching TORONTO Mount Sinai 4,235 4,233 4,055 3,890 4,438 4,361 4,321 4,145


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Facility Number


1999/2000Expected

1999/2000Expected

2001/2002


2001/2002

Actual 1999/2000

Expected 1999/2000

Expected 2001/2002


2001/2002852 Teaching TORONTO St Michael's 1,927 1,922 1,780 1,707 761 747 724 695

858 Large Community TORONTO East General 2,042 2,044 1,892 1,816 1,483 1,449 1,400 1,343

870 Small WALLACEBURG Sydenham 77 80 80 77 23 24 24 23

881 Small STURGEON FALLS West Nipissing 0 0 0 0 1 1 1 1

882 Large Community WINCHESTER District Memorial 254 254 258 247 79 90 93 89

888 Large Community NEW LISKEARD Temiskaming 213 205 203 195 68 76 78 75

889 Small WINGHAM & District 25 26 27 26 8 9 9 9

890 Large Community WOODSTOCK General 465 470 478 459 151 190 196 188

896 Small RED LAKE Marg Cochenour Memorial 31 31 30 29 11 11 11 10

898 Large Community TORONTO St Joseph's 2,124 2,130 1,996 1,915 1,297 1,281 1,244 1,194

900 Large Community FORT FRANCES Riverside Health Care 212 202 212 203 72 71 76 73

903 Large Community HUNTSVILLE District Memorial 206 194 207 199 60 61 65 62

905 Large Community MARKHAM Stouffville 2,018 2,024 2,093 2,008 1,188 1,199 1,210 1,161

906 Large Community NORTH BAY General 892 856 844 810 477 453 456 437

907 Large Community TIMMINS & District General 644 666 656 629 320 393 396 380

916 Large Community ORANGEVILLE Dufferin-Caledon 605 574 585 561 236 213 216 207

927 Large Community WINDSOR Hotel Dieu Grace 1,543 1,511 1,509 1,447 1,436 1,339 1,337 1,283

928 Large Community SMITHS FALLS Perth & Smiths Falls 237 241 248 238 80 86 88 85

930 Large Community KITCHENER Grand River 3,322 3,297 3,305 3,171 1,828 1,696 1,704 1,635

931 Large Community PARRY SOUND West Parry Sound 145 135 142 137 42 57 60 57

933 Large Community WINDSOR Regional 2,058 2,014 2,011 1,930 744 692 691 663

935 Large Community THUNDER BAY Regional 1,620 1,586 1,550 1,487 1,051 961 954 915

936 Teaching LONDON Health Sciences 2,192 2,163 2,136 2,050 1,485 1,493 1,495 1,435

938 Small MINDEN Haliburton Highlands 6 6 7 7 1 1 2 2

940 Large Community COBOURG Northumberland 281 271 285 274 126 111 118 113


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Facility Number


1999/2000Expected

1999/2000Expected

2001/2002


2001/2002

Actual 1999/2000

Expected 1999/2000

Expected 2001/2002


2001/2002941 Large Community TORONTO Humber River Regional 4,205 4,205 4,045 3,881 1,823 1,823 1,786 1,714

942 Teaching HAMILTON Health Sciences Centre 3,196 3,235 3,246 3,115 3,982 3,898 3,908 3,749

946 Large Community KINCARDINE S Bruce Grey Hlth Ctr 181 189 200 192 58 60 64 61

947 Teaching TORONTO University Health Network 3,031 3,023 2,808 2,694 1,453 1,425 1,381 1,325

949 Large Community MISSISSAUGA Trillium Health Centre 3,206 3,397 3,521 3,379 1,487 1,459 1,493 1,432

950 Large CommunityOAKVILLE Halton Heatlhcare Services Corporation

1,788 1,820 1,911 1,833 846 830 842 808

951 Large Community BRAMPTON William Osler 5,653 5,645 5,759 5,526 3,044 2,898 2,932 2,813

952 Large Community OSHAWA Lakeridge Health Corporation 2,845 2,653 2,664 2,556 1,231 1,246 1,251 1,200

953 Teaching TORONTO Sunnybrook & Women's 3,830 3,814 3,602 3,455 3,366 3,309 3,271 3,138

954 Large Community TORONTO Rouge Valley Health System 3,227 3,161 3,109 2,983 1,920 1,870 1,836 1,762

955 Large Community OWEN SOUND Grey Bruce Health Services 680 665 695 667 327 353 373 358

957 Large CommunityBELLEVILLE Quinte Health Care Corporation

1,315 1,285 1,325 1,272 543 619 643 617

958 Teaching OTTAWA The Ottawa Hospital 6,687 6,502 6,360 6,102 4,119 4,423 4,371 4,193

959 Large CommunitySUDBURY Hopital Regional de Sudbury Regional Hospital

1,634 1,732 1,734 1,664 1,062 1,022 1,035 993

960 Large Community TORONTO The Scarborough Hospital 4,150 4,180 4,020 3,857 2,789 2,784 2,715 2,605

962 Large Community ST. CATHARINES Niagara Health System 2,812 2,930 2,912 2,794 1,427 1,313 1,314 1,261


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Appendix 16: Hospital Expected Medical and Surgical Weighted Cases

