ARCHIVED - About the Health Transition Fund
Introduction
The Health Transition Fund (HTF) was a $150 million fund which from 1997 - 2001 supported projects across Canada to test and evaluate innovative ways to deliver health care services. The HTF was announced in the 1997 Federal Budget as part of the federal government's initial response to the final report of the National Forum on Health which recommended a multi-year "Transition Fund" to support innovations leading to a more integrated health system.
Continued evolution of the health system is essential if it is to be sustainable and responsive to the health needs of Canadians. Through national level initiatives, and provincial and territorial evaluation and pilot projects, the HTF provided evidence to help determine which approaches for continued reform and improvement of the health system work best and are feasible for implementation.
Of the $150 million, $120 million was allocated to support provincial and territorial projects with the remaining $30 million devoted to national level initiatives. These initiatives included national pilot and evaluation projects, national conferences on pharmacare, home care and health information, national synthesis and dissemination activities to communicate project results, and the operations of the HTF Secretariat.
Collaboration: A Basic Element of the HTF
The $150 million was provided by the Government of Canada. However, the HTF was a collaborative effort involving the federal, provincial and territorial governments. Accordingly, the structure and operations of the Fund reflected the input of all governments (13 initially, and 14 as of April 1999, when Nunavut was created). For example, from the outset of the HTF, federal, provincial and territorial Ministers agreed to fund projects relating to four priority areas - Home Care, Pharmacare/Pharmaceutical Issues, Primary Care/Primary Health Care, and Integrated Service Delivery. As well, the HTF was guided by a Federal/Provincial/Territorial Working Group. The Working Group was created as the focal point for intergovernmental collaboration as it related to the HTF. It was comprised of one representative from Health Canada and one representative from each of the provincial/territorial Ministries of Health. The program was managed by Health Canada's Health Transition Fund Secretariat. Together, the Executive Director of the HTF Secretariat and one P/T representative shared the responsibilities of co-chairs of the Working Group. This Working Group enabled governments to collaborate on the Fund's design and key program elements, as well as on project selection and the dissemination of findings.
Priority Areas
Federal, provincial and territorial governments agreed upon the following priority areas for the Health Transition Fund:
These priority areas were chosen for three reasons. First, they reflected the broad priorities of a range of parties involved in health care at the federal, provincial and territorial levels. Second, changes in these areas were clearly occurring across Canada. Third, policy and program work was already underway in them, and this work needed better evidence to support it. In essence, the four areas were already relevant to governments, providers and other stakeholders.
The wording of the following definitions was agreed upon by a wide range of participants for the purposes of the HTF.
1. Home Care
Home Care describes a range of services which enable people, incapacitated in whole or in part on either a temporary or ongoing basis, to live at home. Home care services are part of the broader effort to improve the health and well-being of Canadians. These services often prevent, delay or provide a substitute for long-term care or acute care alternatives. Home care may be delivered under many organizational structures and funding and payment mechanisms. It may meet needs specifically associated with a medical diagnosis (e.g., diabetes therapy) and/or may provide support for daily living activities (e.g., bathing, cleaning, cooking). Home care serves a range of people - from those with minor health problems and disabilities, to those who are acutely ill and require intensive and sophisticated services and equipment. There are no upper or lower limits to the age at which home care may be required. However, as is true for other parts of the health system, use tends to increase with age.
2. Pharmacare / Pharmaceutical Issues
Pharmacare refers to a system of insurance coverage for prescription medicines. The design of any particular system may vary in several respects. For example, a system may be universal or offer coverage only to specific sectors of the population such as seniors or social assistance recipients. It may cover all drugs or particular categories of drugs. A system could be financed publicly or privately, or both publicly and privately and could include deductibles, co-payments, etc.
Relevant pharmaceutical issues include: accessibility, affordability, drug utilization and compliance, prescribing practices, drug-distribution systems and information-system infrastructure.
3. Primary Care / Primary Health Care
The HTF adopted a broad definition of Primary Care/Primary Health Care. This definition includes both a narrower primary-medical-service model, focussing on physician services, and a broader concept that encompasses a model in which a range of providers of health and social services generally work in teams. First-level contact with providers, co-ordination of services, health promotion/illness prevention, care for common illness and managing ongoing health problems and services from a wide range of providers are all part of this definition. The terms "Primary Care" and "Primary Health Care" reflect the different terminology used across the country.
