Funding in-hospital same-day surgery in Canada.

The significant advantage of replacing global (i.e., cost-based) ambulatory funding with the same dollar value of case mix (i.e., input-based) ambulatory funding is that the fundamental basis for funding has been altered. First of all, it is widely believed that case mix-based funding establishes even more compelling incentives for hospitals to control resource utilization and costs without reducing service volumes than global systems. Case mix also represents a more precise policy instrument for ministries of health because incentives (e.g., different funding rates for various types of day surgery) can easily be incorporated to direct the composition of services rather than merely limit total hospital day surgery expenditures, as is currently done. Using the hybrid global/case mix day surgery funding system described above, funding policies can be designed to control both total cost and case mix composition while at the same time introducing incentives toward increasing ambulatory services. Although historical funding inequities remain unrectified, further inequities as ambulatory surgery volumes or case mixes change can be avoided.