CMAJ • September 9, 2008; 179 (6). First published August 20, 2008; doi:10.1503/cmaj.081314
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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NEWS

Patient-based funding model endorsed

Roger Collier

CMAJ

The Canadian Medical Association has thrown its weight behind patient-based funding of the health care system.

To that end, the association will develop a "blueprint and a timeline" for the transformation of the system to include patient-focused funding. Delegates to the CMA's 141st annual general council in Montreal, Quebec on Aug. 19, 2008, approved a resolution sponsored by incoming President Dr. Robert Ouellet calling on the CMA to develop such a plan by February, 2009.

Delegates also passed a general motion in support of a patient-based model of funding.

But Canadian Doctors for Medicare Chair Dr. Danielle Martin says the motions are far too broad. "Do we interpret that as opening up the health care system to private competition?"

Tying funding to patients may help in some areas, Martin says. But it comes with risks, including lower quality, reduced accessibility, reduced efficiency and higher costs. "To imply it will solve all the problems in Canada's health care system is stretching."

Former Quebec health minister Claude Castonguay, author of a February 2008 study commissioned by the Quebec government which concluded that money should "follow the patient," told delegates that Canada lags behind many nations in reforming its system.

The majority of member countries in the Organisation for Economic Co-operation and Development have already implemented some form of patient-based funding, Castonguay said, adding that activity-based funding would reward hospitals performing at a high level and give poor performing hospitals an incentive to improve.

Canadian hospitals currently receive money via a block-funding model, which grants annual lump sums. But many other countries — such as the United States and England — have implemented funding systems in which hospitals are rewarded on the basis of patient outcomes (called payment by results or pay for performance) or activity-based funding (CMAJ 2008;178[11]:1207-8).





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