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Alternative Level of Care: Canada's Hospital Beds, the Evidence and Options
Open accessAbstract
Patients designated as alternative level of care (ALC) are an ongoing concern for healthcare policy makers across Canada.These patients occupy valuable hospital beds and limit access to acute care services.The objective of this paper is to present policy alternatives to address underlying factors associated with ALC bed use.Three alternatives, and their respective limitations and structural challenges, are discussed.Potential solutions may require a mix of policy options proposed here.Inadequate policy jeopardizes new acute care activity-based funding schemes in British Columbia and Ontario.Failure to address this issue could exacerbate pressures on the existing bottlenecks in the community care system in these and other provinces. RésuméLes patients qui attendent un autre niveau de soins (ANS) constituent une préoccupation constante pour les responsables des politiques de santé partout au Canada.Ces patients occupent de précieux lits d'hôpital et limitent l' accès aux soins de courte durée.L' objectif de
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In Canada, provincial governments provide block funding to hospitals for acute care based on historical budgets, inflation, and political factors, rather than actual patient numbers or resource demands.
“In Canada, provincial governments provide block funding to hospitals for acute care based on historical budgets, inflation, and political factors, rather than actual patient numbers or resource demands (Sutherland and Crump 2013).”
From Estimating the Cost of Alternate Level of Care When It Is Inextricably Linked to the Cost of Acute Care: A Canadian Example (2026) · cites this paper as Sutherland and Crump 2013
The Financial Incentives Option section says Canadian hospitals have historically received global budgets: single payments independent of the volume or type of care provided. It does not say those budgets are determined by historical spending, inflation, or political factors. The paper also notes that British Columbia and Ontario had begun moving toward activity-based funding, so the claim does not describe every province without qualification. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe study findings reinforce that ALC patients have negative health outcomes, with an incremental effect with length of stay.
“Our findings reinforce the negative health outcomes detrimental to the individual ALC patient, with an incremental effect with length of stay [32].”
From Healthcare-Associated Adverse Events in Alternate Level of Care Patients Awaiting Long-Term Care in Hospital (2022) · cites this paper as [32]
The “Hospital Bed Use: The Case of Alternative Level of Care” section says that waiting in hospital prolongs exposure to adverse events and that delayed discharge can lead to health deterioration, particularly for frail geriatric patients. It does not establish an incremental increase in negative health outcomes with each increase in length of stay. (LLM, conf=0.86)
Experimental — accuracy not yet measuredALC status is an indication of system failure in care quality and equity, placing vulnerable older adults at further risk of functional decline, delirium, falls, and infections, while incurring disproportionate healthcare costs.
“We therefore argue that ALC status is an indication of system failure in care quality and equity, placing vulnerable older adults at further risk of functional decline delirium, falls, and infections, while incurring disproportionate healthcare costs [3,31,32].”
From Healthcare-Associated Adverse Events in Alternate Level of Care Patients Awaiting Long-Term Care in Hospital (2022) · cites this paper as [32]
In “Hospital Bed Use: The Case of Alternative Level of Care” (page not provided), the paper says discharge delays can cause rapid health deterioration in frail geriatric patients and prolong exposure to avoidable adverse events. The Abstract and Discussion (pages not provided) describe inefficient use of costly hospital resources. The paper does not identify delirium, falls, or infections as specific risks, or establish disproportionate healthcare costs; the citing authors present the care-quality-and-equity judgment as their own argument. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDelayed discharge is a prevalent issue across hospitals in many countries including Canada, the United States, and England.
“Delayed discharge is a prevalent issue across hospitals in many countries including Canada [3], the United States [2, 4], and England [5].”
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Research works printed but not linked: 11
- Baker, G.R., P.G. Norton, V. Flintoft, R. Blais, A. Brown, J. Cox et al. 2004. "The Canadian Adverse Events Study: The Incidence of Adverse Events among Hospital Patients in Canada." Canadian Medical Association Journal 170(11): 1678-86.
- Ham, C., J. Dixon and C. Chantler. 2011 (March). "Clinically Integrated Systems: The Future of NHS Reform in England?" British Medical Journal 342(March): d905.
- Hurley, J. 2004. "Regionalization and the Allocation of Healthcare Resources to Meet Population Health Needs." HealthcarePapers 5(1): 34-39.
- Leatt, P., G. Pink and M. Guerriere. 2000. "Towards a Canadian Model of Integrated Healthcare." HealthcarePapers 1(20): 13-35.
- McGrail, K., M. Law and P.C.C. Hébert. 2010. "No More Dithering on e-Health: Let' s Keep Patients Safe Instead." Canadian Medical Association Journal 182(6): 535.
- Meret-Hanke, L.A. 2011. "Effects of the Program of All-inclusive Care for the Elderly on Hospital Use." Gerontologist 51(6): 774-85.
- O'Reilly, J., R. Busse, U. Hakkinen, Z. Or, A. Street and M. Wiley. 2012. "Paying for Hospital Care: The Experience with Implementing Activity-Based Funding in Five European Countries." Health Economics, Policy and Law 7: 73-101.
- Robertson, M.J., R.W. Broyles and A. Khaliq. 2004. "The Influence of Financial Incentives and Racial Status on the Use of Post-Hospital Care." Journal of Aging and Social Policy 16(4): 17-38.
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- HEALTHCARE POLICY Vol.9 No.1, 2013
- Vedel, I., M. Monette, F.F. Béland, J. Monette and H. Bergman. 2011 (March). "Ten Years of Integrated Care: Backwards and Forwards. The Case of the Province of Québec, Canada." International Journal of Integrated Care 11(Spec. Ed.): e004.
Cited by
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Bai, A. D., Dai, C., Srivastava, S., Smith, C. A., & Gill, S. S. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4760-3 · Cited by 79
“Canada [ICD-10-CA].”
BackgroundInfluentialKuluski, K., Im, J., & McGeown, M. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2272-6 · Cited by 37
Lim Fat, G. J., Gopaul, A., Pananos, A. D., & Taabazuing, M.-M. (2022) · Geriatrics · doi:10.3390/geriatrics7040081 · Cited by 13
Basu, K. (2026) · Hospital Topics · doi:10.1080/00185868.2025.2474761 · Cited by 3
Metadata
- Authors
- Sutherland, J., & Crump, R.
- Affiliations
- University of British Columbia (CA)
- ORCID
- Sutherland, Jason
- Venue
- Healthcare Policy | Politiques de Santé
- Publisher
- Longwoods Publishing
- Published
- 2013-08-19
- Volume
- 9
- Issue
- 1
- Pages
- 26-34
- ISSN
- 1715-6572 (ISSN-L)
- 1715-6580
- PMC
- PMC3999549
- OpenAlex
- W2132098069
- Cited by
- 66
- References
- 0
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 4 · 2022: 11 · 2021: 6 · 2020: 10 · 2019: 10 · 2018: 6 · 2017: 5 · 2016: 5 · 2015: 1
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Healthcare policy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Michael Smith Health Research BC
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
- Keywords
- hospital bed utilization, activity-based funding, community care system, British Columbia, Ontario, long-term care
- MeSH terms
- Canada, Health Services Accessibility, Hospitals, Humans, Patient Discharge, Reimbursement, Incentive, Residential Facilities, Delivery of Health Care, Integrated, Capacity Building
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