1999/2000 Medical & Surgical Weighted Cases


Facility Number Hospital Type 2000/2001 Hospital NameActual Expected Expected


592 Small NAPANEE Lennox & Addington 1,646 1,700 1,807 1,734

593 Small NEWBURY Four Counties 743 776 789 757

596 Small ALLISTON Stevenson Memorial 2,589 2,563 2,732 2,621

597 Small ALMONTE General 780 771 806 773

599 Small ARNPRIOR & District Memorial 1,720 1,712 1,782 1,710

600 Small ATIKOKAN General 500 483 489 469

606 Large Community BARRIE Roval Victoria 16,876 16,848 17,941 17,213

611 Small BLIND RIVER St Joseph's 934 926 958 919

614 Large Community BRACEBRIDGE S Muskoka Memorial 3,274 3,733 3,894 3,736

617 Large Community BRANTFORD General 14,400 12,710 13,143 12,610

618 Large Community BRANTFORD St Joseph's 1,679 1,496 1,538 1,476

619 Large Community BROCKVILLE General 6,314 6,987 7,248 6,953

624 Small CAMPBELLFORD Memorial 1,769 1,837 1,951 1,872

626 Small CARLETON PLACE & District Memorial 1,088 1,074 1,125 1,080

627 Small CHAPLEAU General 253 278 301 289

628 Large Community CHATHAM Public General 6,350 6,822 7,058 6,772

629 Large Community CHATHAM St Joseph's 3,588 3,854 3,984 3,822

632 Large Community TORONTO North York General 31,171 31,057 32,436 31,119

633 Small CLINTON Public 1,079 970 1,001 961

638 Small COCHRANE Lady Minto 737 656 678 651

640 Large Community COLLINGWOOD General and Marine 3,831 3,804 4,051 3,887

643 Large Community CORNWALL General 5,052 5,457 5,591 5,364

644 Large Community CORNWALL Hotel Dieu 5,459 5,888 6,035 5,790

646 Small DEEP RIVER and District 570 567 595 571

647 Small DRYDEN District General 1,866 2,241 2,283 2,191

648 Small DUNNVILLE Haldimand War Memorial 1,177 1,127 1,216 1,166

650 Large Community ELLIOT LAKE St Joseph's 2,538 2,539 2,619 2,513

653 Small ENGLEHART & District 709 652 660 633

654 Small ESPANOLA General 973 1,068 1,146 1,099

655 Small EXETER South Huron 827 772 791 759

656 Large Community FERGUS Groves Memorial Comm 2,018 1,992 2,098 2,013

661 Large Community CAMBRIDGE Memorial 11,645 11,014 11,633 11,160

662 Small GERALDTON District Hospital 862 863 886 850

663 Small GODERICH Alexandra Marine & General 2,956 2,666 2,745 2,634

664 Large Community GRIMSBY West Lincoln Memorial 2,424 2,571 2,692 2,583

665 Large Community GUELPH General 8,076 7,976 8,380 8,040

666 Large Community GUELPH St Joseph's Hospital 5,443 5,371 5,638 5,409

674 Teaching HAMILTON St Joseph's 28,636 25,880 26,808 25,720

676 Small HANOVER & District 1,653 1,588 1,623 1,557

681 Small HEARST Notre Dame 851 759 785 753

682 Small HORNEPAYNE Community 150 149 154 148

684 Small INGERSOLL Alexandra 1,494 1,491 1,558 1,495

685 Small IROQUOIS FALLS Anson General 717 639 662 635

686 Small WAWA North Algoma 499 496 512 491

687 Small KAPUSKASING Sensenbrenner 1,855 1,653 1,710 1,640

692 Teaching KINGSTON Hotel Dieu 3,028 2,988 3,039 2,915

693 Teaching KINGSTON General 31,134 31,295 31,823 30,531

696 Large Community KIRKLAND & District 2,114 1,943 1,967 1,887

699 Large Community KITCHENER St Mary's 12,712 13,345 14,034 13,465

701 Large Community RICHMOND HILL York Central 14,845 15,439 17,611 16,896

704 Large Community LEAMINGTON District Memorial 3,479 3,453 3,576 3,430

707 Large Community LINDSAY Ross Memorial 7,831 7,009 7,363 7,064

709 Small LISTOWEL Memorial 1,238 1,097 1,121 1,076

714 Teaching LONDON St Joseph's 20,474 21,251 21,791 20,907

718 Large Community BURLINGTON Joseph Brant Memorial 16,904 14,848 15,586 14,953

719 Small MANITOUWADGE General 186 187 191 183

721 Small MARATHON Wilson Memorial 309 311 322 309

723 Small MATHESON Bingham Memorial 387 344 356 342

724 Small MATTAWA General 493 476 488 469

726 Large Community MIDLAND Huronia 4,262 4,243 4,532 4,348

731 Large Community MISSISSAUGA Credit Valley 17,229 19,061 21,372 20,505


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732 Small KEMPTVILLE District 900 975 1,011 970

