Abstract
Background:Population-based resource allocation is a specific approach to population health planning that is used to address differences in population need to promote equity and efficiency in health and health system outcomes. However, while previous studies havedescribedthis type of funding model, they have not comparedhowsuch policies and practices have been implemented across jurisdictions. This research examined the impacts and outcomes of population-based resource allocation across six high-income countries, with a view to informing strategic decision-making as Ireland progresses its universal healthcare reform agenda.Methods:A concurrent multi-method approach was employed to examine the experiences of six jurisdictions selected for analysis: Australia (New South Wales), Canada (Alberta), England, New Zealand, Scotland and Sweden (Stockholm). A documentary analysis of key policy, strategy and planning publications was combined with a narrative rapid review of peer-reviewed and grey literature (n = 8) to determine how population-based resource allocation is specified and implemented. The findings were checked and verified by national experts.Results:Notable differences were observed across countries in terms of the stated objectives and descriptions of models as well as the criteria for choosing variables and the variables ultimately used in funding formulae. While population-based resource allocation can help improve equity related to healthcare outcomes and access, a number of tensions were revealed between the need to ensure alignment between policy goals and model design; transition between models; support regionalisation policies; and develop robust governance and monitoring mechanisms to maximise outcomes.Conclusions:The review progresses ‘thinking’ about population-based resource allocation beyond the technical aspects of model or formulae construction. Population-based resource allocation should be viewed as just one lever of large-scale health system reform that can be thoughtfully developed, monitored and adjusted in a way that supports the goals of Sláintecare and the delivery of universal healthcare.
Highlights
There is strong global consensus about the importance of implementing universal access to integrated healthcare services to achieve the ‘triple aim’ of improving health, improving quality of care and ensuring sustainability[1]
The findings suggest that funding models are critical to successful regionalisation policies[27] and that variation in efficiency can be influenced by the provision of clear guidelines and direction provided by government[30]
The findings suggest there is a general dissatisfaction with the population-based funding formula (PBFF) across the District Health Boards
Summary
There is strong global consensus about the importance of implementing universal access to integrated healthcare services to achieve the ‘triple aim’ of improving health, improving quality of care and ensuring sustainability[1]. While previous studies have described the ‘what’ of PBRA such as the methods used to develop funding formulae or their key components3,4 - they have not compared PBRA policies and practices across countries. This is needed to facilitate better understanding of how PBRA is being implemented and the strategies that enable its full potential to be realised within different settings and contexts. This research examined the impacts and outcomes of population-based resource allocation across six high-income countries, with a view to informing strategic decision-making as Ireland progresses its universal healthcare reform agenda. While population-based resource allocation can help improve equity related to healthcare outcomes and access, a Invited Reviewers 1 version 1
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