Funding Health and Social Care in Montréal, Québec: A Review of the Methods and the Potential Role of Incentives

by Jason M. Sutherland, Nadya Repin, R. Trafford Crump | Feb 26, 2013
Full Report (PDF, 889 KB)

Jason M. Sutherland, PhD
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia

Nadya Repin, MA
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia

R. Trafford Crump, PhD
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia

Key Messages

  • Healthcare costs in Québec now constitute around 45 percent of the government’s program expenditures. In attempting to control these expenditures, the provincial government balances complex, and sometimes competing, priorities relating to timely access to healthcare,coordination between sectors and providing high quality, efficient care.
  • The healthcare system in Québec is regionalized and funded by the Ministère de la Santé et des Services Sociaux (MSSS). Health regions are funded by the MSSS through a global budget.The MSSS is phasing-in population-based funding to its regions to reduce regional variations in health and social care services funding.
  • The Agence de la Santé et des Services Sociaux de Montréal (ASSSM) is responsible for the organization, delivery and funding of (the majority of) health and social care providers in the Montréal region. The ASSSM currently funds its health and social care providers using global budgets.
  • The ASSSM is exploring changes to the manner in which it funds its health and social care providers. Each of the ASSSM’s program areas has expressed increasing access to healthcare as a pressing priority.
  • The ASSSM should align its funding reform efforts with those being pursued by the MSSS.
  • Experience from other countries indicates that activity-based funding (ABF) is an effective funding mechanism for increasing volume of services and, thus, improving access. ABF is one policy option; while it may increase access to some services, ABF does not create incentives to improve coordination of care between sectors.
  • ABF policies are likely to result in increases in activity, but the policy does not ensure that all activities are necessary. Thus, other policy options will have to be pursued if the ASSSM wishes to reduce over-utilization or inappropriate care.
  • If ABF is pursed, the ASSSM should strengthen data collection in key clinical areas. Timeliness,comprehensiveness and accuracy of data need to be improved and monitored over time. Clear guidelines for data quality should be developed and enforced.
  • Regardless of the funding mechanisms that are pursued, the ASSSM should develop additional sources of clinical data outside of hospitals in order to differentiate resident case mix. Data collection for non-acute patients should be pursued, such as for inpatient rehabilitation and mental healthcare.
  • The ASSSM should develop a comparative reporting system to evaluate whether healthcare is being delivered in the appropriate setting based on the needs of the patient.