Reallocating Cancer Surgery Payments for Alternate Level of Care in Ontario: What Are the Options?
Open accessAbstract
This article examines how alternate-level-of-care (ALC) days are funded through the cancer surgery funding model in Ontario and evaluates policy options to better address ALC days. The contribution of ALC days to hospital funding and the impact of removing or reallocating this funding from cancer surgery is measured. Though costs associated with ALC days in cancer surgery are low, this article highlights the need for policy options that would realign funding across the healthcare system in Ontario to better meet the needs of patients waiting for ALC, reduce pressure on inpatient bed capacity and improve value for money.
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Only one published study, Wong et al. (2020), had estimated the average cost of ALC bed-days in Canada.
“I identified only one published study, Wong et al. (2020), that estimated the average cost of ALC bed-days in Canada.”
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 Wong et al. (2020)
The Discussion reports $829 per ALC day for Ontario colorectal cancer surgery, but identifies this as a QBP funding amount, not the average cost of ALC bed-days across Canada. The Introduction cites Sutherland et al. (2019) for a separate estimated cost of C$1,090 per ALC bed-day. Whether Wong et al. was the only published study identified is the citing author's own assessment, not a finding this source establishes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDuring fiscal year 2015-16, colorectal cancer surgery funded by Quality-Based Procedures cost Cancer Care Ontario $829 per ALC day, or approximately $2 million annually.
“According to Wong et al. (2020), during the fiscal year 2015-16, colorectal cancer surgery funded by Quality-Based Procedures (QBPs) cost Cancer Care Ontario $829 per ALC day, or ∼$2 million annually.”
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 Wong et al. 2020
The Wong et al. funding allocation was based on 4.3% of QBP patient days being designated as ALC, which is significantly lower than the provincial average of 13.9% of all inpatient days.
“This funding allocation was based on 4.3% of QBP patient days being designated as ALC, which is significantly lower than the provincial average of 13.9% of all inpatient days.”
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 Wong et al. 2020
The Wong et al. (2020) study was based on a very small subset of Ontario's inpatient population.
“However, the study was based on a very small subset of Ontario's inpatient population.”
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 Wong et al. (2020)
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Cites
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Seniors and Alternative Level of Care: Building on Our Knowledge
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Cited by
Sorted by citations
Basu, K. (2026) · Hospital Topics · doi:10.1080/00185868.2025.2474761 · Cited by 3 · see citing works
“According to Wong et al. (2020), during the fiscal year 2015–16, colorectal cancer surgery funded by Quality-Based Procedures (QBPs) cost Cancer Care Ontario $829 per ALC day, or ∼ $2 million annually.”
- Authors
- Wong, J., Milroy, S., Sun, K., Iorio, P., Seto, M., Monakova, J., & Sutherland, J.
- Affiliations
- Cancer Care Ontario (CA)
- University of British Columbia (CA)
- ORCID
- Sutherland, Jason
- Venue
- Healthcare Policy | Politiques de Santé
- Publisher
- Longwoods Publishing
- Published
- 2020-11-10
- Volume
- 16
- Issue
- 2
- Pages
- 41-54
- ISSN
- 1715-6572 (ISSN-L)
- 1715-6580
- PMC
- PMC7710964
- OpenAlex
- W3107015929
- Cited by
- 3
- References
- 2
- Citations by year
- 2026: 1 · 2025: 1 · 2020: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Healthcare policy (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Cancer Care Ontario
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- alternate level of care, cancer surgery, hospital finance, health care financing, waiting time, hospital bed capacity, value for money, Ontario health policy
- MeSH terms
- Delivery of Health Care, Female, Financing, Government, Patient Care, Health Policy, Hospitals, Humans, Length of Stay, Male, Neoplasms, Ontario, Patient Discharge, Health Care Costs, Subacute Care, Healthcare Financing
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