Budgeting

The three major sources of income for a hospital are government grants, revenue from medical services provided on a fee-for-service basis and donations.

The Department of Health provides grants to medical institutions on an annual basis, although sometimes grants are committed over a period of time. Negotiations occur between the hospital and the Province for those annual grants.

The Department of Health and the HSC had an arrangement whereby the Province provided an annual grant to the HSC that allowed the HSC to decide how to divide the money among its various departments. This was called global budgeting.

Under global budgeting, the various HSC departments negotiated with hospital administrators and committees for a share of the money. As with any such process, decisions were made in a manner that some saw as unfair. Those involved in pediatrics often felt that the lion's share of funding at the HSC was given to the adult side, leaving pediatrics with less than its fair share. This situation was said to arise because of the inordinate influence that those on the adult side seemed to have over the process of the distribution of money.

One would also have to recognize that the amount of money spent on services to adult patients would tend to reflect the fact that the numbers of adult patients at the HSC greatly outnumbered the pediatric cases. Additionally, adult patients provided a greater source of income from fees for service than did pediatric patients. This was not only because of the greater number of adults but also because the fee schedule, the basis for payment for those services, seemed to pay more for adult procedures than it did for those involving children.

It is difficult to describe with any degree of certainty the extent to which this tension between the adult and pediatric communities within the hospital might have played a role in the events surrounding the Pediatric Cardiac Surgery Program at Children's Hospital in 1994. Nonetheless, where it has been raised or may possibly have been an issue, mention will be made in this report.