733 Small MOUNT FOREST Louise Marshall 824 811 847 813

734 Small HALDIMAND West Haldimand General 1,040 1,004 1,091 1,047

736 Large CommunityNEWMARKET Southlake Regional Health Centre 17,589 17,516 18,938 18,170

739 Small NIPIGON District Memorial 676 680 703 674

745 Large Community ORILLIA Soldiers' Memorial 10,574 10,624 11,244 10,788

751 Specialty OTTAWA CHEO 6,396 6,543 6,816 6,539

753 Large Community OTTAWA Montfort 9,582 10,122 10,472 10,047

755 Large Community OTTAWA SA Grace 3,263 3,248 3,375 3,238

759 Small PALMERSTON & District 946 929 976 936

760 Small PARIS - The Willett 286 251 260 249

763 Large Community PEMBROKE General 5,760 5,725 6,014 5,770

768 Small BARRY'S BAY St Francis Memorial 576 571 594 570

771 Large Community PETERBOROUGH Civic 20,405 19,190 19,833 19,028

776 Small PETROLIA Charlotte Eleanor Englehart 1,353 1,414 1,452 1,393

777 Large Community NEPEAN Queensway-Carleton 13,711 13,492 14,190 13,614

784 Small LITTLE CURRENT Manitoulin 1,594 1,612 1,704 1,635

788 Large Community RENFREW Victoria 1,901 1,891 1,980 1,900

790 Large Community ST CATHARINES Hotel Dieu 10,591 10,960 11,324 10,864

792 Small ST MARY'S Memorial 873 791 808 775

793 Large Community ST THOMAS Elgin General 8,347 8,287 8,711 8,357

795 Large Community SARNIA St. Joseph's 595 622 639 613

796 Large Community SARNIA General 12,600 13,172 13,515 12,966

797 Large Community SAULT STE MARIE General 16,308 16,183 16,737 16,058

800 Large Community HAWKESBURY & District General 2,209 2,469 2,769 2,656

801 Small SEAFORTH Community 732 656 676 649

802 Small ALEXANDRIA Glengarry Memorial 875 947 970 931

804 Large Community SIMCOE Norfolk General 5,545 5,336 5,783 5,548

805 Small SIOUX LOOKOUT District 739 864 885 849

809 Small SMOOTH ROCK FALLS 279 248 257 246

813 Large Community STRATFORD General 6,582 5,903 6,029 5,784

814 Large Community STRATHROY Middlesex General 3,001 3,177 3,262 3,130

819 Small TERRACE BAY McCausland 303 305 311 298

824 Large Community TILLSONBURG District Memorial 2,738 2,705 2,794 2,680

826 Large Community KENORA Lake-of-the-Woods District 2,919 3,363 3,454 3,314

837 Specialty TORONTO Hospital for Sick Children 18,231 18,383 19,262 18,480

842 Teaching TORONTO Mount Sinai 20,278 20,266 21,228 20,366

852 Teaching TORONTO St Michael's 48,289 48,280 50,590 48,537

858 Large Community TORONTO East General 25,455 25,508 26,851 25,761

870 Small WALLACEBURG Sydenham 1,652 1,765 1,827 1,752

881 Small STURGEON FALLS West Nipissing 1,644 1,595 1,638 1,571

882 Large Community WINCHESTER District Memorial 2,394 2,605 2,659 2,551

888 Large Community NEW LISKEARD Temiskaming 3,106 2,862 2,896 2,778

889 Small WINGHAM & District 1,551 1,415 1,446 1,387

890 Large Community WOODSTOCK General 6,059 6,026 6,296 6,040

896 Small RED LAKE Marg Cochenour Memorial 526 627 639 613

898 Large Community TORONTO St Joseph's 22,027 22,144 23,364 22,416

900 Large Community FORT FRANCES Riverside Health Care 2,792 2,709 2,748 2,637

903 Large Community HUNTSVILLE District Memorial 3,205 3,624 3,736 3,584

905 Large Community MARKHAM Stouffville 10,298 10,754 11,806 11,327

906 Large Community NORTH BAY General 12,230 12,068 12,334 11,833

907 Large Community TIMMINS & District General 8,797 7,907 8,184 7,852

916 Large Community ORANGEVILLE Dufferin-Caledon 5,474 4,930 5,238 5,026

927 Large Community WINDSOR Hotel Dieu Grace 24,774 24,376 25,337 24,308

928 Large Community SMITHS FALLS Perth & Smiths Falls 5,396 5,461 5,650 5,421

930 Large Community KITCHENER Grand River 17,393 18,091 19,048 18,275

931 Large Community PARRY SOUND West Parry Sound 2,515 2,776 2,985 2,864

933 Large Community WINDSOR Regional 18,560 18,254 18,978 18,208

935 Large Community THUNDER BAY Regional 24,067 24,392 24,870 23,861

936 Teaching LONDON Health Sciences 62,523 64,065 65,758 63,089

938 Small MINDEN Haliburton Highlands 545 594 707 679


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940 Large Community COBOURG Northumberland 3,669 3,965 4,337 4,161

