Confronting the Alternate Level of Care (ALC) Crisis with a Multifaceted Policy Lens

Dual demands for increased provision of acute episodic care in hospital and chronic care in the community have contributed to an ALC crisis in Canadian hospitals, where large numbers of patients are boarded in acute-care beds rather than in environments more appropriate for their required level of care. Addressing this crisis will be one of the most profound challenges facing provincial health systems in Canada over the coming decades. This paper outlines the magnitude and complexity of confronting this growing crisis as well as defining a paradigm through which to explore and implement policy solutions along the entire continuum of challenges. ALC as an administrative designation aggregates diverse groups of patients covering a wide spectrum of demographic variables, medical diagnoses, social circumstances, discharge destinations and other characteristics, all of which can affect how and when ALC is coded. It is itself a significant challenge to collect consistent, accurate and adequately granular data to inform the design and implementation of policy reforms. With this in mind, a dominant association between advanced age and markedly higher ALC rates needs to be acknowledged and highlights that solutions to the ALC crisis will be significantly interwoven with addressing previously described challenges for the overall health system with an aging population. Clinically and operationally, ALC is a complex health-system issue that reflects and presents challenges from admission, throughout a patient’s hospital stay and after discharge. This paper outlines a holistic approach to categorizing policy interventions that address obstacles along this continuum, describing potential interventions in each phase. To achieve success, policy approaches must incorporate multi-faceted interventions into the overall context and systematize them to prevent, mitigate the burdens of, and improve the management of ALC

The Fiscal, Social and Economic Dividends of Feeling Better and Living Longer

While Canada has socialized most of the costs of treating illness, Canada has maintained a reliance on individuals interacting through private markets to invest in upstream health promotion and disease prevention. The failure of the market to provide the efficient level of upstream investment in health is leading to large and avoidable increases in the need for downstream medical treatment. The way to reduce the future deadweight loss of illness and disease is for provincial governments to address the upstream market failures through an expansion of the scope of public payment for health care to include upstream services for health promotion and disease prevention. Perhaps somewhat counterintuitively, spending public health-care dollars across a broader range of health and wellness services can result in spending less in total, because of the efficiency gains that will come from better health in the population. That is certainly what the evidence from a unique Albertan pilot project leads us to conclude. The Pure North S’Energy Foundation is a philanthropic initiative that pays for and provides preventative health-care services for Albertans drawn from groups that are vulnerable to poor health. This includes homeless people, people suffering from addiction, people with low incomes, people in isolated areas and susceptible seniors. The health improvements observed in those participating in the Pure North program have been significant. Effective health-promotion and disease-prevention services obviously benefit patients. But there are also substantial benefits to society as well. The annual health-care bill for a Canadian in poor health is estimated to be more than $10,000 higher than for someone in good health, meaning that keeping people in good health can be an important means for controlling public health-care budgets, and can free up scarce acutecare hospital resources. If the Pure North program were scaled-up province-wide to cover the nearly quartermillion Albertans in poor health, the resulting health improvement seen in Pure North participants could translate into a nearly 25-per-cent reduction in hospital days used by Alberta patients every year and a net savings of$500 million on hospital and physician costs. That does not even include the economic benefits of keeping workers in better health and productive, while spending fewer days ill or hospitalized. To date, Canada’s approach to health care has largely left it to patients to choose whether to seek healthpromotion and disease-prevention services on their own, suggesting an implicit deference to an individual’s rights and responsibilities. But for many low-income, isolated, addicted or aboriginal Canadians, there often is no choice: These services, when delivered privately, are often too expensive or may be otherwise inaccessible. The initial spirit behind Canadian medicare was to correct a health-market failure, so that no patient would face barriers to accessing necessary treatments. That same philosophy also recommends extending universal coverage for health-promotion and disease-prevention to vulnerable Canadians who today face similar barriers to access. If the Alberta government wants to show both foresight and fairness, the benefits from this kind of program, economically and societally, are simply too attractive to disregard

The association between amalgam dental surfaces and urinary mercury levels in a sample of Albertans, a prevalence study

Article deposited according to agreement with BMC, December 2, 2010 and according to publisher policies: http://www.biomedcentral.com/about/copyright [October 23, 2013].YesFunding provided by the Open Access Authors Fund

Conjoint Analysis Applications in Health - How are Studies being Designed and Reported?: An Update on Current Practice in the Published Literature between 2005 and 2008

Despite the increased popularity of conjoint analysis in health outcomes research, little is known about what specific methods are being used for the design and reporting of these studies. This variation in method type and reporting quality sometimes makes it difficult to assess substantive findings. This review identifies and describes recent applications of conjoint analysis based on a systematic review of conjoint analysis in the health literature. We focus on significant unanswered questions for which there is neither compelling empirical evidence nor agreement among researchers. We searched multiple electronic databases to identify English-language articles of conjoint analysis applications in human health studies published since 2005 through to July 2008. Two independent reviewers completed the detailed data extraction, including descriptive information, methodological details on survey type, experimental design, survey format, attributes and levels, sample size, number of conjoint scenarios per respondent, and analysis methods. Review articles and methods studies were excluded. The detailed extraction form was piloted to identify key elements to be included in the database using a standardized taxonomy. We identified 79 conjoint analysis articles that met the inclusion criteria. The number of applied studies increased substantially over time in a broad range of clinical applications, cancer being the most frequent. Most used a discrete-choice survey format (71%), with the number of attributes ranging from 3 to 16. Most surveys included 6 attributes, and 73% presented 7-15 scenarios to each respondent. Sample size varied substantially (minimum - 13, maximum - 1258), with most studies (38%) including between 100 and 300 respondents. Cost was included as an attribute to estimate willingness to pay in approximately 40% of the articles across all years. Conjoint analysis in health has expanded to include a broad range of applications and methodological approaches. Although we found substantial variation in methods, terminology, and presentation of findings, our observations on sample size, the number of attributes, and number of scenarios presented to respondents should be helpful in guiding researchers when planning a new conjoint analysis study in health.Conjoint-analysis