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REVIEW QUESTIONS - HLTH 245 REVIEW Hospital Financing How...

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HLTH 245: REVIEW Hospital Financing How does financing of acute care hospitals in Canada compare relative to other OECD countries? o Canada has about 2.7 hospitals/1000 population o has fewer acute care feds than OECD avg; U.S has less than Canada How do we compare on bed occupancy rate? What are the implications of this? o Far above the OECD; Canada has highest occupancy rate (89%) o Implications: no wiggle room; hospitals overwhelmed during crisis What have been the trends in financing in Canada? o Hospital expenditure has increased, but number of beds decreased Shift from money to inpatient beds to hospital outpatient services What are the trends with respect to in-patient and out-patient services? What are the implications? o There has been a big shift, more out patients than inpatients; inpatient days have dropped substantially in the past 25 years; visits to ambulatory care units have increased as well as the # of outpatient clinics o Implications: Where is the money ‘spent’ in hospitals? o Nursing inpatient services- ~70% What factors affect hospital costs? o Age; # of co-morbidities; flagged interventions (i.e., IV’s, feeding tubes); other interventions (i.e., rehab, diabetic ulcer) What are the different types of funding formulas/budgets used to fund hospitals? Type of Funding Pros Cons Line by Line funding (a.k.a input based funding; it used to be most popular) - link cost to activities - difficult to re-allocate money; no incentive to improve efficiency, quality etc.; high administration costs; difficult to link to needs of community Global Budgets (focuses on total spending rather than individual services) - allocate $$ depending on the need; easy to calculate; encourages efficiency; integrated health care - unrelated to services; inequities remain; cannot accommodate change; no wiggle room if the demand is higher than funding Service Based funding (case-mixed based approach) - used internationally; weigh the average cost of treating a case; uses the volume and type of cases treated Population Based - uses demographic info to predict demand; can be objective, equitable and accommodate needs; very info dependent - only provides an estimate not incentive for better performance
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Which type is used in Ontario? o Global Budget What are some of the challenges facing the hospital sector? o Full beds; staffing(beds closed due to staff shortages); hospital infrastructure & age Access How is access measured? o Wait list Who is measuring access? o Usually by doctors What do the various sources have to say about access to health services? o Waiting lists are a poor reflection of patient need o Confusion about waitlist terminology and measurement How do we compare with respect to other countries?
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