941 Large Community TORONTO Humber River Regional 36,231 36,289 38,089 36,543

942 Teaching HAMILTON Health Sciences Centre 74,708 68,280 70,675 67,806

946 Large Community KINCARDINE S Bruce Grey Hlth Ctr 4,341 4,115 4,251 4,078

947 Teaching TORONTO University Health Network 81,536 81,927 86,160 82,663

949 Large Community MISSISSAUGA Trillium Health Centre 35,068 38,261 41,913 40,212

950 Large CommunityOAKVILLE Halton Heatlhcare Services Corporation 17,135 16,502 17,681 16,963

951 Large Community BRAMPTON William Osler 41,126 41,767 45,667 43,813

952 Large Community OSHAWA Lakeridge Health Corporation 32,479 32,096 34,034 32,653

953 Teaching TORONTO Sunnybrook & Women's 48,874 48,942 51,285 49,203

954 Large Community TORONTO Rouge Valley Health System 28,211 28,599 30,563 29,323

955 Large Community OWEN SOUND Grey Bruce Health Services 15,047 14,422 14,742 14,144

957 Large Community BELLEVILLE Quinte Health Care Corporation 15,184 16,464 17,178 16,481

958 Teaching OTTAWA The Ottawa Hospital 78,140 79,045 81,877 78,554

959 Large CommunitySUDBURY Hopital Regional de Sudbury Regional Hospital 33,465 34,018 34,956 33,537

960 Large Community TORONTO The Scarborough Hospital 42,978 44,618 46,970 45,064

962 Large Community ST. CATHARINES Niagara Health System 38,504 38,439 39,754 38,140


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Appendix 17: Hospital Total Expected Weighted Cases

Total Weighted Cases

2001/2002 % Over

Facility Number

Hospital Type 2000/2001 Hospital Name Actual 1999/2000

Expected 1999/2000 Expected


Expected 1999/2000

Expected 2001/2000


2001/2002592 Small NAPANEE Lennox & Addington 1,789 1,845 1,953 1,874 3.1% 8.4% -4.5%593 Small NEWBURY Four Counties 745 778 792 760 4.2% 5.9% -1.9%596 Small ALLISTON Stevenson Memorial 2,929 2,894 3,079 2,954 -1.2% 4.8% -0.8%597 Small ALMONTE General 1,053 1,057 1,100 1,056 0.4% 4.3% -0.2%599 Small ARNPRIOR & District Memorial 1,724 1,716 1,786 1,714 -0.5% 3.5% 0.6%600 Small ATIKOKAN General 515 497 504 484 -3.7% -2.3% 6.6%

606Large Community BARRIE Roval Victoria 19,591 19,526 20,767 19,924 -0.3% 5.7% -1.7%

611 Small BLIND RIVER St Joseph's 948 938 970 931 -1.0% 2.3% 1.8%

614Large Community BRACEBRIDGE S Muskoka Memorial 3,484 3,925 4,101 3,934 11.2% 15.0% -11.4%

617Large Community BRANTFORD General 16,136 14,558 15,028 14,418 -10.8% -7.4% 11.9%

618Large Community BRANTFORD St Joseph's 1,679 1,496 1,538 1,476 -12.2% -9.2% 13.8%

619Large Community BROCKVILLE General 6,826 7,496 7,765 7,449 8.9% 12.1% -8.4%

624 Small CAMPBELLFORD Memorial 1,770 1,839 1,952 1,873 3.7% 9.3% -5.5%626 Small CARLETON PLACE & District Memorial 1,089 1,074 1,126 1,080 -1.4% 3.3% 0.8%627 Small CHAPLEAU General 261 286 309 296 8.7% 15.4% -11.8%

628Large Community CHATHAM Public General 7,631 8,150 8,381 8,041 6.4% 9.0% -5.1%

629Large Community CHATHAM St Joseph's 3,613 3,879 4,010 3,847 6.9% 9.9% -6.1%

632Large Community TORONTO North York General 37,110 37,033 38,291 36,737 -0.2% 3.1% 1.0%

633 Small CLINTON Public 1,197 1,090 1,124 1,079 -9.9% -6.5% 11.0%638 Small COCHRANE Lady Minto 798 722 744 714 -10.4% -7.2% 11.7%

640Large Community COLLINGWOOD General and Marine 4,186 4,152 4,418 4,238 -0.8% 5.2% -1.2%

643Large Community CORNWALL General 5,072 5,477 5,612 5,384 7.4% 9.6% -5.8%

644Large Community CORNWALL Hotel Dieu 6,214 6,677 6,838 6,560 6.9% 9.1% -5.3%

646 Small DEEP RIVER and District 570 567 595 571 -0.6% 4.2% -0.1%647 Small DRYDEN District General 2,078 2,451 2,490 2,389 15.2% 16.5% -13.0%648 Small DUNNVILLE Haldimand War Memorial 1,296 1,244 1,340 1,286 -4.2% 3.3% 0.8%

