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Opening independent non-profit hospitals would improve access to care and efficiency in Canada’s healthcare system

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From the Montreal Economic Institute

Autonomous non-profit hospitals tend to perform better than government-run hospitals, shows a study published this morning by the Montreal Economic Institute.

“Interminable waits in Canadian hospitals show that our healthcare systems are struggling to deliver basic services to the population,” says Emmanuelle B. Faubert, economist at MEI and author of the study. “By allowing independent non-profit hospitals to open, our governments would help increase treatment capacity, to the benefit of patients.”

In 2023, the median wait time in Quebec ERs was 5 hours and 13 minutes, up 42 minutes from five years earlier.

It is estimated that as a result of chronic overcrowding in Canadian ERs, there are between 8,000 and 15,000 avoidable deaths each year.

The Canadian health care system ranks 10th out of 11 comparable industrialized countries, just ahead of the United States, in the Commonwealth Fund’s ranking of healthcare systems. The French, German, and Dutch systems are 8th, 5th, and 2nd respectively in the same ranking.

While the Canadian system has no independent non-profit hospitals according to the OECD’s definition, such facilities account for 14 per cent of French hospital beds, 28 per cent of German hospital beds, and 100 per cent of Dutch hospital beds.

The researcher attributes a portion of the success of these facilities to their greater managerial autonomy and to a funding method that encourages the treatment of more patients.

“One of the strengths of these hospitals is how quickly they can adapt, contrary to facilities micromanaged by government ministries, as is the case in Canada,” explains Ms. Faubert. “Since their financing depends on the type and the quantity of ailments treated, administrators see the sustainability of their facilities as being directly linked to their capacity to treat patients.”

Although Canadian hospitals generally have their own boards of directors, the management of their daily activities and their funding are subject to strict government control.

Aside from certain limited experiments, notably in Quebec, Canadian hospitals still depend largely on a global budgeting model, in which funding depends entirely on the level of activity in the previous year.

Since the annual budgetary envelope is fixed, each additional patient is seen as a cost, says the researcher.

In Europe, in contrast, hospitals are largely financed according to an activity-based funding model, whereby a hospital receives a set amount of money for each treatment carried out within its walls. With this system, each additional patient treated represents an immediate source of revenue for the facility, says the researcher.

“It’s clear that our healthcare system can and must do better, and that means changing the incentives of those who manage it,” says Ms. Faubert. “By introducing non-profit hospitals, with a better funding model, and by granting health professionals more flexibility, we will be able to provide better care to more patients, as they do in Europe.”

The MEI study is available here.

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The MEI is an independent public policy think tank with offices in Montreal and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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Alberta

Fourteen regional advisory councils will shape health care planning and delivery in Alberta

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Regional health councils give Albertans a voice

Albertans want a health care system that reflects where they live and adapts to the unique needs of their communities. As part of the province’s health care refocus, Alberta’s government committed to strengthening community voices by providing more opportunities for Albertans to bring forward their local priorities and offer input on how to improve the system.

The regional advisory councils, made up of 150 members from 71 communities, will advise Alberta’s four health ministries and the newly refocused health agencies: Primary Care Alberta, Acute Care Alberta, Assisted Living Alberta and Recovery Alberta. Each council will explore solutions to local challenges and identify opportunities for the health system to better support community decision-making.

“By hearing first-hand community feedback directly, we can build a system that is more responsive, more inclusive and ultimately more effective for everyoneI am looking forward to hearing the councils’ insights, perspectives and solutions to improve health care in all corners of our province.”

Adriana LaGrange, Minister of Primary and Preventative Health Services

“Regional advisory councils will strengthen acute care by giving communities a direct voice. Their insights will help us address local needs, improve patient outcomes and ensure timely access to hospital services.”

Matt Jones, Minister of Hospital and Surgical Health Services

“A ‘one-size-fits-all’ approach does not address unique regional needs when it comes to mental health and addiction challenges. These councils will help us hear directly from communities, allowing us to tailor supports and services to meet the needs of Albertans where they are.”

Rick Wilson, Minister of Mental Health and Addiction

“Every community has unique needs, especially when it comes to seniors and vulnerable populations. These regional advisory councils will help us better understand those needs and ensure that assisted living services are shaped by the people who rely on them.”

Jason Nixon, Minister of Assisted Living and Social Services

Members include Albertans from all walks of life, health care workers, community leaders, Indigenous and municipal representatives, and others with a strong tie to their region. About one-third of members work in health care, and more than half of the council chairs are health professionals. Almost one-quarter are elected municipal officials, including 10 serving as chairs or vice-chairs. Ten councils also include a representative from a local health foundation.

Council members will share local and regional perspectives on health care services, planning and priorities to help ensure decisions reflect the realities of their communities. By engaging with residents, providers and organizations, they will gather feedback, identify challenges and bring forward ideas that may not otherwise reach government.

Through collaboration and community-informed solutions, members will help make the health system more responsive, accessible and better able to meet the needs of Albertans across the province.

