UBC Theses and Dissertations
A study of population needs-based funding applied to health care and physician services in British Columbia Kolbuch, Kathryn Patricia
The BC Ministry of Health has developed a Population Needs-Based Funding (PNBF) model, which allocates funding to Health Regions based on the characteristics and utilization patterns of the residents of their region. The model has several flaws that limit its ability for successful implementation. Technical flaws include extensive data quality issues, poor population segmentation techniques and the reliance on outdated data. The model is sensitive to small data variations, leading to variations in regional funding allocations. The model's intrinsic reliance on historical utilization rates and the absence of defined performance measures, core services, and an implementation plan affect its ability to effectively resolve the current inequities in fund distribution. A survey was deployed to solicit physician opinion on the PNBF model and the potential regionalization of the Medical Services Plan (MSP) budget. The respondents demonstrated little support for the prospect of regionalized funding, for both the delivery of health care services and physician remuneration. Yet, little satisfaction was expressed with the current funding system, with physicians voicing frustrations with the bureaucracy and politics affecting their ability to deliver quality patient care. The regionalization of the MSP budget would likely confine physician fee negotiations to the regional level. The legal agreements currently in place do not explicitly restrict the regionalization of the MSP budget, but restrict the administration of such change. Physicians would potentially be subjected to changes in their access to resources, their level of professional autonomy, pay equity, and the administration of remuneration. The BC PNBF model is unsatisfactory. Further development and analysis of alternate funding formulas is recommended, including exploration of the applicability of Adjusted Clinical Groups. As well, input from stakeholders including patients and physicians must be considered in future model development.
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