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This Pan-Canadian report describes patient and physician perspectives regarding current performance of primary care in each province based on data collected as part of the Quality and Costs of Primary Care (QUALICOPC) study. The QUALICOPC study is an international study of quality and costs of primary care in 34 countries. This report describes results from the data collected in Canada. It includes only data collected from patients and physicians in primary care practices that provide comprehensive primary care. Two patient surveys were conducted as part of the study; one that asked patients about the importance of various aspects of primary care and the other about patients’ experiences with primary care. This report focuses on aspects of primary care that respondents to patient surveys (distributed during visits to primary care physicians) identified as very important aspects of their primary care experience. Primary care physicians from all Canadian provinces were asked to participate in the QUALICOPC study by a research team in each province. In general, one physician from each primary care practice was invited to participate (23 practices, primarily in Quebec, had more than one physician respondent). Physicians who agreed to participate were sent a package containing four different surveys regarding: the practice setting ; the services provided in the practice ; patient values and patient experience. In each practice, the physician was asked to complete the survey about the services provided and any staff member could complete the practice setting survey. One patient was expected to respond to the patient values survey and nine other patients were expected to respond to the patient experience survey. Physicians returned completed surveys to the research team in each province. A total of 8,332 patients of 810 primary care physicians in 785 practices across Canada responded to the surveys. A total of 1,160 completed the patient values survey and a different sampl

The study analyzes the relationship between the risk of a hospitalization for an ambulatory care sensitive condition (ACSC), and the primary care payment and the organizational model used by the patient (fee-for-service, enhanced fee-for-service, blended capitation, blended capitation with interdisciplinary teams).The study used linked patient-level health administrative databases and census data housed at the Institute for Clinical Evaluative Sciences in Ontario. Since the province provides universal health care, the data capture all patients in Ontario, Canada's most populous province, with about 13 million inhabitants. All Ontario patients diagnosed with an ACSC prior to April 1, 2012, who had at least one visit with a physician between April 1, 2012, and March 31. 2013, were included in the study (n=1,710,310). Each patient was assigned to the primary care model of his/her physician. The different models were categorized as Fee-forService (FFS), enhanced-FFS, blended capitation, and interdisciplinary team. A logistic regression was used to model the risk of having an ACSC hospitalization during the one-year observation period. Adjustments were made for patient characteristics (age, sex, health status, and socio-economic status) and for the geographic location of the practice. Using patients belonging to FFS models as the reference group, the risk of an ACSC hospitalization was higher for patients belonging to the blended-capitation model using interdisciplinary teams (Adjusted Odds Ratio [AOR] = 1.06, 95% confidence interval [CI] = 1.00-1.12) and lower for enhancedFFS (AOR = 0.78, CI= 0.74-0.82) and blended capitation patients (AOR = 0.91, CI= 0.86-0.96). Using patients with hypertension as the reference group, the odds of an ACSC hospitalization were much higher for patients with any other ACSC and increased with patients' morbidity. The risk was lower for patients of higher socio-economic status (AOR=0.63, CI=0.60-0.67) in the highest neighborhood income quint

Background The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients’ primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Methods Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Results Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients’ age, morbidity, and lower income quintile across all primary care payment types. Conclusions The new primary care models were associated with lower total health ca

Objective The study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada. Methods Survey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits. Results Because of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models.

This Pan-Canadian report describes patient and physician perspectives regarding current performance of primary care in each province based on data collected as part of the Quality and Costs of Primary Care (QUALICOPC) study. The QUALICOPC study is an international study of quality and costs of primary care in 34 countries. This report describes results from the data collected in Canada. It includes only data collected from patients and physicians in primary care practices that provide comprehensive primary care. Two patient surveys were conducted as part of the study; one that asked patients about the importance of various aspects of primary care and the other about patients’ experiences with primary care. This report focuses on aspects of primary care that respondents to patient surveys (distributed during visits to primary care physicians) identified as very important aspects of their primary care experience. Primary care physicians from all Canadian provinces were asked to participate in the QUALICOPC study by a research team in each province. In general, one physician from each primary care practice was invited to participate (23 practices, primarily in Quebec, had more than one physician respondent). Physicians who agreed to participate were sent a package containing four different surveys regarding: the practice setting ; the services provided in the practice ; patient values and patient experience. In each practice, the physician was asked to complete the survey about the services provided and any staff member could complete the practice setting survey. One patient was expected to respond to the patient values survey and nine other patients were expected to respond to the patient experience survey. Physicians returned completed surveys to the research team in each province. A total of 8,332 patients of 810 primary care physicians in 785 practices across Canada responded to the surveys. A total of 1,160 completed the patient values survey and a different sampl

