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International experiences with ABF policies have been mixed. In health care systems most like our own, such as Norway, Sweden and Denmark, ABF policies have shortened lengths of stay, shifted care from hospitals to continuing care, and increased the number of patients treated. If the objective of implementing ABF is to reduce wait times, shortening lengths of stays is a desirable outcome. Plus ABF creates incentives for hospitals to take the initiative to discharge bed blockers that cause emergency room waits and cancelled day surgeries. However, ABF creates its own set of problems: incentives for hospitals to provide the most profitable types of care by treating the least ill, and to centralize services which may improve efficiency but reduces access for small and remote communities. The biggest criticism of ABF is that while aiming for increased efficiency, hospitals may skimp on quality. Careful monitoring of hospital quality has helped to avoid this. Increasing the numbers of patients treated can also be expensive. ABF, by increasing the numbers of patients treated, has resulted in an increase in overall spending on hospital and physician care costs. ABF in Canada: Move forward with caution A significant change in hospital funding policy in Canadian provinces is not without risks, both political and financial. To date, ABF has been largely supported by Canadian physician groups, though they are not disinterested parties physician payments are tied to the amount of care they provide. Provincial governments are faced with balancing the health care needs of the people while keeping growth in costs in check. ABF is one potential solution to this balancing act, but we cant expect that this change in funding method will resolve financial pressures. Evidence to date suggests that ABF may actually worsen spending pressures. Since more care is not necessarily better for patients, creating incentives for additional hospital care using ABF should be approached with caution. Jason Sutherland is Assistant Professor and Trafford Crump, post doctoral fellow at the Centre for Health Services and Policy Research, University of British Columbia. Jason is also an expert advisor with EvidenceNetwork.ca.