Back to Travel burden for hospital care in Canada

December 10, 2024 — Travel for hospital care is sometimes unavoidable. The need to travel often presents an access barrier for patients, particularly for residents of rural/remote areas. CIHI’s Rural ������ϱ� Systems Model describes a set of key factors to help health system decision-makers and planners better understand what contributes to variation across rural health systems.

Factors related to geography, population, and health system and community context all affect the availability of care nearby. When care is not available close to home, the distance travelled to and from hospital, the transportation options available, and the time and cost associated with travel (including out-of-pocket and opportunity costs for patients and their families, as well as health system costs) contribute to travel burden.

Travel burden is complex and not broadly understood. This analysis goes beyond distance alone to shed new light on travel burden for inpatient hospital care by leveraging factors laid out in CIHI’s Rural ������ϱ� Systems Model. Pan-Canadian hospital data allows us to understand variation in travel burden across all provinces/territories and health regions.

Travel for inpatient hospital care is an important subset of all medical travel. A significant amount of medical travel is associated with other types of care (e.g., primary care, specialist consultations, diagnostic imaging). 

������ϱ� system decision-makers and planners make important decisions surrounding access to care. This analysis can be used to inform decisions about where services are located, how services are shared across communities and how care that is both safe and effective is coordinated.

Note
For additional information on how these factors were used to categorize travel burden, see Travel Burden for Hospital Care in Canada — Methodology Notes.

We developed a 5-point travel burden scale (from very low to very high) to categorize every inpatient hospitalization in Canada between 2018–2019 and 2022–2023.

The category assignment considers patient and hospital locations, including the direct distance between the patient’s home and the hospital where care was provided, and whether these locations are connected by a road network.

Our approach also considers whether the hospitalization was planned (scheduled) or urgent/emergent (unscheduled). Planned hospitalizations can be proactively coordinated, while those that happen unexpectedly can be more disruptive to things like work, home and child care.

Patients who travel to hospital are often accompanied by a support companion, which can result in added logistical considerations and expenses. Our approach factors in patient age, as the impact of travel can be greater for children, seniors and their travel companions.

Our travel burden categorization approach considers combinations of these factors. For example, a hospitalization for an 85-year-old who travelled more than 500 km outside their community where no road network was available for an unscheduled hospital admission is classified as very high travel burden; a hospitalization for a 45-year-old who had a scheduled hospital admission less than 10 km away along a road network is classified as very low travel burden.

Further details about our approach can be found in the methodology notes that accompany this analysis.