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Québec’s leap into the unknown: Financement par activité


Québec’s most recent budget reflects the government’s priority to balance their books. A key component of this effort will be Québec’s continuing and deepening experiment with “Activity Based Funding” or “Financement Par Activité” (FPA). First introduced in 2012, FPA changes the way hospitals receive funding. Both Ministers Barrette and Leitão tout this funding system as a way to streamline health care spending. However, the question remains: streamline spending at what risks?

A recent
CIHR-funded study published in PLOS ONE by an international team of researchers found a 24-per-cent relative increase in discharge from hospitals to post-acute services after implementing ABF. Hospitals using FPA may discharged patients “sicker and quicker”. The researchers also found a possible increase in the rate of re-admission to hospital after discharge. On April 9th, Médecins Québécois pour le Régime Public (MQRP) will host an evening with researchers Dr. Thomas Agoritsas (McMaster University) and Dr. Danielle Martin (University of Toronto) to discuss the impacts of FPA on patients and the health care system..

“Countries worldwide have specific expectations when implementing FPA, but research shows they cannot count on meeting those expectations,” explains Dr. Agoritsas. “In Canada, some hope that FPA will reduce waiting times through faster patient turnover. Our systematic review found no consistent improvements in the volume of hospital care with FPA, particularly in the number of acute admissions.”

FPA is being proposed as an alternative to Quebec’s traditional hospital funding. Instead of annual global budgets to fund hospital care, under FPA, 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, such as appendicitis, pneumonia, traumatic injury or childbirth. However, FPA is not without its pitfalls.

“The message emerging from this comprehensive systematic review of the worldwide evidence is that governments may not necessarily get the benefits they are expecting with activity-based funding,” warns Karen Palmer, the study’s principal investigator and lead author from Simon Fraser University. “There may be adverse consequences for which governments are unprepared.”

Given that results varied across hospitals and jurisdictions, Martin says: “We don’t understand what precise combination of ingredients makes ABF work better or worse. That means that things could go badly wrong, including increases in death rates and increased administrative costs— wasteful spending our system cannot afford.”

“Governments ought to consider the evidence we found, and exercise due caution before making big changes affecting entire populations,” cautions Palmer. “If they move ahead with FPA, they should implement it in stages, and evaluate the impact as they proceed, especially on post-acute-care burden, readmissions, death rates and administrative costs.”

The MQRP-hosted event is being hosted at CHUM (Hôpital St-Luc), Pavillon Edouard Asselin, 264 René-Levesque Est, on April 9, 18:30 – 21:30.

Dr. Thomas Agoritsas (French) and Prof. Karen Palmer (English) are available for interviews prior to and following the event. To arrange an interview, please contact:

Katie Raso (English)
Communication & Outreach Officer
Canadian Doctors for Medicare
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Marie-Alberte Soudan (French)
Médecins québécois pour le régime public
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