650Large Community ELLIOT LAKE St Joseph's 2,703 2,703 2,783 2,670 0.0% 2.9% 1.2%

653 Small ENGLEHART & District 709 652 660 633 -8.8% -7.5% 12.0%654 Small ESPANOLA General 975 1,070 1,148 1,102 8.9% 15.1% -11.5%655 Small EXETER South Huron 828 773 792 760 -7.1% -4.6% 9.0%

656Large Community FERGUS Groves Memorial Comm 2,330 2,310 2,426 2,328 -0.9% 4.0% 0.1%

661Large Community CAMBRIDGE Memorial 13,374 12,705 13,360 12,818 -5.3% -0.1% 4.3%

662 Small GERALDTON District Hospital 898 899 921 884 0.1% 2.5% 1.6%


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2001/2002 % Over

Facility Number




Expected 1999/2000

Expected 2001/2000


2001/2002663 Small GODERICH Alexandra Marine & General 3,076 2,788 2,870 2,754 -10.3% -7.2% 11.7%

664Large Community GRIMSBY West Lincoln Memorial 3,047 3,202 3,342 3,207 4.8% 8.8% -5.0%

665Large Community GUELPH General 10,019 9,958 10,426 10,003 -0.6% 3.9% 0.2%

666Large Community GUELPH St Joseph's Hospital 5,443 5,371 5,638 5,409 -1.3% 3.5% 0.6%

674 Teaching HAMILTON St Joseph's 33,619 30,896 31,763 30,474 -8.8% -5.8% 10.3%676 Small HANOVER & District 1,753 1,688 1,728 1,658 -3.8% -1.4% 5.7%681 Small HEARST Notre Dame 946 862 887 851 -9.7% -6.6% 11.1%682 Small HORNEPAYNE Community 156 155 160 153 -0.8% 2.4% 1.7%684 Small INGERSOLL Alexandra 1,600 1,604 1,674 1,606 0.3% 4.4% -0.4%685 Small IROQUOIS FALLS Anson General 718 640 662 635 -12.1% -8.4% 12.9%686 Small WAWA North Algoma 562 559 575 552 -0.6% 2.2% 1.9%687 Small KAPUSKASING Sensenbrenner 1,986 1,796 1,851 1,776 -10.6% -7.3% 11.8%692 Teaching KINGSTON Hotel Dieu 3,028 2,988 3,039 2,915 -1.3% 0.3% 3.9%693 Teaching KINGSTON General 34,936 35,051 35,605 34,160 0.3% 1.9% 2.3%

696Large Community KIRKLAND & District 2,259 2,090 2,114 2,028 -8.1% -6.9% 11.4%

699Large Community KITCHENER St Mary's 12,712 13,345 14,034 13,465 4.7% 9.4% -5.6%

701Large Community RICHMOND HILL York Central 17,796 18,442 20,724 19,883 3.5% 14.1% -10.5%

704Large Community LEAMINGTON District Memorial 4,078 4,037 4,159 3,990 -1.0% 1.9% 2.2%

707Large Community LINDSAY Ross Memorial 8,380 7,567 7,962 7,639 -10.7% -5.2% 9.7%

709 Small LISTOWEL Memorial 1,438 1,304 1,334 1,280 -10.2% -7.8% 12.3%714 Teaching LONDON St Joseph's 27,214 27,961 28,486 27,330 2.7% 4.5% -0.4%

718Large Community BURLINGTON Joseph Brant Memorial 18,796 16,746 17,442 16,734 -12.2% -7.8% 12.3%

719 Small MANITOUWADGE General 194 195 199 190 0.5% 2.2% 2.0%721 Small MARATHON Wilson Memorial 358 358 368 353 0.0% 2.6% 1.5%723 Small MATHESON Bingham Memorial 387 345 357 343 -12.2% -8.5% 13.1%724 Small MATTAWA General 494 477 489 469 -3.6% -1.0% 5.2%

726Large Community MIDLAND Huronia 4,679 4,650 4,961 4,760 -0.6% 5.7% -1.7%

731Large Community MISSISSAUGA Credit Valley 22,160 24,120 26,627 25,547 8.1% 16.8% -13.3%

732 Small KEMPTVILLE District 901 975 1,011 970 7.6% 10.9% -7.2%733 Small MOUNT FOREST Louise Marshall 861 847 885 849 -1.6% 2.8% 1.3%734 Small HALDIMAND West Haldimand General 1,040 1,004 1,091 1,047 -3.6% 4.7% -0.7%

736Large Community

NEWMARKET Southlake Regional Health Centre 20,421 20,506 22,012 21,118 0.4% 7.2% -3.3%

739 Small NIPIGON District Memorial 678 682 705 676 0.6% 3.8% 0.2%

745Large Community ORILLIA Soldiers' Memorial 11,860 11,887 12,583 12,072 0.2% 5.7% -1.8%