This thesis documents the development and implementation of a dynamic, stochastic model of decision-making in the context of type 2 diabetes mellitus (T2DM), with specific reference to the Province of Manitoba. The second chapter (i.e., after the introduction) informs development of the model by summarizing the state of knowledge regarding T2DM and surveying existing economic models and frameworks. T2DM is a chronic condition that can reduce life expectancy, adversely affect labour market performance, and profoundly impact quality of life. People can reduce their risk of T2DM and manage its progression in various ways but exert limited control over health outcomes. Within this context, this thesis studies optimal decision-making by fully-rational, forward-looking individuals by extending Peter Zweifel, Friedrich Breyer, and Mathias Kifmann’s model of health production and demand. The third chapter conceptualizes health-related decision-making as a dynamic optimization problem in which health and economic events constitute transitions between predefined states. T2DM and its complications detract from quality of life, increase mortality risk, and restrict opportunities to engage in consumption and leisure. People can reduce, but not eliminate, the chance of developing T2DM and the rate of diabetic progression through regular physical activity and adherence to healthy eating habits and pharmacotherapy, but only by sacrificing time and income that could be allocated to other things. The model cannot be solved analytically but is amenable to application of numerical techniques. The remainder of Chapter 3 selects values or ranges for model parameters to reflect the circumstances in which Manitobans make health-related decisions. The fourth chapter describes model implementation, interprets key results, and illustrates potential applications. Fully-rational, forward-looking individuals are generally motivated to invest in health, but this is mediated by their circumstances

This thesis documents the development and implementation of a dynamic, stochastic model of decision-making in the context of type 2 diabetes mellitus (T2DM), with specific reference to the Province of Manitoba. The second chapter (i.e., after the introduction) informs development of the model by summarizing the state of knowledge regarding T2DM and surveying existing economic models and frameworks. T2DM is a chronic condition that can reduce life expectancy, adversely affect labour market performance, and profoundly impact quality of life. People can reduce their risk of T2DM and manage its progression in various ways but exert limited control over health outcomes. Within this context, this thesis studies optimal decision-making by fully-rational, forward-looking individuals by extending Peter Zweifel, Friedrich Breyer, and Mathias Kifmann’s model of health production and demand. The third chapter conceptualizes health-related decision-making as a dynamic optimization problem in which health and economic events constitute transitions between predefined states. T2DM and its complications detract from quality of life, increase mortality risk, and restrict opportunities to engage in consumption and leisure. People can reduce, but not eliminate, the chance of developing T2DM and the rate of diabetic progression through regular physical activity and adherence to healthy eating habits and pharmacotherapy, but only by sacrificing time and income that could be allocated to other things. The model cannot be solved analytically but is amenable to application of numerical techniques. The remainder of Chapter 3 selects values or ranges for model parameters to reflect the circumstances in which Manitobans make health-related decisions. The fourth chapter describes model implementation, interprets key results, and illustrates potential applications. Fully-rational, forward-looking individuals are generally motivated to invest in health, but this is mediated by their circumstances

