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Table 2 Factors supporting or limiting PBF programme implementation in Quebec and Ontario

From: Hospital funding reforms in Canada: a narrative review of Ontario and Quebec strategies

 

Adoption supports

Alignment with policy and programme objectives

Funding and pricing strategy barriers

Key stakeholder engagement

Key features

Clinical guidelines

Additional budget to support innovation and training

Government direct purchase of equipment

Quality goals

Volume goals

Priority health areas

Unclear pricing systems

Misalignment between surgery categories and prices

Average costs defining pricing

Lack of key stakeholder, such as patients, physicians, and policy-makers, engagement

Programmes

CRC screening programme (QC)

Quality-based procedures (ON)

Wait time strategy (ON)

CRC screening programme (QC)

Access to Surgery programme (QC)

Wait time strategy (ON)

Access to Surgery programme (QC)

Wait Time Strategy (ON)

Quality-based procedures (ON)

Access to Surgery programme (QC)

Quality-based procedures programme (ON)

Wait Time Strategy (ON)

Quebec

CRC screening programme:

 Funding conditional on following best practice guidelines

 Additional budget for software innovation

CRC screening programme:

 Improvement of quality of care objectives ensured by funding conditional on quality measures (in this case, as defined by the clinical guidelines)

Access to Surgery programme:

 Alignment with the 2003 Health Accords’ key health priority areas (namely cancer treatment, cardiac surgeries, joint replacement, cataract surgeries and diagnostic imaging)

Access to Surgery programme:

 Prices did not always reflect the actual cost of the surgeries

 Programme funding given to the regional authorities rather than to health organizations implementing the programme

Access to Surgery programme:

 Information system did not allow reconciliation and verification of data regarding the surgeries and the corresponding funding

 Physicians were disconnected from the cost and quality management

Ontario

Quality-based procedures programme and Bundled care programmes:

Availability of clinical guidelines; however, funding not linked to them

Wait Time Strategy programme:

 Additional budget to support innovation and staff training

Government direct purchase: of CT and MRI equipment in bulk

Wait Time Strategy programme:

 Incentives for increasing volume of care

 Alignment with the 2003 Health Accords’ key health priority areas

Wait Time Strategy:

 The tariff set for each category of care based on prices volunteered by hospitals

 Quality-based procedures programme: pricing was the 40th percentile of the average costs incurred over a 3-year period, meaning that only the 60% less-performing institutions had the financial incentive to reduce their costs and increase their efficiency

Wait Time Strategy:

 Focus on empowering patients and accountability of healthcare providers

 Quality-based procedures programme:

educational strategies to optimize the care and the cooperation between patients and caregivers

In both programmes:

 Ministry of Health and Long-Term Care and different healthcare organizations as well as patients were consulted to fix the prices, to determine the care pathways or to plan the framework

Weaknesses

Limited integration of quality metrics into PBF models

Wait Time Strategy programme

(ON): Lack of incentives for ensuring appropriateness of care

In Quebec, the method used to calculate volume increase did not incentivize efficiency and sustainability across all programmes

Unclear funding and pricing strategies generated a perceived disconnect between the service provided and the financial reward

Not all programmes consistently engaged with relevant stakeholders

Difficulties facilitating physician engagement [17] and encouraging communication between all actors