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2001/2002 % Over

Facility Number




Expected 1999/2000

Expected 2001/2000


2001/2002751 Specialty OTTAWA CHEO 7,466 7,692 7,963 7,639 2.9% 6.2% -2.3%

753Large Community OTTAWA Montfort 10,573 11,151 11,492 11,026 5.2% 8.0% -4.1%

755Large Community OTTAWA SA Grace 4,606 4,585 4,699 4,508 -0.4% 2.0% 2.2%

759 Small PALMERSTON & District 1,026 1,012 1,061 1,018 -1.4% 3.3% 0.8%760 Small PARIS - The Willett 287 253 261 251 -13.7% -9.9% 14.5%

763Large Community PEMBROKE General 6,476 6,493 6,808 6,531 0.3% 4.9% -0.9%

768 Small BARRY'S BAY St Francis Memorial 577 572 596 571 -0.8% 3.2% 0.9%

771Large Community PETERBOROUGH Civic 22,405 21,164 21,936 21,046 -5.9% -2.1% 6.5%

776 Small PETROLIA Charlotte Eleanor Englehart 1,405 1,471 1,509 1,448 4.5% 6.9% -3.0%

777Large Community NEPEAN Queensway-Carleton 14,438 14,212 14,904 14,299 -1.6% 3.1% 1.0%

784 Small LITTLE CURRENT Manitoulin 1,661 1,683 1,776 1,704 1.3% 6.4% -2.5%

788Large Community RENFREW Victoria 2,001 1,998 2,092 2,007 -0.1% 4.3% -0.3%

790Large Community ST CATHARINES Hotel Dieu 10,593 10,962 11,325 10,865 3.4% 6.5% -2.5%

792 Small ST MARY'S Memorial 875 793 810 777 -10.3% -8.0% 12.6%

793Large Community ST THOMAS Elgin General 9,183 9,219 9,683 9,290 0.4% 5.2% -1.2%

795Large Community SARNIA St. Joseph's 595 622 639 613 4.3% 6.9% -2.9%

796Large Community SARNIA General 13,705 14,367 14,713 14,116 4.6% 6.9% -2.9%

797Large Community SAULT STE MARIE General 17,679 17,505 18,068 17,335 -1.0% 2.2% 2.0%

800Large Community HAWKESBURY & District General 2,444 2,727 3,031 2,908 10.4% 19.4% -16.0%

801 Small SEAFORTH Community 737 661 681 653 -11.6% -8.3% 12.8%802 Small ALEXANDRIA Glengarry Memorial 875 947 970 931 7.5% 9.8% -6.0%

804Large Community SIMCOE Norfolk General 6,019 5,802 6,282 6,027 -3.7% 4.2% -0.1%

805 Small SIOUX LOOKOUT District 869 993 1,014 973 12.5% 14.3% -10.6%809 Small SMOOTH ROCK FALLS 279 248 257 247 -12.3% -8.6% 13.2%

813Large Community STRATFORD General 7,622 6,996 7,152 6,862 -9.0% -6.6% 11.1%

814Large Community STRATHROY Middlesex General 3,304 3,479 3,559 3,415 5.0% 7.2% -3.2%

819 Small TERRACE BAY McCausland 319 320 326 313 0.6% 2.2% 1.9%

824Large Community TILLSONBURG District Memorial 2,870 2,844 2,939 2,819 -0.9% 2.3% 1.8%

826Large Community KENORA Lake-of-the-Woods District 3,261 3,703 3,796 3,641 11.9% 14.1% -10.4%

837 Specialty TORONTO Hospital for Sick Children 22,398 22,491 23,350 22,402 0.4% 4.1% 0.0%


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2001/2002 % Over

Facility Number




Expected 1999/2000

Expected 2001/2000


2001/2002842 Teaching TORONTO Mount Sinai 28,950 28,861 29,603 28,401 -0.3% 2.2% 1.9%852 Teaching TORONTO St Michael's 50,978 50,949 53,094 50,939 -0.1% 4.0% 0.1%

858Large Community TORONTO East General 28,980 29,001 30,143 28,919 0.1% 3.9% 0.2%

870 Small WALLACEBURG Sydenham 1,752 1,869 1,931 1,853 6.3% 9.3% -5.4%881 Small STURGEON FALLS West Nipissing 1,646 1,597 1,639 1,573 -3.1% -0.4% 4.6%

882Large Community WINCHESTER District Memorial 2,727 2,950 3,010 2,888 7.6% 9.4% -5.6%

888Large Community NEW LISKEARD Temiskaming 3,387 3,143 3,177 3,048 -7.8% -6.6% 11.1%

889 Small WINGHAM & District 1,585 1,449 1,482 1,422 -9.4% -7.0% 11.5%

890Large Community WOODSTOCK General 6,675 6,685 6,970 6,687 0.1% 4.2% -0.2%

896 Small RED LAKE Marg Cochenour Memorial 568 668 680 653 15.0% 16.6% -13.0%

898Large Community TORONTO St Joseph's 25,448 25,555 26,604 25,524 0.4% 4.3% -0.3%

900Large Community FORT FRANCES Riverside Health Care 3,075 2,982 3,036 2,913 -3.1% -1.3% 5.6%

903Large Community HUNTSVILLE District Memorial 3,471 3,879 4,008 3,845 10.5% 13.4% -9.7%