This thesis documents the development and implementation of a dynamic, stochastic model of decision-making in the context of type 2 diabetes mellitus (T2DM), with specific reference to the Province of Manitoba. The second chapter (i.e., after the introduction) informs development of the model by summarizing the state of knowledge regarding T2DM and surveying existing economic models and frameworks. T2DM is a chronic condition that can reduce life expectancy, adversely affect labour market performance, and profoundly impact quality of life. People can reduce their risk of T2DM and manage its progression in various ways but exert limited control over health outcomes. Within this context, this thesis studies optimal decision-making by fully-rational, forward-looking individuals by extending Peter Zweifel, Friedrich Breyer, and Mathias Kifmann’s model of health production and demand. The third chapter conceptualizes health-related decision-making as a dynamic optimization problem in which health and economic events constitute transitions between predefined states. T2DM and its complications detract from quality of life, increase mortality risk, and restrict opportunities to engage in consumption and leisure. People can reduce, but not eliminate, the chance of developing T2DM and the rate of diabetic progression through regular physical activity and adherence to healthy eating habits and pharmacotherapy, but only by sacrificing time and income that could be allocated to other things. The model cannot be solved analytically but is amenable to application of numerical techniques. The remainder of Chapter 3 selects values or ranges for model parameters to reflect the circumstances in which Manitobans make health-related decisions. The fourth chapter describes model implementation, interprets key results, and illustrates potential applications. Fully-rational, forward-looking individuals are generally motivated to invest in health, but this is mediated by their circumstances

This thesis documents the development and implementation of a dynamic, stochastic model of decision-making in the context of type 2 diabetes mellitus (T2DM), with specific reference to the Province of Manitoba. The second chapter (i.e., after the introduction) informs development of the model by summarizing the state of knowledge regarding T2DM and surveying existing economic models and frameworks. T2DM is a chronic condition that can reduce life expectancy, adversely affect labour market performance, and profoundly impact quality of life. People can reduce their risk of T2DM and manage its progression in various ways but exert limited control over health outcomes. Within this context, this thesis studies optimal decision-making by fully-rational, forward-looking individuals by extending Peter Zweifel, Friedrich Breyer, and Mathias Kifmann’s model of health production and demand. The third chapter conceptualizes health-related decision-making as a dynamic optimization problem in which health and economic events constitute transitions between predefined states. T2DM and its complications detract from quality of life, increase mortality risk, and restrict opportunities to engage in consumption and leisure. People can reduce, but not eliminate, the chance of developing T2DM and the rate of diabetic progression through regular physical activity and adherence to healthy eating habits and pharmacotherapy, but only by sacrificing time and income that could be allocated to other things. The model cannot be solved analytically but is amenable to application of numerical techniques. The remainder of Chapter 3 selects values or ranges for model parameters to reflect the circumstances in which Manitobans make health-related decisions. The fourth chapter describes model implementation, interprets key results, and illustrates potential applications. Fully-rational, forward-looking individuals are generally motivated to invest in health, but this is mediated by their circumstances

Background: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. Methods: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. Findings: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. Interpretation: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Diffe

Background The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients’ primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Methods Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models.Results Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients’ age, morbidity, and lower income quintile across all primary care payment types. Conclusions The new primary care models were associated with lower total health car

The study analyzes the relationship between the risk of a hospitalization for an ambulatory care sensitive condition (ACSC), and the primary care payment and the organizational model used by the patient (fee-for-service, enhanced fee-for-service, blended capitation, blended capitation with interdisciplinary teams).The study used linked patient-level health administrative databases and census data housed at the Institute for Clinical Evaluative Sciences in Ontario. Since the province provides universal health care, the data capture all patients in Ontario, Canada's most populous province, with about 13 million inhabitants. All Ontario patients diagnosed with an ACSC prior to April 1, 2012, who had at least one visit with a physician between April 1, 2012, and March 31. 2013, were included in the study (n=1,710,310). Each patient was assigned to the primary care model of his/her physician. The different models were categorized as Fee-forService (FFS), enhanced-FFS, blended capitation, and interdisciplinary team. A logistic regression was used to model the risk of having an ACSC hospitalization during the one-year observation period. Adjustments were made for patient characteristics (age, sex, health status, and socio-economic status) and for the geographic location of the practice. Using patients belonging to FFS models as the reference group, the risk of an ACSC hospitalization was higher for patients belonging to the blended-capitation model using interdisciplinary teams (Adjusted Odds Ratio [AOR] = 1.06, 95% confidence interval [CI] = 1.00-1.12) and lower for enhancedFFS (AOR = 0.78, CI= 0.74-0.82) and blended capitation patients (AOR = 0.91, CI= 0.86-0.96). Using patients with hypertension as the reference group, the odds of an ACSC hospitalization were much higher for patients with any other ACSC and increased with patients' morbidity. The risk was lower for patients of higher socio-economic status (AOR=0.63, CI=0.60-0.67) in the highest neighborhood income quint

Objective The study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada. Methods Survey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits. Results Because of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models.

