Dr Jean-Bernard Trudeau, the president of the Quebec Medical Association, that the province consider implementing service-based funding in its hospitals, echoing the calls for reform that Dr Brian Day has been shouting from the rooftops for over a year.
It is interesting to note that hospital funding in Quebec - the primary expenditure in our health-care system - is not very realistic. A hospital's budget is still very largely allocated on a historical basis, determined by the budget from the previous year.
Dr Day outlined the case for service-based funding .
This funding model creates some major adverse effects. Patients are seen as an expense. Rationing becomes a management method.
Why not introduce market forces that promote competition among public institutions? A recent OECD report (Toward High-Performing Health Systems, 2004) observed that these forces reduce the cost of hospital services even when they are administered primarily by the state.
The Quebec Medical Association advocates public patient-focused funding. In other words, clinicians and managers should see patients as a source of revenues, and not as a source of expenditure. Hospitals should be financed according to the services and care that are actually dispensed. The money should follow the patient, so to speak.
It is clear - and this is supported by experience in Europe - that such a funding mechanism would increase the system's production capacity.
Check out our website: