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 |