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Priority Setting in a Canadian Long-Term Care Setting: A Case Study Using Program Budgeting and Marginal Analysis*

Published online by Cambridge University Press:  31 March 2010

Craig Mitton ,
Cam Donaldson  and
Pat Manderville
Craig Mitton*
Affiliation:
Centre for Health and Policy Studies, University of Calgary
Cam Donaldson
Affiliation:
University of Newcastle upon Tyne/University of Calgary
Pat Manderville
Affiliation:
Headwaters Health Authority
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Craig R. Mitton, Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr. N.W., Calgary, AB T2N 4N1. ([email protected])
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Abstract

Canadian health regions are required to set priorities and allocate resources within a limited funding envelope. Program budgeting and marginal analysis (PBMA) was piloted in continuing care in Claresholm, Alberta, with the aim of improving overall benefit from available resources. A marginal-analysis expert panel was used to assess options for continuing-care delivery. Inputs into the decision-making process included evidence from the literature, regional and provincial reports, program budgeting information, and local knowledge. Recommendations included implementing adult, day-and-night support programs and converting long-term beds to convalescent beds. Changes were funded through allocating provincial Broda funding and altering nursing assistant and physiotherapy activity. PBMA was demonstrated to be an effective framework in aiding decision makers with redesigning services in Claresholm. This case study is one of several which indicate PBMA to be a valuable aid to priority setting in health care service provision.

Résumé

Les régions canadiennes de santé doivent établir des priorités et affecter des ressources à même une enveloppe budgétaire restreinte. La Budgétisation des programmes et l'analyse différentielle (BPAD) a fait l'objet d'un programme de soins continus à Claresholm, en Alberta. Le but était d'améliorer et de profiter pleinement des ressources disponibles. Un groupe composé d'experts en analyse différentielle a évalué les options disponibles pour la distribution des soins continus. Plusieurs suggestions se sont ajoutées au processus de prise de décisions : des témoignages provenant de la littérature, des rapports régionaux et provinciaux, des renseignements sur la programmation budgétaire et des connaissances de base. La mise en oeuvre de programmes d'appui jour et nuit des adultes et la transformation de lits à long terme en lits convalescents faisaient partie des recommandations. Les changements ont reçu un financement par l'entremise de l'affectation provinciale « Broda » et par la réfection des infirmiers auxiliaires et des activités de physiothérapie. Le projet a démontré que BPAD est un cadre efficace qui peut aider les décideurs a modifié les services à Claresholm. Cette étude de cas se joint à plusieurs autres études démontrant que BPAD soutient l'établissement de priorités en matière d'affectation de services de santé.

Keywords

agingpriority settinglong-term carecontinuing carevieillissementajustement de prioritéssoins de longue duréesoins continus
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 22 , Issue 3 , Fall/Automne 2003 , pp. 311 - 321
Copyright
Copyright © Canadian Association on Gerontology 2003

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Footnotes

*

The authors would like to thank Francesco Mosaico, University of Alberta, and Kris Aksomitis, University of Calgary, for their assistance on this project. The authors would also like to acknowledge the Canadian Health Services Research Foundation and the Alberta Heritage Foundation for Medical Research.

