Resource allocation in the public health sector: Current status and future prospects

Abstract

Background: Funding practices in Ontario's acute care sector have undergone a substantive shift away from ‘lump-sum funding’ towards a combination of population-needs and performance-based financing (MOHLTC, 2013). In contrast very little is known about how funds are distributed across the province’s public health sector, specifically the 36 public health units (PHUs) that are mandated to deliver health promotion and disease prevention programs across Ontario. In fact the funding arrangement utilized by the public health sector has remained unchanged for several years, despite the growing burden of responsibilities on PHUs in terms of evolving population health needs and more expansive programmatic and performance expectations. Current literature on the processes, variables and overarching principles that govern the distribution of funds across PHUs remains considerably limited.

Objectives: The objectives of this study were to develop a better understanding of how PHUs in Ontario are currently funded, and to examine what principles public health professionals believe should guide the distribution of resources across PHUs. The project sought to identify the fundamental principles that public health professionals believe should inform future thinking around public health funding.

Methods: The perspectives of public health professionals who have proximal links to the current public health funding process served as the basis of the data discovery component for this study. A total of 14 in-depth interviews were conducted with a number of public health professionals to gather their insights on the current funding arrangement, and explore what principles they believe should be used to guide allocation decisions in the public health sector. Interviews were followed by a web survey to examine how public health professionals rank principles and perceive trade-offs between competing principles.

Results: Public health professionals proposed a total of 12 principles to guide the distribution of resources across PHUs. These principles were grounded in three core social value judgments (need, equity, and transparency and accountability). The study provides important insights into the fundamental principles that public health professionals believe should guide allocation decisions and illustrates the complexity associated with distributing limited resources across health units, as well as possible directions for future research on this topic.