“As Primary Care Alberta works to improve access to primary health care services and programs across Alberta, we are grateful to have the opportunity to tap into a dedicated group of community leaders and representatives. These people know their communities and local needs, and we look forward to learning from their experiences and knowledge as we shape the future of primary care in Alberta.”

Kim Simmonds, CEO, Primary Care Alberta

“The regional advisory councils will help to bring forward the voices of patients, families and front-line providers from every corner of Alberta. Their insights will help us plan smarter and deliver care that’s timely, effective and truly local. We look forward to working closely with them to strengthen hospital and surgical services across the province.”

Dr. Chris Eagle, interim CEO, Acute Care Alberta

“Nobody understands the health care challenges unique to a community better than the people who live there. The regional health advisory councils are made up of those living and working on the front lines across the province, ensuring we are getting the perspective of Albertans most affected by our health care system.”

Dr. Sayeh Zielke, CEO, Assisted Living Alberta

“Alongside Recovery Alberta’s staff and physician team, these regional advisory councils will build upon the high standard of mental health, addiction and correctional health services delivered in Alberta.”

Kerry Bales, CEO, Recovery Alberta

Indigenous Advisory Council

Alberta’s government continues to work directly with Indigenous leaders across the province to establish the Indigenous Advisory Council to strengthen health care services for First Nation, Métis and Inuit communities.

With up to 22 members, including Indigenous health care workers, community leaders and individuals receiving health care services, the council will represent diverse perspectives across Alberta. Members will provide community perspectives about clinical service planning, capital projects, workforce development and cultural integration in health care.

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Cannabis Legalization Is Starting to Look Like a Really Dumb Idea

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The Audit David Clinton's avatar David Clinton

Back in March 2024, I wrote about some early indications that Canada’s legalization of cannabis was, on balance, causing more harm than good. Well it looks like we’ve now moved past “early indications” and entered the “nervously searching for the exit” stage.

The new concerns follow the recent release of a couple of groundbreaking Canadian studiesCannabis Use Disorder Emergency Department Visits and Hospitalizations and 5-Year Mortality which found evidence relating cannabis use to early death, and Convergence of Cannabis and Psychosis on the Dopamine System which describes a possible biological mechanism linking cannabis use to psychosis.

Canadian governments had very little moral liability for the medical consequences of cannabis use before they legalized it in 2018. However, legalization predictably led to a near doubling of consumption. In 2012, according to Statistics Canada, just 12.2 percent of Canadians 15 and over had used cannabis in the previous 12 months. By 2022, that number had climbed to 22 percent – representing nearly seven million Canadians. Cases of cannabis use disorder (CUD) treated in Ontario hospitals increased from just 456 in 2006 to 3,263 in 2021.

The government’s decision to legalize the drug¹ has arguably placed millions of additional people at risk of serious health outcomes.

Let’s take a look at the new evidence. The mortality study used hospital care and mortality data for more than eleven million Ontario residents. The researchers were given meaningful access to raw data from multiple government sources and were apparently compliant with all appropriate privacy regulations. They tracked 107,103 individuals who, between 2006 and 2021, were treated in an Ontario hospital for cannabis use disorder.

The main control group used for statistical comparison was all Ontarians. And the secondary control group was made up of individuals with incident hospital-based care for other substance use disorders, like alcohol, opioids, stimulants.

The primary outcome tracked by the study was all-cause mortality. The secondary outcome was mortality subdivided into alcohol poisoning, opioid poisoning, poisoning by other drugs, trauma, intentional self-harm, cancer, infection, diseases of the circulatory system, respiratory system, and gastrointestinal system.

The researchers adjusted for age, sex, neighborhood income quintile, immigrant status, and rurality (urban vs rural residence). They also controlled for comorbid mental health and care for substance use during the previous 3 years.

In other words, this looks like a well-constructed retrospective study based on excellent data resources.

What did they discover? People who received hospital-based care for cannabis use disorder were six times more likely to die early than the general population. And those CUD-related deaths lead to an average 1.8 life-years lost. After adjusting for demographic factors and other conditions, the added risk of early death was still three times greater than the general population. (Although people with CUD incidents were less likely to die young than those with other substance abuse disorders.)

CUD incidents were associated with increased risks for suicide (9.7 times higher), trauma (4.6 times higher), opioid poisoning (5.3 times higher), and cardiovascular and respiratory diseases (2 times higher).

The Convergence of Cannabis and Psychosis study was performed in and around London, Ontario. This one is a bit beyond my technical range, but they claim that:

Elevated dopamine function in a critical SN/VTA subregion may be associated with psychosis risk in people with CUD. Cannabis was associated with the hypothesized final common pathway for the clinical expression of psychotic symptoms.

Which does indicate that there may be more connecting cannabis to overall harm than just social or economic influences.

I’m not suggesting that the government should restore the original ban on cannabis. Like alcohol prohibition, the moment when that might have been possible is now long past. But I am wondering why politicians find it so difficult to wait for even minimal scientific evidence before driving the country over the cliff?

 

1 This should not be confused with the separate question of decriminalization – which has probably provided significant net value to society.
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