Hospital funding reforms in Canada: a narrative review of Ontario and Quebec strategies.
Activity-based funding
Hospital funding
Implementation science
Narrative review
Patient-based funding
Journal
Health research policy and systems
ISSN: 1478-4505
Titre abrégé: Health Res Policy Syst
Pays: England
ID NLM: 101170481
Informations de publication
Date de publication:
27 Jun 2022
27 Jun 2022
Historique:
received:
18
04
2022
accepted:
10
06
2022
entrez:
27
6
2022
pubmed:
28
6
2022
medline:
30
6
2022
Statut:
epublish
Résumé
In the early 2000s, Ontario and Quebec, two provinces of Canada, began to introduce hospital payment reforms to improve quality and access to care. This paper (1) critically reviews patient-based funding (PBF) implementation approaches used by Quebec and Ontario over 15 years, and (2) identifies factors that support or limit PBF implementation to inform future decisions regarding the use of PBF models in both provinces. We adopted a narrative review approach to document and critically analyse Quebec and Ontario experiences with the implementation of patient-based funding. We searched for documents in the scientific and grey literature and contacted key stakeholders to identify relevant policy documents. Both provinces targeted similar hospital services-aligned with nationwide policy goals-fulfilling in part patient-based funding programmes' objectives. We identified four factors that played a role in ensuring the successful-or not-implementation of these strategies: (1) adoption supports, (2) alignment with programme objectives, (3) funding incentives and (4) stakeholder engagement. This review provides lessons in the complexity of implementing hospital payment reforms. Implementation is enabled by adoption supports and funding incentives that align with policy objectives and by engaging stakeholders in the design of incentives.
Sections du résumé
BACKGROUND
BACKGROUND
In the early 2000s, Ontario and Quebec, two provinces of Canada, began to introduce hospital payment reforms to improve quality and access to care. This paper (1) critically reviews patient-based funding (PBF) implementation approaches used by Quebec and Ontario over 15 years, and (2) identifies factors that support or limit PBF implementation to inform future decisions regarding the use of PBF models in both provinces.
METHODS
METHODS
We adopted a narrative review approach to document and critically analyse Quebec and Ontario experiences with the implementation of patient-based funding. We searched for documents in the scientific and grey literature and contacted key stakeholders to identify relevant policy documents.
RESULTS
RESULTS
Both provinces targeted similar hospital services-aligned with nationwide policy goals-fulfilling in part patient-based funding programmes' objectives. We identified four factors that played a role in ensuring the successful-or not-implementation of these strategies: (1) adoption supports, (2) alignment with programme objectives, (3) funding incentives and (4) stakeholder engagement.
CONCLUSIONS
CONCLUSIONS
This review provides lessons in the complexity of implementing hospital payment reforms. Implementation is enabled by adoption supports and funding incentives that align with policy objectives and by engaging stakeholders in the design of incentives.
Identifiants
pubmed: 35761397
doi: 10.1186/s12961-022-00879-2
pii: 10.1186/s12961-022-00879-2
pmc: PMC9235246
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
76Informations de copyright
© 2022. The Author(s).
Références
Health Policy. 2016 Oct;120(10):1125-1140
pubmed: 27745916
Health Res Policy Syst. 2018 Aug 3;16(1):74
pubmed: 30075735
Milbank Q. 2018 Dec;96(4):782-813
pubmed: 30417941
Healthc Policy. 2008 Aug;4(1):23-9
pubmed: 19377338
Health Policy. 2013 May;110(2-3):115-30
pubmed: 23380190
London J Prim Care (Abingdon). 2018 Mar 23;10(3):48-53
pubmed: 30042802
Health Policy. 2012 Oct;107(2-3):209-17
pubmed: 22386890
Health Policy. 2011 Apr;100(1):60-70
pubmed: 21186065
Eur J Clin Invest. 2018 Jun;48(6):e12931
pubmed: 29578574
J Nurs Manag. 2016 Jan;24(1):50-8
pubmed: 25424770
Health Econ Policy Law. 2012 Jan;7(1):73-101
pubmed: 22221929
Health Res Policy Syst. 2019 Nov 27;17(1):94
pubmed: 31775772
Clin Med (Lond). 2013 Oct;13(5):487-91
pubmed: 24115707
Healthc Pap. 2016;16(1):8-14
pubmed: 27734784
Health Policy. 2015 Aug;119(8):1096-110
pubmed: 26004845
Med Care Res Rev. 2016 Aug;73(4):437-57
pubmed: 26545852
Cochrane Database Syst Rev. 2019 Jul 05;7:CD011156
pubmed: 31276606
Milbank Q. 2014 Sep;92(3):568-623
pubmed: 25199900
Health Serv Manage Res. 2008 May;21(2):106-16
pubmed: 18482934
Res Integr Peer Rev. 2016 Sep 4;1:12
pubmed: 29451529
Ann Emerg Med. 2016 Apr;67(4):496-505.e7
pubmed: 26215670
Health Policy. 2013 Nov;113(1-2):127-33
pubmed: 23746931
Implement Sci. 2013 Jun 06;8:61
pubmed: 23742217
PLoS One. 2014 Oct 27;9(10):e109975
pubmed: 25347697
Eur J Health Econ. 2012 Dec;13(6):755-67
pubmed: 21660562
PLoS One. 2018 Jan 26;13(1):e0191996
pubmed: 29373587
Health Policy. 2021 Jun;125(6):768-776
pubmed: 33906795
BMC Health Serv Res. 2013 Sep 29;13:367
pubmed: 24073625
Open Med. 2013 Oct 08;7(4):e94-7
pubmed: 25237405
Healthc Q. 2006;9(2):44-51, 2
pubmed: 16640132
Health Aff (Millwood). 1991 Fall;10(3):7-21
pubmed: 1748392
Can Med Assoc J. 1984 Jan 1;130(1):1A-1B
pubmed: 6689985
Med Care. 1980 Feb;18(2 Suppl):iii, 1-53
pubmed: 7188781
J Gen Intern Med. 2016 Apr;31 Suppl 1:61-9
pubmed: 26951276
Health Policy. 2014 Aug;117(2):146-50
pubmed: 24962536
Ann Intern Med. 2017 Mar 07;166(5):341-353
pubmed: 28114600