The Devil in the Details: Some Conclusions about How Funding Changes Translate into Financial Incentives in the Canadian Health System

Every funding system creates “incentives.” However, in real policy applications, the motivating quality of a funding change is not inherent to the funding structure. Rather, contextual factors highly determine how organizations and individuals interpret, feel motivated by, and act in response to funding arrangements. Important contextual factors include relationships between and within affected organizations, social role expectations, regulations, and structures such as information and institutions. This paper surveys the findings of seven case studies that explored how stakeholders interpreted and responded to various funding reforms. Funding structures can be interpreted to alter relationships, to herald good or bad fortune, to carry, hide, or drop policy mandates, or to create enabling or disabling structures. We conclude that the incentives created by funding arrangements may be necessary to support health care reforms, but are unlikely ever to be sufficient to carry reforms through in the absence of similar-spirited regulations, information, and institutional arrangements.