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Objective: To measure total public and private expenditures on mental health in each province. Method: Data for expenditures on mental health services were collected in the following categories: physician expenditures (general and psychiatrist fees for service and alternative funding), inpatient hospital (psychiatric and general), outpatient hospital, community mental health, pharmaceuticals, and substance abuse. Data for 2 years, 2003 and 2004, were collected from the Canadian Institute for Health Information (hospital inpatient and fees for service physicians), the individual provinces (pharmaceuticals, alternative physician payments, hospital outpatient, and community), and the Canadian Centre on Substance Abuse. Totals were expressed in terms of per capita and as a percentage of total provincial health spending. Results: Total spending on mental health was $6.6 billion, of which $5.5 billion was from public sources. Nationally, the largest portion of expenditures was for hospitals, followed by community mental health expenses and pharmaceuticals. This varied by province. Public mental health spending was 6% of total public spending on health, while total mental health spending was 5% of total health spending. Conclusions: Canadian public mental health spending is lower than most developed countries, and a little below the minimum acceptable amount (5%) stated by the European Mental Health Economics Network.

N umerous different methods are used to estimate people with mental health needs within a given population. These methods include reviewing local, national, and international literature; using expert opinions; consulting with agencies, service providers, and consumers; epidemiologic studies, and service use data. The Canadian Community Health Survey is a populationbased epidemiologic survey. 1 In 2002, about 32 000 Canadians were surveyed about their mental health symptoms and treatment. A survey of this type provides the advantage of obtaining individual perspectives regarding the problems experienced, and does not rely on clinical records

Canadian public mental health spending is lower than most developed countries, and a little below the minimum acceptable amount (5%) stated by the European Mental Health Economics Network.

Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.

Objectives:In Canada, most mental health services are embedded in the public health care system. Little is known of the cost distribution within the mental health population. Our study aims to estimate the depression care costs of patients with a depression diagnosis, ranking them by the increasing total depression health care costs. Methods:For fiscal year 2007/08, we extracted administrative health care records from across the continuum, including physicians, outpatient services, and hospitals. Using a unique patient identifier, all service costs were merged for each person. Costs were summed by service categories and then divided by the served population into 10 equalsize groups. Further, we divided costs in the top decile into 10 percentile groups.Results: There were 208 167 people (5.9% of Albertans) who had at least 1 health care visit for depression. The total cost for depression treatment services was $114.5 million, an average $550 per treated person. In the first 9 deciles, most costs were for general practitioners. By the ninth decile, cost per person was about $400. Within the tenth decile, costs increased regularly, and in the top 1 percentile (1% of patients) there was an increase of cost per patient to $25 826 from $5792 in the previous percentile. Conclusion:Per person costs were highly skewed. Until the ninth decile, the cost increased slowly, consisting of mainly physician costs. In the last decile, costs increased substantially, mainly because of hospitalizations. Thus both primary care and specialist care play key roles. W W WObjectifs : Au Canada, la plupart des services de santé mentale sont intégrés dans le système de santé public. Mais la répartition des coûts dans la population de la santé mentale est beaucoup moins connue. Notre étude vise à estimer les coûts des soins de la dépression pour les patients ayant un diagnostic de dépression, en les classant selon les coûts croissants totaux des soins de santé pour la dépression.Méthodes : Pour l'exercice financier 2007-2008, nous avons extrait les dossiers administratifs des soins de santé sur tout le continuum, notamment les médecins, les services ambulatoires, et les hôpitaux. À l'aide d'un identificateur unique à chaque patient, tous les coûts des services ont été fusionnés pour chaque personne. Les coûts ont été additionnés par catégories de service puis divisés par la population desservie en 10 groupes de taille égale. En outre, nous avons divisé les coûts du décile supérieur en 10 groupes percentiles.Résultats : Il y avait 208 167 personnes (5,9 % des Albertains) qui avaient eu au moins 1 consultation de soins de santé pour la dépression. Le coût total des services de traitement de la dépression était de 114,5 millions de dollars, une moyenne de 550 $ par personne traitée. Dans les 9 premiers déciles, la plupart des coûts étaient pour les omnipraticiens. Au neuvième décile, le coût par personne était d'environ 400 $. Dans le dixième décile, les coûts augmentaient régulièrement, et dans le premier 1 percentile (1 % des patients), le co...

The purpose of the study was to estimate the direct 2002 fiscal year costs for mental health, services in Alberta. Data were collected on mental health publicly funded services and costs. Mental health services cost $573 million annually, amounting to about 8.4% of all provincial health services. The greatest share of costs was for regional inpatient services and physician services (both at 22%). The more direct method used in this study shows higher estimates of mental health costs than previous studies.

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