Population Health and Health Reform: Needs-Based Funding in Five Provinces

A key component of provincial health reform plans in the 1990s (and directly linked to the process of health system regionalization) was the attempt to move funding for service delivery to new models based on some notion of ‘population needs’. The intent of these models was to fund newly created regional health authorities relative to the health service needs of the population as determined by demographic, socio-economic and other measures of the population. This was done in the belief that it would facilitate the reorganization of service delivery to focus on ‘upstream’ determinants of health rather than merely treating ‘downstream’ illness and injury. This paper, part of a larger multi-faceted examination of provincial health reform decision makers involving researchers from across the country, summarizes and compares the experiences of five provinces (AB, SK, ON, QC and NF). Drawing on lengthy interviews with policy makers, political actors and stakeholder organizations the paper to the strong institutional and interest-based barriers that have blunted efforts to reform system financing at the regional level. Overcoming these barriers continues to be a key challenge for advocates of reorienting the delivery of health services to upstream determinants of population health