Project Title: Do Regionalization Models Matter? Home Care Resource Allocation in the Maritime Provinces

Research team:
Deber, R.
Williams, A.P.
Conrad, P.
Nestman, L.
Khouri, D.

Partners:
Canadian Institute for Health Information

Home care, in contrast to acute hospital care, has not been "protected" under the Canada Health Act. One rationale for integrating health services under regional authorities has been the potential for reallocating resources from hospitals to community-based services to improve the efficiency and effectiveness of health care delivery. The extent to which this promise has been realized, however, is not clear. This study compared how different health regions in the provinces of Nova Scotia, New Brunswick, and Prince Edward Island allocate resources to such services as home care, hospitals, mental health, public health, etc. and whether this is affected by the varying configurations of services incorporated into regional budget envelopes.

These three provinces constitute a natural experiment. Over the period being studied, regional authorities included: in PEI, all health and community services; in New Brunswick, only hospitals and home care formerly funded by the Extramural Hospital; and in Nova Scotia, hospitals and some community programs but not home care. Integrated budgets are believed to break down the traditional budget silos. The results of such reforms are less clear. Three separate views would predict three separate results: Health reformers have assumed home care should benefit if budgets can be reallocated. Political science logic predicts the more powerful actors, such as hospitals, will protect their budgets, possibly at the expense of other programs. Bureaucratic logic might argue that inertia will triumph, and that there will be no changes in resource allocation.

This policy research is mapping out how regional budgets for home care are set and distributed by comparing budget data, and by conducting elite interviews to clarify the meaning of the numbers and the decision making processes used. Financial indicators include comparisons and trends in: distribution and rate of change of provincial and regional funding by sector of care (measured per capita, and as a percentage of health expenditures). The study should assist policy makers by clarifying the advantages and disadvantages of different configurations of funding envelopes.

This project received seed funding from M-THAC to transcribe interviews . It was funded by NHRDP/CIHR, and will form the basis of the Ph.D. thesis of Pat Conrad. Papers are in preparation.

Selected Presentations:

• Conrad P, Deber RB, Williams AP, Nestman L.Win, Lose, or Draw? The Financial Implications of Regional Models For Home Care. Presentation to the Canadian Home Care Conference, Vancouver, November 21, 2002.

• Conrad P, Deber RB, Williams AP, Nestman L. Do regionalization models matter? Home care resource allocation in the Maritime provinces. Paper presented to the Annual Meeting of the Canadian Health Economics Research Association, Halifax, Nova Scotia, May 2002.