Request for Letters of Intent (RFP 004): Private Sector Delivery in Canada's Current Health Care System: Research into the Scope and Extent

I. Deadline

Letters of Intent: January 15, 2002 (12:00pm E.S.T.)

II. Funding & Project Duration

Maximum funds available for all projects: Up to $600,000.00

Maximum funds per project (with noted exceptions): Up to $300,000.00

Maximum project duration: 24 months

Funding is expected to begin in the fall of 2002. Projects with budgets that exceed $300,000.00 will be deemed ineligible without exception. Reduced funding will be considered for proposals that address a limited number of questions, as indicated below. The HPRP expects to fund between 2 and 6 proposals.

III. Scope of Competition

Objective

Health Canada is seeking to improve its understanding of the role currently played by the private sector in the delivery of health care services within the context of Canada's current health care system. To achieve this goal, Health Canada is inviting Letters of Intent (LOI) for research to address one or more of the following topics:

1. Quantify the scope and extent of private delivery of health care services in Canada's current health care system by province/territory and type of service delivered.
2. Identify and develop an understanding of the mechanisms that exist to regulate private delivery of health care services and private sector service providers.
3. Identify and develop an understanding of the role that guidelines play in preventing conflicts of interest in situations where private organizations deliver health care services within Canada's current health care system.

Context

Canada has a predominantly publicly financed, privately delivered health care system that is best described as an interlocking set of ten provincial and three territorial health insurance plans. Known to Canadians as "Medicare", the system provides access to universal, comprehensive coverage for medically necessary hospital and physician services as stated in the Canada Health Act.

Canada does not generally have a system of "socialized medicine", with physicians employed by the government. Rather, most physicians are private practitioners who work in independent or group practices and enjoy a high degree of autonomy. Some physicians work in community health centres, hospital-based group practices or work in affiliation with hospital out-patient departments. Private practitioners are generally paid on a fee-for-service basis and submit their service claims directly to their respective provincial health insurance plan for payment. Physicians in other practice settings may also be paid on a fee-for-service basis, but are more likely to be salaried or remunerated through an alternative payment scheme. Other providers (e.g. nurses, dentists, pharmacists, etc.) work in a mix of private not-for-profit, private for-profit and public delivery settings.

Most Canadian hospitals operate as private not-for-profit entities run by community boards of trustees, voluntary organizations or municipalities. However, the services within hospitals (e.g. pharmacies, food preparation, facilities maintenance, etc.) are provided by a mix of private for-profit, private not-for-profit and public sectors. Certain publicly financed extended health care services (e.g. continuing care programs) are also subject to a mix of public and private delivery mechanisms, with increasing emphasis on private for-profit delivery of public services.

A chart providing examples of how health care services are financed and delivered within Canada's current health care system is provided for your reference. This chart serves as an example only. It does not include an exhaustive list of services nor does it account for all possible mixes of funding and delivery (e.g. hospital services are generally publicly funded and delivered by private not-for-profit resources, but this does not preclude the possibility of other arrangements).

Policy Research Questions

All proposals must address one of the following:

• All questions (maximum of $300,000.00 budget); or
• Question 1 (a & b) only (maximum of $225,000.00 budget); or
• Questions 2 & 3 only (maximum of $75,000.00 budget).

Preference will always be given to LOIs that examine a broad spectrum of services across all jurisdictions. However, LOIs that focus on a select number of jurisdictions (with the minimum level of analysis being the provincial/territorial level) and/or a select number of services will also be considered. Proposals that address the identified policy research questions and have additional questions outside this scope will also be considered.

1a) Quantify the scope and extent of private for-profit and private not-for profit delivery of health care services in Canada's current health care system by province/territory and type of service. Types of services include, but are not limited to:

• nursing services
• physician services, including surgery
• laboratory services
• diagnostic services
• hospital/facility management
• dental care
• optical care
• rehabilitation services (e.g. physiotherapy, occupational therapy, etc.)
• home care
• long-term residential care
• ancillary services (e.g. food preparation, facilities maintenance, etc.)

At a minimum, the analysis must include i), ii) and iii) of the following categories (i - v):

i) Services offered: types of services delivered by private not-for-profit and private for-profit sectors.

ii) Source of financing: source of payment (e.g. regional health authorities, hospitals, provincial insurance plans, private insurers, etc.) to private organizations (not-for-profit and for-profit) for the private delivery of health care services;

iii) Method of financing: method of payment (e.g. fee-for-service, capitation, lump-sum payment for a fixed period of time) to private organizations (not-for-profit and for-profit) for the private delivery of health care services;

iv) Background information on private delivery organizations: for-profit or not-for-profit, market share in Canada, internal governance structure, links to international firms, etc.;

v) Target clients /patients: profile of clients/patients serviced by private delivery mechanisms.

1b) Conduct a trend analysis to illustrate how the extent of private for-profit delivery of health care services has changed over the last 25 years.