905Large Community MARKHAM Stouffville 13,505 13,977 15,109 14,496 3.4% 10.6% -6.8%

906Large Community NORTH BAY General 13,599 13,377 13,634 13,080 -1.7% 0.3% 4.0%

907Large Community TIMMINS & District General 9,761 8,965 9,236 8,861 -8.9% -5.7% 10.2%

916Large Community ORANGEVILLE Dufferin-Caledon 6,316 5,717 6,039 5,794 -10.5% -4.6% 9.0%

927Large Community WINDSOR Hotel Dieu Grace 27,753 27,226 28,183 27,039 -1.9% 1.5% 2.6%

928Large Community SMITHS FALLS Perth & Smiths Falls 5,713 5,789 5,987 5,744 1.3% 4.6% -0.5%

930Large Community KITCHENER Grand River 22,544 23,084 24,057 23,081 2.3% 6.3% -2.3%

931Large Community PARRY SOUND West Parry Sound 2,702 2,968 3,187 3,058 9.0% 15.2% -11.7%

933Large Community WINDSOR Regional 21,361 20,960 21,680 20,800 -1.9% 1.5% 2.7%

935Large Community THUNDER BAY Regional 26,737 26,939 27,374 26,263 0.7% 2.3% 1.8%

936 Teaching LONDON Health Sciences 66,200 67,721 69,390 66,573 2.2% 4.6% -0.6%938 Small MINDEN Haliburton Highlands 552 602 716 687 8.3% 22.9% -19.6%

940Large Community COBOURG Northumberland 4,076 4,347 4,740 4,548 6.2% 14.0% -10.4%

941Large Community TORONTO Humber River Regional 42,259 42,316 43,921 42,138 0.1% 3.8% 0.3%

942 Teaching HAMILTON Health Sciences Centre 81,886 75,414 77,830 74,670 -8.6% -5.2% 9.7%


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2001/2002 % Over

Facility Number




Expected 1999/2000

Expected 2001/2000


2001/2002

946Large Community KINCARDINE S Bruce Grey Hlth Ctr 4,580 4,364 4,514 4,331 -5.0% -1.5% 5.8%

947 Teaching TORONTO University Health Network 86,019 86,374 90,349 86,682 0.4% 4.8% -0.8%

949Large Community MISSISSAUGA Trillium Health Centre 39,761 43,117 46,928 45,023 7.8% 15.3% -11.7%

950Large Community

OAKVILLE Halton Heatlhcare Services Corporation 19,769 19,151 20,433 19,604 -3.2% 3.3% 0.8%

951Large Community BRAMPTON William Osler 49,823 50,310 54,359 52,152 1.0% 8.3% -4.5%

952Large Community OSHAWA Lakeridge Health Corporation 36,555 35,995 37,950 36,409 -1.6% 3.7% 0.4%

953 Teaching TORONTO Sunnybrook & Women's 56,070 56,065 58,158 55,797 0.0% 3.6% 0.5%

954Large Community TORONTO Rouge Valley Health System 33,358 33,630 35,508 34,067 0.8% 6.1% -2.1%

955Large Community OWEN SOUND Grey Bruce Health Services 16,053 15,440 15,809 15,168 -4.0% -1.5% 5.8%

957Large Community BELLEVILLE Quinte Health Care Corporation 17,043 18,368 19,147 18,370 7.2% 11.0% -7.2%

958 Teaching OTTAWA The Ottawa Hospital 88,946 89,970 92,608 88,849 1.1% 4.0% 0.1%

959Large Community

SUDBURY Hopital Regional de Sudbury Regional Hospital 36,162 36,771 37,725 36,194 1.7% 4.1% -0.1%

960Large Community TORONTO The Scarborough Hospital 49,918 51,582 53,705 51,525 3.2% 7.1% -3.1%

962Large Community ST. CATHARINES Niagara Health System 42,742 42,682 43,980 42,195 -0.1% 2.8% 1.3%


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APPENDIX 18 INTEGRATION AND IMPLEMENTATION COMMITTEE TERMS OF REFERENCE

Mandate

To date the Ontario hospital funding models have attempted to achieve equity in hospital funding by analysis of hospital costs by individual hospital programmatic areas. This Committee will investigate the possibility of integrating the various Ontario funding models (e.g. growth, priority programs, adjustment factors) into a single comprehensive formula.

Objectives

• To review the current hospital funding models;

• To identify and indicate relevant funding models that could be integrated;

• To propose other funding models that could be integrated, as data become available;

• To evaluate implementation options and recommend implementation strategies to phase in new funding models and stabilize funding levels in the province; and

• To propose strategies to provide education and information concerning the implementation of new funding formulas

Deliverables

• Provide the Funding Committee with evidence on which to base a decision on the value of integrating all hospital funding formulas for the 2001-2002 funding year.

• To provide the Funding Committee with an implementation and communication strategy for the integration of all hospital funding formulas.

Time Line

The Committee will complete the work over a three-year period.


The Integration and Implementation Committee will report directly to the Funding

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Committee of the JPPC.

