FOR IMMEDIATE RELEASE
October 28, 2014
New Hospital Funding Model Heightens Pressure on Community Care
A new study of worldwide evidence shows changes in funding provide incentive to discharge patients “sicker and quicker,” placing massive pressure on community care. The study cautions governments on the potential effects that activity-based funding (ABF) of hospitals could have on health systems.
The new study, funded by the Canadian Institute for Health Research (CIHR), is the first systematic review of worldwide evidence on how ABF performs.
The results show cause for significant concern, with a 24% relative increase in discharge from hospital to post-acute care after ABF was implemented. Consistent with the shortened length of hospital stays associated with ABF, patients discharged from hospital sooner put far more pressure on community services and families. The study’s results also showed possible increases in readmissions to hospitals.
“If Canada were to experience a relative increase of 24% in discharge of patients from hospital to post-acute care, governments would need to urgently ramp up community capacity and funding, or families would bear the burden of caring for patients at home", said Dr. Monika Dutt, Chair of Canadian Doctors for Medicare. “We lack post-acute care services, and funding is a mixed bag of public and private, which has serious implications for equitable access to this level of care.”
ABF is being actively pursued in Canada, particularly in British Columbia, Ontario, and Quebec. Global budgets normally fund Canadian hospitals. Under ABF, hospitals receive a pre-determined fee for each episode of care. The fee is intended to cover the bundle of services and products ordinarily provided to patients with particular diagnoses
“The concerns raised by this new study should alert governments to the potential benefits and harms of ABF, especially threats to equitable access to care, and give decision-makers pause about implementing it,” added Dr. Dutt.
The study was carried out by an international team of 19 researchers from Canada, the EU, and Australia. The research team systematically screened more than 16,000 articles from around the world on the impact of ABF over the past 30 years.
Canadian Doctors for Medicare welcomes the insights from the new study “Activity-Based Funding of Hospitals and its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis,” published October 27, 2014 in PLOS ONE, and summarized in this Fact Sheet. Such evidence-based studies assist decision-makers in designing sound policy, and in laying the building blocks for an equitable and effective health care system.
Canadian Doctors for Medicare supports better medicare for all Canadians. This requires a high-quality, equitable, sustainable health system built on the best available evidence, ensuring Canadians get the right care, at the right time, and in the right location, whether that be the hospital or the community.
“Activity-Based Funding of Hospitals and its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis,” Karen S Palmer, Thomas Agoritsas, Danielle Martin, Taryn Scott, Sohail M Mulla, Ashley P Miller, Arnav Agarwal, Andrew Bresnahan, Afeez Abiola Hazzan, Rebecca A Jeffery, Arnaud Merglen, Ahmed Negm, Reed A Siemieniuk, Neera Bhatnagar, Irfan A Dhalla, John N Lavis, John J You, Stephen J Duckett, Gordon H Guyatt. PLOS ONE, October 27, 2014 http://dx.plos.org/10.1371/journal.pone.0109975
For media inquiries and additional information on the study, please contact:
Sean Meagher, Executive Director
Canadian Doctors for Medicare