Some 2,300 healthcare jobs will be cut over the next two years in Alberta, Canada, where the Capital Health Authority, which controls regional healthcare spending, is converting three hospitals to community health centers and closing an additional 470 hospital beds.
Expressing "shock at the magnitude" of the job losses, Ron Hodgins, a spokesman for the Health Care Employees Union of Alberta, said the health authority last year led the union to believe only 950 workers would be laid off.
But health authority Chairman Campbell Miller equated the "unavoidable job loss" with the "unfortunate reality of consolidation." The measures are part of $51 million in budget cuts this year. (Editor's note: Dollar figures in this story are Canadian. One Canadian dollar is equivalent to approximately 69 U.S. cents.)
Such consolidation is taking place throughout the Canadian healthcare system. Changes need to be made because while government funding went up by as much as 10% a year during the 1980s, today it is virtually flat. Analysts agree that governments' capacities to beef up funding will get worse before they get better. Meanwhile, the patient population keeps expanding and aging.
"If we are to preserve quality and access, there will have to be a major shift in the way hospital services are delivered," said Edward Crawford, chairman of the Metropolitan Toronto District Health Council Hospital Committee. Earlier this year the committee released interim results of a two-year study of 44 publicly funded Toronto-area hospitals.
The report is one of three released recently that suggest streamlining Canadian facilities, cutting services and rerouting funding could ultimately save billions of dollars.
Changes in care settings.The hospitals in the Toronto study, which had combined annual budgets of $2.9 billion, are operating "in a rapidly changing environment with no road map to indicate where they should go individually or collectively," the committee reported.
Taking into account some restructuring that's already happening, the report made suggestions to better plan what healthcare services should be provided and where.
It advocated immediately reducing inpatient capacity by 22%, or 2,670 beds. Another 13%, or 1,600 beds, should go by 2001, the report said.
To compensate for those reductions, funding could be shifted to different types of inpatient care as well as outpatient, diagnostic and therapeutic services.
For example, some 38% of hospital bed capacity for the continuing care of uncomplicated medical problems should be diverted from acute-care to long-term-care facilities, the report said. Another 350 rehabilitation beds should be added, backed by a coordinated network of complementary services.
Emergency rooms should be merged and reorganized geographically, with alternate settings for follow-up visits and ongoing primary care for nonurgent cases.
In addition, 140 palliative-care beds and 390 transitional- or convalescent-care beds should be added, as well as another 45 beds for relatives caring for patients, the report said.
Searching for savings.On a nationwide scale, provinces could save about $7 billion, or 15% of the country's public healthcare costs, by making changes in the system, a separate report found.
The three-year study on the cost-effectiveness of Canada's healthcare system was completed by the University of Ottawa (Ontario) and Queen's University at Kingston (Ontario).
It found that if Ontario enacted a 20% cut in acute-care beds and length of stay, transferred 28,000 patients from acute to continuing care, substituted same-day surgery for inpatient surgery, and moved 58,000 patients to residential or community care, it would save $1.5 billion of the province's annual $17 billion healthcare bill (See chart).
The recommended changes encourage and expand the restructuring that is taking place in Ontario, where this year five hospitals will be reduced to two in Windsor and two Guelph hospitals will be merged into one. Also, a new system of community-based services is beginning to support patients who need long-term care (See chart).
Quebec could emulate Ontario, the report suggested, by reducing the intensity of services and using alternative facilities for long-term patients.
The provinces have much to share, the report said. It noted "wide variations in regulation and cost performance" in what should be a uniform healthcare system.
British Columbia, for instance, could examine wage rates in other provinces. Its own are above the national average.
And by working together, continuing care could be improved. The report suggested implementing a database to make a patient's medical record accessible nationwide and to integrate services for populations such as the elderly. It also recommended coordinated assessment and placement, standard classification for improved case management and planning, and a single administration to facilitate payment among various programs.
Changes already made.Citing several incidents of service consolidation and moves to restructure care, the Canadian Hospital Association late last year released an update on health reform.
The report noted:
In British Columbia, $41.7 million in new funding was given to services that had been taken away from hospitals. The money went for such things as home intravenous therapy, support for early maternity discharge, palliative home care and community rehabilitation services.
In Saskatchewan, registered nurses, registered psychiatric nurses and licensed practical nurses are being coordinated to deliver home-based care.
Manitoba's two tertiary-care facilities have, as a first phase, consolidated the administration of neurosciences and cardiac programs, without any loss of jobs, and improved management of surgical waiting lists.
In Quebec, McGill University Hospital Centre, five teaching hospi-tals and the university's medical faculty are considering a merger. Six French university hospitals also are considering a consolidation or merger.
In neighboring New Brunswick, 51 hospital boards have been reduced to eight health regional boards.
This story was written by Albert Warson, a Toronto-based freelance writer.