Membership

Membership will include representatives from the Ministry of Health, the Ontario Hospital Association, Ontario Hospitals, Academia, and others as necessary.

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APPENDIX 19 INTEGRATION AND IMPLEMENTATION COMMITTEE MEMBERSHIP LIST

Adam Topp, Chair Sunnybrook & Womens Health Sciences Centre

Paul Barker Ministry of Health and Long-Term Care


Jim Elliott Toronto Rehabilitation Institute

Murray Glendinning Ministry of Health and Long-Term Care

Bill Hart Kingston General Hospital

Gordon Key Huronia District Hospital

Lorna MacDonald Ontario Hospital Association


David Mercer Ministry of Health and Long-Term Care


Barry Potter St. Joseph’s Care Group

Jenny Rajaballey Ministry of Health and Long-Term Care


John Sutherland Huron Perth Hospitals Partnership

Phil Thom Hotel Dieu Hospital, Kingston

Vicki Truman William Osler Health Centre, Brampton

Mark Vimr Cardiac Care Network

Lorne Zon Markham Stouffville Hospital Cop

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APPENDIX 20 HOSPITAL FUNDING COMMITTEE

TERMS OF REFERENCE

MANDATE The Hospital Funding Committee (HFC) establishes a partnership between hospitals, and the MOHLTC. The HFC will:

• Make recommendations on a hospital funding system that promotes effectiveness, efficiency and equity among hospitals within a restructured and reformed Ontario health care system; and

• Provide a forum where the hospitals and the MOHLTC can discuss and make recommendations on the policies, directives, guidelines and specific methods required to provide funding reform. OBJECTIVES In support of it mandate, the objectives of the HFC are as follows:

• Research Research, discuss and make recommendations on hospital funding methodologies used in other jurisdictions (nationally and internationally), or identified in the literature, in order to ascertain their desirability/applicability, in whole or in part, for the Ontario environment.

Research the compatibility and implication of complementary incentives for Physicians and other providers.

• Refinement of existing methodologies

Establish long-term goals for funding in Ontario hospitals and to discuss, and make recommendation on the continued use of case mix methodology in the funding system.

Consider and make recommendations on the future use of the funding methods developed under the Transitional Funding initiative. Specifically, considering the desirability of extending the coverage of the Equity formula to both inpatient and out-patient activities.

Establish a workplan and priorities for developing funding formula.

Develop recommendations on funding incentives.

• Refinement of Formulae Refine formulae and case weights, as necessary, for equity funding payments until an alternative funding system is created and adopted.

Make recommendations on future of life support payment.

Make recommendations on the future of the Growth Fund. MEMBERSHIP The committee will consist of MOHLTC and hospital representatives. The President of the Ontario Hospital Association will appoint hospital and OHA members. MOHLTC members will by appointed by the Ministry.

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FREQUENCY OF MEETINGS The committee will normally meet on the third Monday of every month at 10:00am. These meetings may be cancelled or supplemented at the discretion of the Chair. SUPPORT A JPPC coordinator will be assigned to support the work of the HFC. Primary responsibilities will be: providing research and quantitative and qualitative analysis for the evaluation of issues and corresponding policy options; preparing briefs and position papers on these issues and policies and their implications; educating and obtaining feedback from hospitals, OHA and MOHLTC on these issues and options; and facilitating the implementation of policy decisions; committee organization, work-plan and budget reporting. REPORTING RELATIONSHIP The HFC is accountable to the JPPC through the Secretariat, which has a facilitating and coordinating role.

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APPENDIX 21 HOSPITAL FUNDING COMMITTEE

MEMBERSHIP LIST

John Oliver, Chair Halton Health Care Services

Paul Barker Ministry of Health and Long-Term Care

Randy Belair Lake of the Woods District Hospital

Don Benoit Ministry of Health and Long-Term Care

Michel Bilodeau Sisters of Charity of Ottawa Hospital


Dan Carriere South Lake Regional Health Centre

Jim Cruickshank Ontario Hospital Association

Kenneth Deane Hamilton Health Sciences Corp

Murray Glendining Ministry of Health and Long-Term Care

Linda Hunter Ministry of Health and Long-Term Care

Marc Joyal Monfort Hospital

Bruce Laughton Quinte Healthcare Corporation – Belleville

John Lott Kingston General Hospital

Mimi Lowi-Young St. Johns Rehabilitation Hospital

Frank Lussing York Central Hospital

Bill MacDonald Hotel Dieu Grace Hospital

Norman Maciver West Parry Sound Health Centre


Peter Marshall Ministry of Health and Long-Term Care

John McKinley Ministry of Health and Long-Term Care

David Mercer Ministry of Health and Long-Term Care



John Sutherlan Huron Perth Hospitals Partnership

Adam Topp Sunnybrook & Womens Health Sciences Centre

Tony Vines Ross Memorial Hospital

Ken White Trillium Health Centre

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Documents

Hospital Funding Using 1999/2000 Data · RD 9-12 Hospital Funding Formula using 1999/2000 Data Page 3 do other groups In order to develop hypot heses concerning which characteristics