Commissioned Research

Exploring Alternative Level of Care (ALC ) and the Role of Funding Policies: An Evolving Evidence Base for Canada

by Jason M. Sutherland, R. Trafford Crump | Sep 20, 2011

CHSRF Series of Reports on Cost Drivers and Health System Efficiency: Paper 8

Full Report (PDF, 544 KB)

Jason M. Sutherland, PhD
Centre for Health Services and Policy
Research School of Population and Public Health
University of British Columbia, Vancouver

R. Trafford Crump, PhD
Centre for Health Services and Policy
Research School of Population and Public Health
University of British Columbia, Vancouver

This report synthesizes the evidence regarding funding policies designed to improve patient care in the transition period between acute and post-acute settings. Those in this transition period are referred to as alternate level of care (ALC) patients. They are not able to be discharged to a post-acute provider or to the community even though they no longer require the intensity or specialized medical care provided by acute hospitals. Projected to be in excess of $55 billion in spending in 2011, acute care hospitals represent a significant component of provincial expenditures. Consequently, much emphasis is placed on the high number of acute care beds occupied by patients ready to be discharged to post-acute by health system managers.

In many respects, ALC use is an inefficient use of scarce hospital-based care. To combat ALC use, provinces and regions are using a variety of strategies; however, there are difficult measurement issues involved in assessing which strategies are effective at reducing ALC while providing high-quality care. Moreover, solving ALC will involve challenging a number of different provider types comfortable with operating within their silo of care.

Policy tools that create incentives for reducing ALC are not yet in use in Canada. Potential tools aiming at lowering ALC utilization must span silos of care, serving both as an incentive to coordinate safe care and promote the delivery of effective care in the appropriate setting. In order for these solutions to be effective, however, data systems that provide timely and relevant information to both caregivers and policy-makers are needed.