Sutherland Jason M, Liu Guiping, Crump R Trafford, Law Michael
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
Health Policy. 2016 Nov;120(11):1322-1328. doi: 10.1016/j.healthpol.2016.09.010. Epub 2016 Sep 24.
For decades, Canadian hospitals have been funded using global budgets, a lump sum for providing care irrespective of the volume or mix of patients. In 2010, British Columbia (BC) introduced a controversial, but limited, form of activity-based funding (ABF) for hospitals. This study uses a quasi-experimental design to evaluate the impact of the introduction of ABF funding in the province.
Our analysis used the population of patient-level acute hospitalization and day surgery discharge summaries from BC's acute hospitals from April 1, 2008 to March 31, 2013. Our outcome measures focused on both the intended and unintended impacts of ABF including the volume of cases, the efficiency of care, and the quality of care delivered. Our analysis used interrupted time series analysis.
There was an increase in the volume of inpatient surgical activity associated with the implementation of ABF. The volume of medical cases dropped, and medical patients' lengths of stays increased. There were no changes in measures of quality.
Hospitals' measurable responses to ABF policies on a number of key performance measures were mixed. Though BC's experiment with ABF was not associated with increases in hospital volumes for all types of care, the experience provides key lessons that small magnitude and short-term reforms are unlikely to change hospitals' behaviors quickly.
几十年来，加拿大医院一直通过整体预算获得资金，即提供护理的一笔总金额，而不考虑患者的数量或类型。2010年，不列颠哥伦比亚省（BC省）引入了一种有争议但有限的基于活动的资金分配（ABF）形式用于医院。本研究采用准实验设计来评估该省引入ABF资金的影响。
我们的分析使用了2008年4月1日至2013年3月31日BC省急症医院患者层面的急性住院和日间手术出院总结数据。我们的结果指标聚焦于ABF的预期和非预期影响，包括病例数量、护理效率以及所提供护理的质量。我们的分析采用了中断时间序列分析。
与ABF的实施相关，住院手术活动量有所增加。内科病例数量下降，内科患者住院时间延长。质量指标没有变化。
医院对ABF政策在一些关键绩效指标上的可衡量反应喜忧参半。尽管BC省的ABF试验并未使所有类型护理的医院量增加，但该经验提供了关键教训，即小规模和短期改革不太可能迅速改变医院的行为。
