Why equity in financing first nations on-reserve health services matters: findings from the 2005 national evaluation of the health transfer policy.

backgroundThis paper reports on selected findings from the 2005 National Evaluation of the Health Transfer Policy. Three hypotheses were tested, namely: (1) that inequalities in per capita financing exist between First Nations organizations, (2) that variations in per capita funding among communities cannot be explained by variations in the program responsibilities each assumed and (3) that First Nations organizations that transferred in the early 1990s now have access to fewer resources on a per capita basis than those that transferred more recently.

methodsWe compared (1) the per capita funding for 30 medium-sized communities (population = 401-3,000) that have Health Centres and the 13 similarly sized communities that have Health Stations, (2) program responsibilities and per capita funding for the same 30 communities and (3) the relationship between 2001-2002 per capita funding and the year of transfer for the same communities. We used data provided to us by the First Nations and Inuit Health Branch of Health Canada from 1989 to 2002.

resultsThe results show that differences in per capita funding exist among and within regions. These differences cannot be explained by the responsibilities each community chose to assume. Differences are also related to the year First Nations entered into a transfer agreement.

conclusionsWe recommend that formula-based financing be adopted to reduce inequalities. Such a formula should reflect needs, population growth and changes in costs of service delivery.