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Government & policy

Changes looming for healthcare system in Alberta

EDMONTON – Alberta has released Vision 2020, a document that identifies major problems in the provincial healthcare system and offers some solutions. The report notes that major, urban hospitals are operating at close to capacity. But smaller, rural hospitals are often half-empty and running at low levels of efficiency.

Local observers are already reading between the lines of the report and are forecasting the conversion of these facilities. Don Braid, a columnist with the Calgary Herald, recently noted:

“There can be no doubt the role of rural hospitals is about to change radically. The future state of those hospitals, the report says, will be marked by investments in ambulatory care centres, tele-health, selected rural hospitals and EMS.

“Crack the code and the message is: Alberta will have fewer rural acute-care hospitals. Some will be converted into what those of us who don’t write bureaucratic reports would call clinics. The system will rely on ambulances to get sick rural people to city hospitals.”

Alberta’s government employed the consulting firm McKinsey and Co. to analyze the state of healthcare in the province. Its conclusions have been incorporated into the Vision 2020 document.

Some of the key challenges for the province are noted in the Vision 2020 report:

• Today in Alberta, the 10 largest hospitals in the province have an average occupancy of more than 90 per cent. The vast majority of long-term care facilities have greater than 96 per cent occupancy. However, more than half of the hospitals in Alberta with fewer than 20 beds have occupancy rates below 75 per cent, and almost 20 per cent of these have occupancy rates below 50 per cent. And, almost 50 per cent of Alberta’s hospitals with fewer than 20 beds are within 50 kilometres of another hospital.
• Access to some services takes too long. Sometimes patients are not being cared for in the right setting, resulting in increased waits for needed services. Too many emergent patients are using emergency departments for health concerns that could be handled by a primary care practitioner, and too many continuing care patients are being cared for in hospitals. This backs up admissions throughout the hospital and delays emergency room admissions and hospital services for people needing scheduled surgical procedures.
• There are critical shortages of health service providers. As just one example, Alberta currently has a shortage of more than 1,500 nurses. By 2020, if care patterns do not change and training is not expanded, the province may be short by more than 6,000 nurses. Adding to the shortage is the fact that only 40 per cent of Alberta’s registered nurses work full-time, the lowest rate in the country and well below the Canadian average of 56 per cent. Alberta also has a growing shortage of allied health care providers, including pharmacists, physical therapists, medical technologists, and especially health-care aides.
• Our population is growing, rapidly aging and facing a significant burden of chronic disease. Alberta’s population is predicted to grow by another half million people by the year 2020. Between 2007 and 2020, forecasts show the demand for hospital beds in Alberta will grow by 32 per cent, the demand for long-term care beds will climb by 52 per cent, and the demand for primary care physicians and nurses will rise 40 per cent. The high prevalence of chronic disease and cancer will drive a disproportionate share of health-care costs.
• The cost of delivering health care continues to rise. Today, Alberta Health and Wellness spends $13.4 billion on health services, or 35 per cent of all provincial spending. If the rise in demands on the health system remain unchanged and more efficient ways of delivering health services are not implemented, the money spent by former regional health authorities could potentially triple. For example in 2007-08, regional health authority spending was $8 billion. This could grow to $24 billion by 2020.

To prepare for the future, Vision 2020 says that Alberta will have to branch into new directions and greatly expand some innovative initiatives that have already started. They include:

• In rural settings, review the range of services at hospitals that are existing, approved and underway, and those in the capital planning process to ensure they reflect local requirements and evaluate what services can be delivered more effectively in either short-stay care, outpatient care or other clinic-type arrangements;
• Centralize key functions such as patient intake assessment and triage for select services to improve co-ordination on a provincial level;
• Enable emergency medical technicians to practise to the full extent of their knowledge and skills, supported by necessary medical supervision and training requirements;
• Develop incentive programs modeled after initiatives such as the Rural Physician Action Plan to encourage other professions to work in rural settings; and
• Promote use of telehealth (e.g. remote monitoring, specialist consultation, etc.) for preventative care, treatment purposes, and increased access in local communities.

When it comes to the coordination and delivery of care, the report says the following steps must be taken:

• Prioritize improvements in service co-ordination starting with cardiac care, cancer services, respiratory disorders, diabetes, joint problems, mental health and addictions, including the use of technology to monitor wait times;
• Address unique service gaps for mental health, addictions and seniors’ care;
• Undertake targeted operational service efficiency reviews to identify and implement process improvements;
• Improve Albertans’ awareness of recommended healthy living practices, knowledge of the health system, personal health history and ability to book health services directly by implementing an on-line, personal and confidential health portal which will be made available to all Albertans;
• Pursue a long-term information and communication technology implementation and consolidation strategy for improved evidence-based decisions and timely information sharing; and
• Develop and implement a patient navigator model to support Albertans in accessing and navigating a co-ordinated and seamless health system.

The Vision 2020 document can be found at: http://www.health.alberta.ca/.

“A major theme of our Health Action Plan released in April was to ensure the future sustainability of Alberta’s health system,” said Ron Liepert (pictured above), Minister of Health and Wellness. “A commitment in that action plan was to table a long-term health system sustainability plan, and phase one of the roadmap for achieving that goal is this Vision 2020 report. By linking the right services, in the right location, and at the right time, patients will get faster treatment. These types of efficiencies will, in turn, ensure our health system is sustainable for years to come.”

Actions to be implemented from Vision 2020 include: providing more health care in community settings - including more care options for seniors; integrating the skills of emergency medical technicians more fully into the health-care system; changing reimbursement incentives for health professionals to align with new ways of delivering care; and reviewing the role of small hospitals to ensure they meet local needs.

“Vision 2020 is about a stronger, more efficient and sustainable publicly-funded health system focused on patient needs,” said Liepert. “The next step will be to develop a joint implementation plan in the new year, complete with timelines and targets, between Alberta Health and Wellness and Alberta Health Services in order to put the report into action.”

 

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