Specific examples of Primary Care/Primary Health Care services include (but are not limited to): screening, health information, eye exams, treatment in a physician' s office, vaccinations, hearing exams, prenatal care, home visits, nutritional counselling, some mental-health services, drug-dispensing information, palliative care, etc. Primary Care/Primary Health Care providers include family physicians, nurses in family physicians' offices, public health nurses, nurse practitioners, pharmacists, nutritionists, physiotherapists, midwives, chiropractors, long-term care providers, psychologists, optometrists, social workers, etc.
4. Integrated Service Delivery
Integrated Service Delivery is the broadest of the four priority areas, and can include the other priority areas. It refers to any effort or initiative that tries to better integrate or co-ordinate a range of services which relate to health. The emphasis is on integrating or co-ordinating services at the transition points in the health-care system - i.e., the points at which one service (such as home care) takes over from another, e.g., the hospital.
Integration can occur on a system-wide basis, or focus on a specific link in a particular community. Integration usually involves a range of people and organizations involved in the funding and delivery of services. Co-ordination and integration could occur along one or more of the following dimensions:
- across the continuum of physical and mental health services - from prevention, to primary care, acute care and continuing care - supporting health, well-being and quality of life;
- across the range of delivery sites, including homes, ambulatory sites (such as clinics and physicians' offices, diagnostic facilities, pharmacies), hospitals, and long-term-care facilities;
- across service providers (for example, physicians, nurses, social workers, physiotherapists); and
- across the range of planning and management systems or information systems.
How Projects Were Selected For Funding
Very early on, governments agreed to divide the $150 million into two parts: $120 million would go to provincial/territorial projects (allocated to provinces and territories on a per capita basis) and $30 million to national projects and other initiatives as described earlier.
Decisions about provincial/territorial projects were made by the province or territory in question and the Government of Canada. Provinces and territories had discretion in terms of how they would decide what proposals to submit. However, all proposals had to meet the selection criteria agreed to nationally by the FPT Working Group on the HTF. In general, provincial/territorial projects focussed primarily on issues or models that were of particular relevance to the health system of a province, territory or region, and they generally took place exclusively within that jurisdiction.
In choosing which national projects to fund, the multi-lateral FPT Working Group reviewed more than 150 national proposals. In general, these projects addressed issues of interest to the health systems of several or all jurisdictions. Many, but not all, involved more than one jurisdiction.
The HTF received many more proposals for funding than could be accommodated, and funding decisions were difficult. In some cases, very good projects were not funded - not because they had not been well prepared or were not consistent with the Fund - but because other similar projects had already been funded or because funding had been exhausted.
General Profile of Funded Projects
The amount of HTF funding for individual projects ranged from $6,000 to $18 million. These projects related to a variety of areas - from small, local issues to the system-wide reform of health care. In many cases, the HTF was the sole source of funding; in others, it was one of several.
Of the 140 projects, 38 were national, and 102 were provincial/territorial. While projects were categorized for administrative purposes as relating to one priority area, in fact, many related to two or three. For example, the priority area of Integrated Service Delivery, by its very nature, often includes elements of the other three priority areas. Therefore, some projects categorized as Integrated Service Delivery have significant components that relate in some way to the other priority areas.
In addition to the projects associated with each priority area, clusters of projects emerged that related to particular subject areas or populations. For example, a number of projects focussed on populations such as children, seniors, Aboriginal people, women and people with mental illnesses. Other projects dealt with specific issues around providing care in rural or remote geographic areas, or using telehealth and telemedicine technology and information tools. Several others focussed on issues relating to health professionals (e.g., the use of nurse practitioners and collaborative teams involving different professions, different payment mechanisms, etc.).
Synthesis and Dissemination
The HTF's mandate was to support projects that contributed to "evidence-based" decision making. Clearly, evidence has to reach decision makers and other stakeholders in a useful and timely manner. Accordingly, a national synthesis and dissemination strategy was undertaken to guide the analysis and communication of what was learned through HTF projects, individually and in aggregate. It was based on consultations with target audiences about what they want, with dissemination/research transfer experts about what works, and with project proponents about how they planned to disseminate their results.
The national strategy was based on a number of principles and relied on several key activities, including analytical synthesis, conferences and web-based communications. It was intended to ensure that the pool of project results was consolidated, analysed and disseminated in a manner that offered useful evidence and policy-relevant lessons for decision-makers across the country.
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