The closure of rural hospitals in Saskatchewan: method or madness?

Abstract

On April 14, 1993 the Minister of Health of the Province of Saskatchewan announced the closure of 52 of the 112 small hospitals using the criteria of: size, utilization for two consecutive years and distance to the nearest-neighbouring hospital. Amazingly, that government was re-elected. This study compared two models of reasons for hospital closure: the government criteria; and historical population, resource, and utilization factors, gathered for the year prior to closure and a decade earlier. Of the 112 small hospitals in Saskatchewan, the 10 hospitals in the frontier area were not included. Hospitals in the settled part of the province were divided into two distinct zones. The Northern zone, with 53 hospitals is characterized by rich dark soil and prosperous trade centres and the Southern zone, with 49 hospitals is characterized by light brown sandy soil and oil and gas exploration centres. Two discriminant models were developed. The government model consisted of size, two years of utilization and distance. The historical model consisted of population, resource, and utilization factors for the years 1981/1982 and 1991/1992. The dependent variable for both models was hospital status (open=1 and closed =0). The government model accurately predicted 91.18% of the closure decisions. The historical model had a classification accuracy of 95.10% for the whole of settled Saskatchewan, 96.23% for the Northern zone, and 95.92% for the Southern zone. The historical model was more accurate than the government model. Closing a hospital is a sad event. The manner in which the government closed nearly half of the small hospitals in Saskatchewan and gained re-election is an important account of responsible public policy. The historical model developed to examine this story takes public policy one step further in that it is possible for governments to recognize signals that indicate when communities should undertake orderly transitions in the operation of their health services facilities.