2. What legislative, regulatory and/or policy frameworks governing private delivery of health care services in the public system currently exist? What is the accountability of private delivery organizations (not-for-profit and for-profit) to the public sector?

3. What specific guidelines are in place across Canada to prevent conflicts of interest where private organizations deliver health care services within Canada's current health care system? Examples of conflict of interest include, but are not limited to:

i) ownership of shares in a private company by an individual with decision making authority in the awarding of contracts to organizations offering private delivery of services; ii) situations where patients are encouraged to seek private services by a physician practising in both the private and the public sector.

IV. Policy Contacts

When developing a LOI, policy inquiries should be directed to:

Kimberley Kargus Health Care System Division Health Care Strategies and Policy Directorate Health Policy and Communications Branch (613) 957-3413 Email: Kimberley_Kargus@hc-sc.gc.ca

The policy contact is responsible for ongoing interaction with researchers to provide contextual guidance and advice to researchers when developing their LOI. We encourage all applicants to consult with the policy contact prior to preparing a LOI.

Policy contacts are to be consulted on the policy issues and LOI content only. Formatting, eligibility/ineligibility, and other administrative questions (such as time frames, budgets, etc.) should be directed to the HPRP Program Officer(s).

DO NOT forward LOIs (draft or otherwise) to policy contacts for their review at any time. Preliminary review of a LOI by a policy contact will be deemed a conflict of interest and may result in the disqualification of your proposal.

V. How to Apply

There is a two phase application process. Researchers are invited to submit a LOI before 12:00 pm (E.S.T) on January 15, 2002. Only researchers with LOIs found to be eligible and relevant to the identified policy research priority will then be invited to submit a full proposal in the spring of 2002.

Researchers are strongly encouraged to consult the Health Policy Research Program Guide before preparing a LOI . If you are interested in submitting a LOI in relation to this Request for LOI, please refer to APPENDIX A: How to Prepare a Letter of Intent and APPENDIX B: Assessment Criteria for Letters of Intent.

When developing a LOI, please direct inquiries regarding eligibility, the LOI preparation and review process, and terms and conditions of the HPRP to:

Sherrill MacDonald A/Senior Program Officer Health Policy Research Program Research Management & Dissemination Division Health Canada Tel: (613) 954-0830 Fax: (613) 954-7363 Email: Sherrill_MacDonald@hc-sc.gc.ca

Elizabeth Maddocks Senior Program Officer Health Policy Research Program Research Management & Dissemination Division Health Canada Tel: (613) 954-8557 Fax: (613) 954-7363 Email: Elizabeth_Maddocks@hc-sc.gc.ca

APPENDIX A

How to Prepare a Letter of Intent

I. Instructions

Content of each Letter of Intent (LOI) must not exceed three (3) pages (8 ½ x 11 inches). No appendices or attachments are permitted. Print must be 1½ line spacing and be a font similar to Times Roman 12 pts. A one inch (1") margin must appear at the top, bottom, left and right sides of each page.

PART A - Provide the following information in this order:

1. Principal Investogator's name (one investigator only) and signature; 2. Full mailing address; 3. Telephone/fax/e-mail; 4. Name of institution which would administer the funds and signature of authorized officer; 5. Title of project; 6. Specific policy research topic addressed; 7. Approximate total budget (and annual breakdown) and duration of research project (budgets that exceed the amount allowed per project, as indicated in the Request For Letter of Intent, will be deemed ineligible without exception); 8. List of all co-investigators with affiliations and their roles on the project.

PART B - Provide the following information in this order:

9. Proposed research objective(s) and /or research question(s); 10. Rationale showing how the proposed research objectives/questions will supply critical parts of the evidence base for addressing the policy question(s); 11. Brief outline of the study design and methodologies to be used; 12. Team strengths, including the mix of team skills and abilities to address the question(s) from a policy perspective; 13. The linkages the team has developed and/or proposes to develop with Health Canada and other relevant partners in the context of this project; 14. Expected outcomes including the significance of the new knowledge that will be generated from the study and its ability to inform the specific priority question(s) identified in the RFLOI.

Completed LOIs must be submitted to the HPRP at the following address: Sherrill MacDonald Health Policy Research Program Research Management & Dissemination Division Health Canada, Room 1528B, Jeanne Mance Building Tunney's Pasture / Ottawa, Ontario / KIA 0K9 Tel. (613) 954-0830 / Fax. (613) 954-7363

APPENDIX B

Assessment Criteria for Letters of Intent

1. Eligibility

Eligibility of both the Principal Investigator and the Agency will be assessed according to Sections 6, 6.1 and 6.2 of the Guide.

2. Completeness/conformity

All information identified in APPENDIX A: How to Prepare a Letter of Intent must be provided to enable assessment of policy priority fit.

3. Policy Review

Assessment of the level of policy fit (ranking) of the research question(s) outlined in the Letter of Intent with the priorities identified in the Request for Letters of Intent.