University of British Columbia, Faculty of Medicine, Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, B.C., V6T 1Z3, Canada.
BMC Health Serv Res. 2011 Jun 24;11:150. doi: 10.1186/1472-6963-11-150.
Accounting for 36% of public spending on health care in Canada, hospitals are a major target for cost reductions through various efficiency initiatives. Some provinces are considering payment reform as a vehicle to achieve this goal. With few exceptions, Canadian provinces have generally relied on global and line-item budgets to contain hospital costs. There is growing interest amongst policy-makers for using activity based funding (ABF) as means of creating financial incentives for hospitals to increase the 'volume' of care, reduce cost, discourage unnecessary activity, and encourage competition. British Columbia (B.C.) is the first province in Canada to implement ABF for partial reimbursement of acute hospitalization. To date, there have been no formal examinations of the effects of ABF policies in Canada. This study proposal addresses two research questions designed to determine whether ABF policies affect health system costs, access and hospital quality. The first question examines the impact of the hospital funding policy change on internal hospital activity based on expenditures and quality. The second question examines the impact of the change on non-hospital care, including readmission rates, amount of home care provided, and physician expenditures.
METHODS/DESIGN: A longitudinal study design will be used, incorporating comprehensive population-based datasets of all B.C. residents; hospital, continuing care and physician services datasets will also be used. Data will be linked across sources using anonymized linking variables. Analytic datasets will be created for the period between 2005/2006 and 2012/2013.
With Canadian hospitals unaccustomed to detailed scrutiny of what services are provided, to whom, and with what results, the move toward ABF is significant. This proposed study will provide evidence on the impacts of ABF, including changes in the type, volume, cost, and quality of services provided. Policy- and decision-makers in B.C. and elsewhere in Canada will be able to use this evidence as a basis for policy adaptations and modifications. The significance of this proposed study derives from the fact that the change in hospital funding policy has the potential to affect health system costs, residents' access to care and care quality.
在加拿大的医疗保健公共支出中，医院占 36%，因此成为通过各种效率举措降低成本的主要目标。一些省份正在考虑将支付改革作为实现这一目标的手段。除了少数例外，加拿大各省通常依靠全球和项目预算来控制医院成本。政策制定者越来越有兴趣使用基于活动的资金（ABF）作为激励医院增加“护理量”、降低成本、抑制不必要的活动和鼓励竞争的手段。不列颠哥伦比亚省（B.C.）是加拿大第一个实施 ABF 来部分报销急性住院费用的省份。迄今为止，加拿大还没有对 ABF 政策的效果进行正式审查。本研究提案旨在确定 ABF 政策是否会影响卫生系统成本、获得和医院质量，提出了两个研究问题。第一个问题考察了医院资金政策变化对基于支出和质量的内部医院活动的影响。第二个问题考察了这种变化对非医院护理的影响，包括再入院率、提供的家庭护理量和医生支出。
方法/设计：将采用纵向研究设计，纳入不列颠哥伦比亚省所有居民的综合基于人群的数据集；还将使用医院、长期护理和医生服务数据集。将使用匿名链接变量在各个来源之间链接数据。将为 2005/2006 年至 2012/2013 年期间创建分析数据集。
由于加拿大医院不习惯详细审查提供了哪些服务、提供给了谁以及结果如何，因此向 ABF 的转变意义重大。这项拟议的研究将提供关于 ABF 影响的证据，包括所提供服务的类型、数量、成本和质量的变化。不列颠哥伦比亚省和加拿大其他地区的政策制定者和决策者将能够利用这些证据作为政策调整和修改的基础。这项拟议研究的意义在于，医院资金政策的变化有可能影响卫生系统成本、居民获得护理的机会和护理质量。
