Case Studies:

To focus the conference on very real problems faced by decision-makers, the organizers have gathered case studies from regional boards across the province of Alberta. The issues described below are indicative of the kind of dilemmas that the conference will address.

A health board is wrestling with how it is to decide what level of resources ought to be dedicated to self-managed care clients. Within community/home care regulations there is a stipulation that funding can be given to a client to hire his/her own caregivers to maximum of $x thousand/month. But how is a regional maximum limit to be determined? At what point does an individual client cost too much to support on his or her own terms? When is it permissible to institutionalize a patient because doing so costs less than self-managed care?

How is funding for new and expensive modalities for treating disease to be balanced with broader health prevention and promotion initiatives? For example, a new cardiac medication is available that is very efficacious, but hugely expensive (it will add $100k to the Intensive Care Unit budget). In order to provide this drug the board will need to take away funding from somewhere else. So does the board help a smaller group of intensely ill people with the new drug, or does it hire a dietician or speech pathologist who might help hundreds of children with needs less acute? In short, how is funding for new and expensive modalities for treating disease to be balanced with broader health prevention and promotion initiatives?

Part of a regional board's mandate is to be responsive to the needs of the community and to ensure that the voices of a wide variety of stakeholders are heard and considered in the process of decision-making. Yet it is often the case that certain groups are better able to have their concerns aired and heard while others, with potentially equally serious needs and concerns, are able to exert much less influence and persuasion over important decision-making processes. How are boards to balance the competing needs of diverse stakeholders in their resource allocation decisions?

In a particular health region, there is no region-wide preventative breast screening program. If the board had extra dollars, it could fund a region-wide mammogram program; but because there is pressure to have up-to-date technological equipment and services, such preventative programs cannot be funded. To what extent should board members give in to external pressure to fund certain programs when they believe that directing the funds elsewhere would be more appropriate and beneficial?