FRONTLINES EDITORIAL Communications (Letter to the editor)

FRONTLINES
EDITORIAL
It has been said that any discussion on the health care system will
inevitably revolve around one of the three M's: money,
management or medicine. With fiscal restraint becoming the
overriding concern in policy debates about the Canadian health care
system, it is not surprising that all of the articles in the final issue of
FORUM for 1991 are related, either directly or indirectly, to
money.
Our lead article by Judith Lave, Philip Jacobs and Frank Markel
provides an assessment of a transitional funding initiative which
l i n k s hospital payments to a CMG-based fixed amount, prospective
payment basis, rather than on a global budget system. One of the
key features of this experiment is to change the incentives for
providen by encouraging more effective use of scarce health care
resources. In a future issue of FORUM we hope to report on a
similar model currently being piloted in Alberta.
Corporations in the private sector have long recognized the value
of using statistics and data in the decisionmaking process. Charles
Botz's article contributes to the growing body of analysis on Case
Mix Groups (CMGs) and Resource Intensity Weights (RIW), which
are being looked upon increasingly by central funding authorities as
the enabling mechanism for effective cost containment strategies.
The successful application of CMG-RIW methodology to identify
utilization and cost problems will depend, to a large extent, on the
adjustments that are made to facilitate accurate, inter-organizational
comparisons of efficiency.
The final article in FORUM, by George Pink, Raisa Deber, Joe
Lavoie and Eric Aserlind, moves the discussion from a cost to a
revenue perspective. Revenue generation has long been a hallmark
of the market-oriented health care system in the United States,
unlike Canada, where cost containment has been the major focus.
Until recently, there has been little positive incentive for Canadian
health care facilities, accustomed to operating within the boundaries
of a global budget, to augment their operating and capital
requirements. In some provinces, such as Ontario, programs have
been established to enable health care facilities to engage in limited
forms of revenue-generating activity. As the authors note, the
results have been mixed -although there are examples such as
University Hospital in London, where a hospital has managed to
reduce its overall reliance on global budget funding from the
provincial Ministry of Health.
With 1991 drawing to a close, FORUM looks ahead to next year.
We will strive to present College members and other readers with
current and relevant information on management developments and
policy issues affecting the Canadian health care system.
Toute discussion sur les s y s t h e de soins de santt serait, dit-on,
intvitablement axie sur I'un de ces trois iliments :I'argent, la gestion ou la
midecine. Les restrictions budgitaires sont en train de devenirla principale
inquiitude dans les dibats sur les politiques du systkme canadien de soins de
santi, alors rien de surprenant que tous les articles du demier numtro de
FORUM en 1991 traitent directement ou hdirectement de l'argent.
Notre article de tdte, par Judith Lave, Philip Jacobs et Frank Markel, constitue une tvaluation d'une initiative de financement transitoire qui relie les
paiements aux h6pitaux ii un montant fixe fond6 sur un GMC, une base prospective de paiements, de prifirence ii un s y s t h e de budget global. Un des objectifs clis de cette exptrience est de modifier Ies incitations aux fournisseurs en
encourageant l'utilisation plus efficace des ressources peu nombreuses en soins
de la santi. Dans un prochain numtro de FORUM, nous espirons publier un
rapport sur un mod& semblable actuellement B 1'Ctape de projet pilote en Alberta.
Les entreprises du secteur privi ont reconnu depuis longtemps l'importance
de l'utilisation des statistiques et des donnies dans le processus dtcisionnel.
L'article de Charles Botz contribue B I'ensemble croissant de travaux d'analyse
sur les groupes mixtes de cas (GMC) et les facteurs de pondtration de la teneur
en ressources (PTR) qui sont de plus en plus considCr6s parles autoritCs
centrales de financement comme les micanismes qui permettent l'adoption de
strategies efficaces d'endiguement des cotits. Dans une large mesure, la riussite
de la mise en oeuvre de la mithodologie des GMC-PTR pour identifier les
problhes d'utilisation et de costs reposera sur les ajustements apportis afin de
faciliter des comparaisons exactes de l'efficacitt entre les organisations.
Le demier article de FORUM par George Pink, Raisa Deber, Joe Lavoie et
Eric Aserlind transporte la discussion d'une perspective de coats ii celle des
revenus. La production de recettes est depuis longtemps une caracttristique du
s y s t h e de soins de sand des Jhats-Unis qui est orient6 vers le march6, B
l'encontre du Canada, oa l'on a principalement insist6 sur l'endiguement des
cofits. Jusqu'B ricemment, il y avait peu d'incitations positives pour que les
Ctablissements de soins de santi canadiens augmentent leurs besoins de
fonctionnement et d'immobilisations puisqu'ils avaient l'habitude de fonctionner dans les limites d'un budget global. Dans certaines provinces, comme
l'Ontario, on a itabli des programmes pour pernettre aux itablissements de
soins de santt de pratiquer, dans certaines limites, des activitis criatrices de
revenus. Comme les auteurs l'ont noti. les risultats sont mitigis-bien qu'il y
ait des exemples, comme le University Hospital de London, oh un h6pital a
rtussi ii riduire l'ensemble de sa dipendance envers le financement du budget
global du ministhe provincial de la Sand.
Avec 1991 qui tire ii sa fin, FORUM se pripare ii l'an prochain. Nous
essaierons de presenter aux membres du College et B nos autres lecteurs des
informations actuelles et pertinentes sur les nouveautis en gestion et les grandes questions qui influent sur le s y s t h e canadien de soins de santt.
Randall R. Steffan, CHE
Managing Editor
Randall R. Steffan, AAAS
Ridacteur en chef
r
Communications (Letter to the editor)
Dear Editor,
I picked up the summer edition of FORUM last night, and with great pleasure found the article by Monk and Edgar on
restructuring a nursing department for today's challenges.
It was terrific! I was so pleased to see such a thought-provoking, candid and visionary description of changes for
nursing. Many nursing leaders are grappling with the same problems concurrently with serious institutional financial
difficulties. New models are of great help when considering the possibilities.
Thank you for publishing it. I will at once share it with colleagues who are seeking help with necessary changes in their
departments and with classmates in the Nursing Administration Graduate Program at the University of Toronto.
Beverley Simpson, RN, BScN
Toronto, Ontario