Commission on the Reform of Ontario's Public Services

There are inefficiencies in the health care system
Chapter 5: Health
The Canadian Institute for Health Information’s Health Care in Canada 2010 report discusses
a number of examples of inefficiency in the Canadian health care system. For example,
despite lack of evidence of benefit, 3,600 therapeutic knee arthroscopies and 1,050
vertebroplasties were performed in Canada in 2008–09. 28 At 19 per cent of all deliveries,
caesarean sections far exceed clinical guidelines, as does the continuing widespread practice
of hysterectomy. 29 Compared with other countries, Canada does poorly on avoidable hospital
admissions for diabetes. The OECD noted in its 2010 Canada Survey that hospitalizations in
Canada for diabetes per 100,000 people are above the OECD average. The CIHI draws the
link to the observation that only 32 per cent of diabetics reported receiving all four
recommended tests in 2007. 30 This illustrates the shift that is needed from hospital-based
treatment to clinic and home-based prevention.
Many hospital beds are occupied by patients who could get better quality care at a lower
overall cost elsewhere in the system. The CIHI tracks what is known as alternate level of
care (ALC), which refers to patients who occupy hospital beds but no longer need acute
care services — “bed-blockers,” in popular parlance. In 2008–09, five per cent of
hospitalizations and 13 per cent of all hospital days were ALC. 31 It is understandable to a
degree that patients would end up classified as ALC near the end of their hospital stay.
But nine per cent of ALC patients were admitted to acute care as ALC and they account for
11 per cent of ALC days. The most common reasons for patients being in ALC status is that
they seek palliative care (34 per cent), are waiting for admission to another adequate facility
(27 per cent) or seek physical therapy (11 per cent). These ALC patients tend to stay that way
for a long time — 62 per cent stay more than a week and 24 per cent more than a month. Five
per cent stay even longer than 100 days.
Case Study #2:
After the death of his wife, the family of a 76-year-old man decided to move their father closer to their home, which was 250 kilometres
away. After noticing some dementia, he was moved into the family home where the dementia worsened to the point where the family
brought him to the local hospital emergency department. Home care could not be given for more than two days per week. He was
admitted directly to a hospital unit where steps for placement into a long-term care facility were taken. He was in an ALC hospital bed for
115 days awaiting placement because the long-term care homes did not consider him suitable despite the fact that they had empty beds.
28 CIHI, “Health Care in Canada,” 2010, op. cit., pp. 22–24.
29 Ibid., pp. 25–35.
30 Ibid., pp. 43–45.
31 Ibid., pp. 49–54.
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