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:
- 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.
- Identify and develop an understanding of the mechanisms that
exist to regulate private delivery of health care services and
private sector service providers.
- 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).
The Interface between Financing and Delivery of Health Services
in Canada
|
Delivery |
Public |
Private |
Financing |
not-for-profit |
for-profit |
Public |
Public health services |
hospital services |
physician services |
Private |
|
private insurance coverage for additional,
non-medically necessary services (e.g. semi-private/private
rooms) |
non-medically necessary services provided
in private clinic settings
dental care (excluding in-hospital) |
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.
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