Healthcare Reform Is Not Yet on the Horizon.

Healthcare reform is on everyone's lips these days. persistent calls for a "difference" and "change" are becoming louder. But will these calls reach a tipping point and precipitate fundamental changes in how provinces design healthcare delivery and how they pay for it?

Impact of the COVID-19 pandemic on alcohol or drug use symptoms and service need among youth: a cross-sectional sample from British Columbia, Canada.

BACKGROUND: Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic's impact on known risk and protective factors for substance use. However, the pandemic's immediate and long-term impact on youths' substance use patterns has been less clear. Thus, this study sought to determine how the COVID-19 pandemic impacted alcohol or drug use and its risk and protective factors among youth accessing integrated youth services. METHODS: We conducted a repeated cross-sectional study of patient-reported outcomes data collected between May 2018 and February 2022 among youth (n = 6022) ages 10-24 accessing a provincial network of integrated youth services in Canada. The main exposure of interest was the COVID-19 pandemic (March 2020 - February 2022) compared with a pre-pandemic period (May 2018 - February 2020). As measured by the Global Appraisal of Individual Needs - Short Screener, outcomes included the average number of past month alcohol or drug use symptoms and past month likelihood of service need for alcohol/drug use (moderate/high vs. low need). Interrupted time series (ITS) examined change in average monthly alcohol/drug use symptoms between the pre- and pandemic periods. Stratified multivariable logistic regression investigated how the pandemic modified the effects of established risk/protective factors on likelihood of alcohol/drug use service need. RESULTS: Fifty-percent of youth met the criteria for moderate/high likelihood of alcohol/drug use service need, with the odds being 2.39 times (95% confidence interval = 2.04, 2.80) greater during the pandemic compared to the pre-pandemic period. Results from the ITS indicated significant immediate effects of the pandemic on monthly substance use symptoms (p = 0.01). Significant risk/protective factors for service need included exposure to violence, engagement in meaningful activities, and self-rated physical and mental health; and the direction of their effects remained consistent across pandemic and pre-pandemic periods. CONCLUSIONS: This study demonstrated that the COVID-19 pandemic corresponded with increased alcohol or drug use among youth accessing integrated services. This signals an urgent need for increased clinical capacity in existing youth services and policies that can respond to risk/protective factors for substance use earlier.

Long-Term Care during COVID-19: A Special Look under the Hood.

Long-term care (LTC) is an OFT-overlooked critical component of provinces' health and social care systems. Its residents have borne a disproportionate share of the negative impact of the COVID-19 pandemic. Healthcare Policy believes that rules, regulations, policies and health system delivery factors that were associated with excess mortality and poor health and social outcomes in LTC should be closely examined so that the recent mistakes made in that sector can be avoided in the future.

New Spending Programs and Old Frustrations: Where Is the Vision?

The spring has ushered in an unexpected number of major health policy announcements compared with the last 10 years. They are led by the federal government's outlines of a national pharmacare program, an unexpected dental care program (Prime Minister of Canada Justin Trudeau 2022), plus "top-up" funding for clearing provincial surgical and imaging backlogs. These announcements are on top of the voices expressing concerns about COVID-19-related healthcare expenditure trends (Bailey 2022). Without a doubt, taxpayer money is flowing freely into healthcare (Labby 2020).

Engaging with Policy Makers: The Need for Accessible and Timely Health Services and Systems Research in 2020.

In its conception, Healthcare Policy was a partnership between the canadian Institutes of Health Research's Institute of Health Services and Policy Research (IHSPR), the Canadian Association of Health Services and Policy Research and Longwoods Publishing. With the support of IHSPR's scientific director at the time, Dr. Morris Barer, the objective of the journal was to "stimulate communication and cross-fertilization between researchers and healthcare decision makers" (Government of Canada 2006). With a strong focus on knowledge translation and interdisciplinary research, the journal links policy makers with researchers, thus carrying its founding objective forward as a guiding principle for Healthcare Policy.

COVID-19 and a Window into Healthcare Providers' Resiliency.

As contemporaneous data emerge from publicly funded healthcare providers, the COVID-19 pandemic provides a unique opportunity to measure their resiliency. Resiliency matters because it connotes a higher level of confidence in being able to provide needed healthcare during times of health, social or environmental stress or calamity. At the beginning of the first wave of the COVID-19 pandemic in early 2020, there were warnings regarding hospitals' ability to successfully manage large surges of critically ill COVID-19 patients who were expected to soon be presenting at hospitals in every province and territory. Shortly thereafter, hospitals implemented policies to clear hospital beds - there were public reports that hospitals rapidly went from nearly full occupancy to below 50% (CIHI 2020a; Howlett 2020; Zeidler 2020).

The Mounting Opportunity Cost of Pivoting to COVID-19-Related Health Systems and Services Research.

In 2020, the COVID-19 pandemic unexpectedly upended everyone's life, from sudden mass unemployment to family separations. In spite of this upheaval, health systems and services research carried on. Often, these efforts supported public health efforts to slow the spread of the virus.

Measuring the impact of delayed access to elective cholecystectomy through patient's cost-utility: an observational cohort study.

BACKGROUND: Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient's health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient's cost utility due to delayed elective cholecystectomy. METHODS: This study is based on retrospective analysis of a longitudinal sample of participants who have had elective cholecystectomy and completed the EQ-5D(3L) measuring health status preoperatively and postoperatively. Emergent cases were excluded. Patients younger than 19 years of age, unable to communicate in English or residing in a long-term care facility were ineligible. Quality-adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and postoperative time points. The loss in quality-adjusted life years due to delayed access was calculated under four assumed scenarios regarding the length of the delay. The mean cost per quality-adjusted life years are shown for the overall sample and by sex and age categories. RESULTS: Among the 646 eligible patients, 30.1% of participants (N = 195) completed their preoperative and postoperative EQ-5D(3L). A delay of 12 months resulted in a mean loss of 6.4%, or 0.117, of the quality-adjusted life years expected without the delay. Among patients older than 70 years of age, a 12-month delay in their surgery corresponded with a 25.1% increase in the cost per quality-adjusted life years, from $10 758 to $13 463. CONCLUSIONS: There is a need to focus on minimizing loss of quality of life for patients affected by delayed surgeries. Faced with equal delayed access to elective surgery, triage may need to prioritize older patients to maximize their health over their remaining life years.

Surgical wait list management in Canada during a pandemic: many challenges ahead.

Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog of cases. There is a dearth of research on whether the provinces' approaches to managing wait lists are equitable from a patients' needs perspective or if they are associated with patients' perception of outcomes. The surgical cost models used in the past won't be useful to governments and hospital managers. New models based on hospitals' marginal costs, associated with running on weekends or off-hours and social distancing parameters, will be needed. Surgeon input, collaboration and leadership during the strategy development, implementation and management of surgical wait lists postpandemic will be imperative, as these decisions will significantly affect the health and lives of many Canadians.