How does travel burden vary depending on the type of care you receive?

Back to Travel burden for hospital care in Canada

December 10, 2024 — Not all types of care are available at all hospitals across Canada. This means that people who require hospital care may need to travel — particularly for care levels that are specialized and for care types that are available at only a few locations. Travel burden varies not only by where people live,Reference1 but also by the level and type of care they receive. This analysis looks at how travel burden varies across Canada using CIHI’s Case Mix Group+ (CMG+) aggregation variables (which assign each hospital case to a mutually exclusive care level and to a provider service group based on the most responsible provider). For more information on CMG+, please refer to the Related resources section below.

Travel burden increases with level of specialization

��ϱ�classifies every hospitalization into 1 of 3 mutually exclusive care levels that reflects the degree of specialization: general, specialized and highly specialized.

General care is typically available at all hospitals and provided by a general practice physician (examples include hospitalizations for uncomplicated delivery, pneumonia and heart failure).
Specialized care is typically intervention-based and provided by a specialist; it is often concentrated in larger urban centres (examples include hospitalizations for hip replacement, Caesarean section and pacemaker implant).
Highly specialized care is advanced care requiring complex medical and/or surgical interventions that are available in selected facilities (examples include hospitalizations for organ transplant, gastric bypass and coronary bypass).

For specialized and highly specialized care, even residents of urban areas that have a wider range of health services may need to travel.

Travel burden for highly specialized hospital care was nearly 3 times higher than for general care. High and very high travel burden accounted for 19.7% of highly specialized hospital care and 6.9% of general care.

Among general care patients, 21.2% of those from rural/remote areas had high or very high travel burden, compared with only 3.0% of those from urban areas (about a 7-fold difference). For highly specialized care, the geographic differential was only a 4-fold difference (51.3% for rural/remote patients and 11.8% for urban patients).

Patients receiving obstetric and gynecology care had the smallest proportion of high or very high travel burden

Every hospitalization can be classified into a mutually exclusive provider service group. Travel burden was lower for patients who received obstetric and gynecology care compared with those who received internal medicine and subspecialty care — a provider service group that includes non-surgical specialties such as cardiology, gastroenterology and hematology/oncology.

Of all provider service groups, obstetric and gynecology care had the smallest proportion of patients with high or very high travel burden, regardless of patients’ geographic location. There was, however, a 13-fold difference in travel burden between obstetric and gynecology patients from rural/remote areas compared with those from urban areas (18.9% high or very high travel burden compared with 1.4%).

��ϱ� system decision-makers and planners can use this information to understand how travel burden compares for the populations they serve. Combining travel burden with other information, including hospitalization rates and population needs, can paint a more fulsome picture of health system access. This information can be helpful when considering service changes, such as adding, enhancing, reducing or removing a service, or consolidating service sites.

Find out how travel burden for residents of your health region compares using these interactive maps

Use the interactive maps below to explore variation in age–sex-standardized rates per 1,000 population of high and very high travel burden across Canada’s health regions, and by care level and provider service group.

Data is available for the following breakdowns:

Overall (all hospitalizations)
Level of specialization
- General
- Specialized
- Highly specialized
Provider service group
- Internal medicine and subspecialty
- Surgery
- General pediatrics
- Psychiatry
- Family medicine
- Obstetric and gynecology

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Downloadable data tables

Information on travel burden at national, provincial/territorial and regional levels, by urban and rural/remote geographic location and by care received.

Download data tables (XLSX)