Prelude to a Systematic Review of Activity-based Funding of Hospitals: Potential Effects on Cost, Quality, Access, Efficiency, and Equity

Until recently, hospital funding in Canada has been based predominantly on global budgets, but health care system decision-makers throughout the country are now seriously considering an alternative funding model referred to as activity-based funding (ABF). Under this system, hospital services are classified prospectively into clinically meaningful "bundles" of care that use similar levels of resources. Opinion is divided as to whether ABF would help the Canadian health care system to achieve any of the putative benefits originally achieved by ABF in other countries, or whether the risks would outweigh the benefits. As yet, there has been no systematic review of the evidence. In March 2012 our research team launched a systematic review to inform Canadian policy-makers about how this funding model affects health care systems around the world. Of the more than 16 000 potentially eligible titles and abstracts screened, 261 studies, representing 64 countries (either singly or in aggregate), provide data on at least one of the cost, quality, access, efficiency, and equity outcomes of interest to our research team. We are now in the process of analyzing data from the eligible studies most germane to the Canadian context. This commentary is intended to alert decision-makers to the upcoming release of a series of papers based on our systematic review of ABF, in the hope that our synthesis will soon provide a more robust evidence base to better inform decision-makers.