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Understanding the Importance of Health System Funding in B.C. by Nora Whyte RN

Paddy Rodney’s blog on the Transformation of Health Care in Canada (Jan. 16, 2012) and news from the Council of the Federation meetings in Victoria have generated considerable interest during the past few weeks.

For anyone wishing to do more background reading on health system funding as it pertains to British Columbia, I suggest two documents that have captured my interest, and that of the ARNBC Board —both highly relevant at this time of renewed attention to health system transformation in Canada.  I encourage all registered nurses to stay informed about this type of issue which will impact all of us as we strive to provide safe, competent patient care.

Beyond the Hospital Walls: Activity Based Funding Versus Integrated Health Care Reform was released this month by the BC Office of the Canadian Centre for Policy Alternatives. It offers a thoughtful examination of options for cost-effective health funding. The authors point out the challenges associated with inappropriate use of hospitals and the need for improvement in integrating care across the continuum. They draw upon examples of health system reform in other countries and within B.C., cautioning against the trend towards engaging in activity-based funding with a narrow focus on wait times, to a broader look at large-scale system improvements. I encourage nurses to read and reflect on the ideas in this report since it offers a progressive economic analysis on health care spending in the context of its impact.

Summary Report

Full Report

A second document worth reviewing on the same theme is BCNU’s July 2011 Position Statement on “Patient Focused Funding” (this is the umbrella term used by the BC Government to encompass activity-based funding and other performance incentives). The BCNU position statement provides background on the introduction of Patient-Focused Funding currently being piloted in selected B.C. hospitals and presents the view that this funding model “has no place in B.C.’s healthcare system” (BCNU 2011, p. 1).  It complements the first report, providing a nursing perspective along with recent references on these proposed funding models.

The BCNU statement highlights concerns about the potential impact of financial incentives on the quality of patient care.It serves as an example of the profession’s role in informing the public about new policies by offering a nursing analysisas we monitor impact in all the settings where nurses practice. Nurses have a unique capacity to envision the longer-term repercussions of changes across the care continuum—we should use this knowledge to speak out about the unintended consequences of policies.

BCNU Position Statement on “Patient Focused Funding”



Nora Whyte is ARNBC’s Project Manager.  She is an independent nursing consultant with experience in community health nursing, project management, nursing education and health policy work. She has managed primary health care initiatives and has worked with professional associations, civil society organizations and First Nations health organizations. She has a longstanding interest in nursing leadership development at local, provincial, national and international levels.




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Thank you for posting about these great resources! It's so nice to see that you've included links to external reports that provide different but useful views on such an important issue.

I couldn't agree more that nurses need to educate ourselves about what is happening in the big picture in health. If we don't know what the leadership is thinking, we run the risk of having decisions being made without awareness of how they will impact us. I will be sharing this blog with my colleagues and encouraging them to read through the documents too.


I find it troublesome that we force our family physicians to also become business-people. The fee-for-service and "patient-focused" funding models do not promote quality care or innovations where time is spent with a person to better understand their health needs from a holistic perspective thus preventing future complications. In the above models, it seems that the faster we can get the patient out the door the better it is for everyone...except the patient. As an NP, I love that I'm trained and encouraged to spend time with patients to give them a little extra education about their condition or support them in their health choices. Something as simple as taking the time to explain a treatment, procedure or medication often prevents unnecessary returns to the clinic and therefore saves the entire system a little bit. However, the time that I spend with a client is money directly out of the pocket of a GP. No wonder walk-in clinics are so much more lucrative for physicians...less ongoing responsibility, no on-call, quick visits, more money. This has resulted in a severely fragmented primary care system where more and more patients do not have a primary health care provider to help organize their care and provide the continuity so many of them need. It becomes so much more inefficient as diagnostic tests are re-ordered and symptoms left to get worse.

IMHO, it's time we moved towards health care teams where family physicians are paid a fair and equitable salary and acknowledged for their strengths as "primary health care specialists". A team where physicians are utilized and paid for their strengths in advanced primary care and not for performing basic health screening which can be done by a nurse or NP. In this model physicians, nurses, NPs, other HCPs might actually be able to truly work together without the ongoing concern for power, control and money and the primary concern would be good client care. Right provider at the right time in the right setting.


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