References

Alberta Health. (2000). Alberta for All Ages: Directions for the Future. Edmonton, AB: Alberta Community Development, Communications Branch.Google Scholar
Auld, P., Donaldson, C., Mitton, C., & Shackley, P. (2001). Economic evaluation. In Detels, R., Holland, W., McEwan, J., & Omenn, G. (Eds.), Oxford Textbook of Public Health (4th ed.). Oxford: Oxford University Press.Google Scholar
Berdes, C. (1996). Driving the system: Long-term care coordination in Manitoba, Canada. Journal of Case Management 5(4), 168–172.Google ScholarPubMed
Black, R.E. (1995). Priority setting in case management based on need and risk. Journal of Case Management 4(3), 79–84.Google ScholarPubMed
Brody, B.L., Simon, H.J., & Stadler, K.L. (1997). Closer to home (or home alone?): The British Columbia longterm care system in transition. Western Journal of Medicine 167(5), 336–342.Google Scholar
Cohen, D. (1994). Marginal analysis in practice: An alternative to needs assessment for contracting health care. British Medical Journal 309, 781–785.CrossRefGoogle ScholarPubMed
Crichton, A. (1997). Long-term care in Canada. Health Care Management 3(1), 115–124.Google ScholarPubMed
Cloutier-Fisher, D., & Joseph, A.E. (2000). Long-term care restructuring in rural Ontario: Retrieving community service user and provider narratives. Social Science and Medicine 50, 1037–1045.Google Scholar
Donaldson, C., & Farrar, S. (1993). Needs assessment: Developing an economic approach. Health Policy 25, 95–108.CrossRefGoogle ScholarPubMed
Frankish, C.J., Kwan, B., Ratner, P.A., Higgins, J.W., & Larsen, C. (2002). Challenges of citizen participation in regional health authorities. Social Science and Medicine 54(10), 1471–1480.CrossRefGoogle ScholarPubMed
Ham, C., & Coulter, A. (2001). Explicit and implicit rationing: Taking responsibility and avoiding blame for health care choices. Journal of Health Services Research and Policy 6(3), 163–169.CrossRefGoogle ScholarPubMed
Hollander, M.J., & Pallan, P. (1995). The British Columbia continuing care system: Service delivery and resource planning. Aging 7(2), 94–109.Google ScholarPubMed
Jacobs, P., Mills, C., & Hollander, M. (1997). Financing long-term care in Canada. Health Care Management 3(1), 101–105.Google ScholarPubMed
McKeever, P. (1996). The family: Long-term care research policy formulation. Nursing Inquiry 3(4), 200–206.CrossRefGoogle ScholarPubMed
Martin, D.K., Pater, J.L., & Singer, P.A. (2001). Priority-setting decisions for new cancer drugs: A qualitative case study. Lancet 358(17), 1676–1682.CrossRefGoogle ScholarPubMed
Mitton, C., & Donaldson, C. (2001). Twenty-five years of programme budgeting and marginal analysis in the health sector, 1974–1999. Journal of Health Services Research and Policy 6(4), 239–248.CrossRefGoogle ScholarPubMed
Mitton, C., Donaldson, C., Halma, L., & Gall, N. (2002). Setting priorities and allocating resources in regional health authorities: A report from two pilot exercises using program budgeting and marginal analysis. Healthcare Management FORUM 15(1), 39.Google Scholar
Mooney, G.H. (1978). Planning for balance of care of the elderly. Scottish Journal of Political Economy 25(2), 149–164.CrossRefGoogle Scholar
Mooney, G. (2002). Priority setting in mental health services. Applied Health Economics and Health Policy 1(2), 15–24.Google Scholar
Peacock, S. (1998). An Evaluation of Program Budgeting and Marginal Analysis Applied in South Australian Hospitals. Melbourne, Australia: Centre for Health Program Evaluation, Monash University.Google Scholar
Ruta, D., Donaldson, C., & Gilray, I. (1996). Economics, public health and health care purchasing: The Tayside experience of programme budgeting and marginal analysis. Journal of Health Service Research and Policy 1(4), 185–193.CrossRefGoogle ScholarPubMed
Shiell, A., Mooney, G. (2002). A Framework for Determining the Extent of Public Financing of Programs and Services. Ottawa: Commission on the Future of Health Care in Canada.Google Scholar
Singer, P.A., Martin, D.K., Giacomini, M., & Purdy, L. (2000). Priority setting for new technologies in medicine: Qualitative case study. British Medical Journal 321, 1316–1318.Google Scholar
Statistics Canada. (1996). Census 96. Retrieved 4 Sept. 2002, from www.statscan.caGoogle Scholar
Statistics Canada. (2001). Community Profiles 2001. Retrieved 4 Sept. 2002, from www.statscan.caGoogle Scholar
Wiseman, V., Mooney, G., & Jan, S. (1998). Aboriginal and Torres Strait islander communities setting their own health care priorities. SPHERe discussion paper series, University of Sydney.Google Scholar
Wodchis, W. (1998). Applying activity-based costing in long-term care. Healthcare Management FORUM 11(4), 25–32.Google Scholar