Changing and Improving our RHAs - moving from global budgets to budgets based on services delivered

For years, I have been calling for changes to Regional Health Authorities to improve accountability and to improve the quality of services.



Presently, Regional Health Authorities are funded with global budgets. In this approach, the money is provided as a global budget to the administration of the Regional Health Authority and the dollars trickle down to fund the services which are delivered. This trickle down approach is not working.



We need to move to budgets for Regional Health Authorities based on the front-line services provided. We use this approach to fund cataract surgery in Manitoba, and we need to extend it much more broadly until we have moved fully to funding based on services provided. This approach focuses the funding, the effort, the accountability and the quality control on the services being delivered.

The 2002 Kirby Report on the Health of Canadians looked at approaches to the funding of health services, in particular hospitals, in Canada and in other countries. The report said "The Committee believes that service-based funding has numerous advantages over the methods currently used to finance hospitals in Canada."

The Kirby Report concluded that "Hospitals should be funded on a service-based remuneration scheme." The report further recommended that "the shift to service-based funding should occur as quickly as possible. The Committee considers a five-year period to be a reasonable time-frame for the full implementation of the new hospital funding."

Here we are, today, in 2009, some seven years after the Kirby Report was released, and the NDP in Manitoba are still using an outdated and suboptimum approach to funding health care. It is time to change, as the Kirby report recommends, to a better way of funding health care, one with more accountability and more quality control.

It should be noted that "The majority of witnesses that appeared before the Committee supported the idea of moving to service-based funding for hospitals. As Michael Decter, former Deputy Minister of Health in Manitoba and Ontario said "the right way of funding hospitals, in my view, is to fund them for what they do, for what they actually accomplish in outcome terms."

The Kirby report noted that service-based funding is better on all of the following: a) Better information; b) Transparency and Accountability; c) Equity in the Distribution of Funding; d) Investment in Capital; e) Independence of health care delivery from government; f) reduction in the size of provincial health departments and RHAs; g) Patient oriented service delivery and h) Efficiency and performance.