North East LHIN’s health system planning and funding functions are now part of Ontario Health, a government agency responsible for ensuring Ontarians continue to receive high-quality health care services where and when they need them.

Health System Funding Reform (HSFR)

A significant focus of the Ontario government’s Action Plan for Health Care is health funding reform to support the move away from a provider-centred model toward a patient-centred system.  Health System Funding Reform (HSFR) is based on the key principles of quality, sustainability, access and integration.

Historically, health service providers received an across-the-board funding increase annually. Health service providers now receive funding based on how many patients/clients/residents they look after, the services they deliver, the evidence-based quality of those services, and the specific needs of the population they serve. This began on April 1, 2012 in a phased-in approach over three years.

HSFR consists of two funding models: Quality Based Procedure (QBP) funding and Health Based Allocation Model (HBAM) funding:

  • Quality Based Procedures are identified by the Ministry of Health and funded on a formula (price x volume) for providing selected services.
    • For year 1 in 2012-13, four QBPs were implemented: primary hip replacements, primary knee replacements, cataract surgery and chronic kidney disease (CKD).
    • In year 2 (2013/14), six additional QBPs were added: colonoscopy, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), stroke, chemotherapy-systemic treatment and non-cardiac vascular.
    • In year 3 (2014/15), six additional QBPs were added: Pneumonia, Hip Fracture, Tonsillectomy , Neonatal jaundice, Bilateral Hip and Knee, Non Cardiac Vascular - Aortic Aneurism (excludes advanced pathway).
    • In year 4 (2015/16), three additional QBPs were added: Knee Arthroscopy, Prostate Cancer Surgery, and Colorectal Cancer Surgery.
    • With HSFR fully implemented 30% of hospital funding is based on QBPs.30% on HBAM, and 40% global base generally.
  • HBAM is an evidence-based funding model that considers factors such as age, gender, socio-economic status, rural geography and patient flows. It compares actual costs and volumes to expected costs and volumes.

Relevant Links

HSFR

Clinical Services Review

Community-Based Specialty Clinics