This Pan-Canadian report describes patient and physician perspectives regarding current performance of primary care in each province based on data collected as part of the Quality and Costs of Primary Care (QUALICOPC) study. The QUALICOPC study is an international study of quality and costs of primary care in 34 countries. This report describes results from the data collected in Canada. It includes only data collected from patients and physicians in primary care practices that provide comprehensive primary care. Two patient surveys were conducted as part of the study; one that asked patients about the importance of various aspects of primary care and the other about patients’ experiences with primary care. This report focuses on aspects of primary care that respondents to patient surveys (distributed during visits to primary care physicians) identified as very important aspects of their primary care experience. Primary care physicians from all Canadian provinces were asked to participate in the QUALICOPC study by a research team in each province. In general, one physician from each primary care practice was invited to participate (23 practices, primarily in Quebec, had more than one physician respondent). Physicians who agreed to participate were sent a package containing four different surveys regarding: the practice setting ; the services provided in the practice ; patient values and patient experience. In each practice, the physician was asked to complete the survey about the services provided and any staff member could complete the practice setting survey. One patient was expected to respond to the patient values survey and nine other patients were expected to respond to the patient experience survey. Physicians returned completed surveys to the research team in each province. A total of 8,332 patients of 810 primary care physicians in 785 practices across Canada responded to the surveys. A total of 1,160 completed the patient values survey and a different sampl

Objectives The pandemic and public health response to contain the virus had impacts on many aspects of young people’s lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates. Design Population-based repeated cross-sectional study. Setting Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada. Participants All children 6–12 years of age (n=2 043 977), adolescents 13–17 years (n=1 708 754) and young adults 18–24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021. Primary outcome measures Outpatient mental health visits to family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems. Inpatient mental health visits to emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex. Results During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries. Conclusions Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolesc

Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Study design: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collection/extraction methods: Data collected by ICCONIC partners. Principal findings: Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Conclusion: Although there are cross-country differences in the availability and structure of data sources

Objective To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). Study Design We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. Data Collection/Extraction Methods We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Principal Findings Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Conclusions Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.

Background: It is not known whether equity-oriented primary care investment that seeks to scale up the delivery of effective care in disadvantaged communities can reduce health inequality within high-income settings that have pre-existing universal primary care systems. We provide some non-randomised controlled evidence by comparing health inequality trends between two similar jurisdictions–one of which implemented equity-oriented primary care investment in the mid-to-late 2000s as part of a cross-government strategy for reducing health inequality (England), and one which invested in primary care without any explicit equity objective (Ontario, Canada). Methods: We analysed whole-population data on 32,482 neighbourhoods (with mean population size of approximately 1,500 people) in England, and 18,961 neighbourhoods (with mean population size of approximately 700 people) in Ontario. We examined trends in mortality amenable to healthcare by decile groups of neighbourhood deprivation within each jurisdiction. We used linear models to estimate absolute and relative gaps in amenable mortality between most and least deprived groups, considering the gradient between these extremes, and evaluated difference-in-difference comparisons between the two jurisdictions. Results: Inequality trends were comparable in both jurisdictions from 2004–6 but diverged from 2007–11. Compared with Ontario, the absolute gap in amenable mortality in England fell between 2004–6 and 2007–11 by 19.8 per 100,000 population (95% CI: 4.8 to 34.9); and the relative gap in amenable mortality fell by 10 percentage points (95% CI: 1 to 19). The biggest divergence occurred in the most deprived decile group of neighbourhoods. Discussion: In comparison to Ontario, England succeeded in reducing absolute socioeconomic gaps in mortality amenable to healthcare from 2007 to 2011, and preventing them from growing in relative terms. Equity-oriented primary care reform in England in the mid-to-late 2000s may have hel

Objective The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. Data Sources We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. Data Extraction Methods Data were extracted from existing administrative data systems in each participating country. Study Design This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. Principal Findings Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. Conclusion In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional c