Moving rocks: block‐funding in pEI as an incentive for Cross sectoral reallocations among human services

: In 1993, Prince Edward Island introduced block-funding to five Health and Community Services regional boards for all human services except education. We view this as the introduction of a financial incentive (or removal of a disincentive) to undertake cross-sectoral reallocations to address the broader determinants of health. We use case-study methods to evaluate the way in which this incentive was communicated from policy makers to the regions, how the regions interpreted the policy makers' signals, and how the regions responded. The block-funding incentive became a “fuzzy” signal to the regions, because it was communicated as part of a larger reform package that included expenditure reductions, devolved governance, and the need for integration and coordination. Nevertheless, the regional boards interpreted the block-funding as facilitating cross-sectoral reallocations, but because of various concerns, including opposition expressed by their employee providers, as well as their physicians and the public, they moved only cautiously to exploit the incentive. Most regions focused more on enhancing administrative efficiency through integration and coordination than on cross-sectoral reallocations to address the determinants of health. Finally, lessons for other jurisdictions are outlined based on the PEI experience. Sommaire: En 1993, l‘ile-du-Prince-Edouard a adopte le mode de financement en bloc Jonathan Lomas has a master of arts degree and is professor in the Department of Clinical Epidemiology and Biostatistics, McMaster University, and the Centre for Health Economics and Policy Analysis. Michael M. Rachlis is a doctor of medicine and has a master of science degree. He is assistant professor in the Department of Clinical Epidemiology and Biostatistics, McMaster University. This study would not have been possible without the exemplary research assistance of Sameer Kumar. We are also grateful for the help of Mita Giacomini and Laurie Goldsmith, overall leader and coordinator of the larger project, “Financial Incentives in the Canadian Healthcare System,” of which this was a part. Funding for the project was provided by Health Canada through the National Health Research and Development Program. Useful comments on an earlier draft were provided by John Eyles and Jerry Hurley. Finally, the time and assistance provided by all our interviewees in Prince Edward Island were central to our ability to complete the analysis, and any misrepresentations that may remain after their input and feedback is our responsibility alone. The Journal's anonymous referees are gratefully acknowledged. en ce qui concerne cinq Conseils regionaux de services de sante communautaires, pour tous les services humains sauf l’education. A notre avis, il s'agit la d'un incitatif financier (ou de l‘elimination d'un anti-incitatif) pour entreprendre des reallocations entre les secteurs afin qu'on s'occupe des elements plus fondamentaux qui determinent la sante. Nous utilisons des methodes d’etude de cas pour evaluer la maniere dont cet incitatif a ete communique par les decideurs politiques aux regions, la maniere dont les regions ont interprete ce que leur disaient les decideurs, et la reaction des regions. L'incitatif de financement en bloc est devenu un signal «vague» pour les regions parce qu'il faisait partie d'un ensemble de reformes plus vaste comprenant la reduction des depenses, la gerance decentralisee et le besoin d'integration et de coordination. Neanmoins, les Conseils regionaux ont interprete ce financement comme un moyen permettant de faciliter la reallocation entre secteurs, mais a cause de diverses preoccupations, dont l'opposition exprimee par leurs employes, leurs medecins et leur public, ils se sont montres tres prudents dans Sexploitation de cet incitatif. La plupart des regions se sont concentrees davantage sur l'efficacite administrative que permettaient l'integration et la coordination plutot que sur les reallocations entre secteurs afin de s'occuper des determinants de la sante. Enfin, on mentionne des lecons que peuvent tirer d'autres territoires en fonction de l'experience dans l‘ile-du-Prince-Edouard.