Population Health and Health Reform: Needs-Based Funding in Five Provinces
Bibliographic record
Abstract
A key component of provincial health reform plans in the 1990s (and directly linked to the process of health system regionalization) was the attempt to move funding for service delivery to new models based on some notion of ‘population needs’. The intent of these models was to fund newly created regional health authorities relative to the health service needs of the population as determined by demographic, socio-economic and other measures of the population. This was done in the belief that it would facilitate the reorganization of service delivery to focus on ‘upstream’ determinants of health rather than merely treating ‘downstream’ illness and injury. This paper, part of a larger multi-faceted examination of provincial health reform decision makers involving researchers from across the country, summarizes and compares the experiences of five provinces (AB, SK, ON, QC and NF). Drawing on lengthy interviews with policy makers, political actors and stakeholder organizations the paper to the strong institutional and interest-based barriers that have blunted efforts to reform system financing at the regional level. Overcoming these barriers continues to be a key challenge for advocates of reorienting the delivery of health services to upstream determinants of population health.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".