Open Access Research article

Decision maker perceptions of resource allocation processes in Canadian health care organizations: a national survey

Neale Smith1*, Craig Mitton12, Stirling Bryan12, Alan Davidson3, Bonnie Urquhart4, Jennifer L Gibson56, Stuart Peacock278 and Cam Donaldson9

Author Affiliations

1 Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 W 10 Avenue, V5Z1M9, Vancouver, BC, Canada

2 School of Population and Public Health, University of British Columbia, Vancouver, Canada

3 Faculty of Health and Social Development, UBC Okanagan, Kelowna, Canada

4 Northern Health Authority, Prince George, Canada

5 University of Toronto Joint Centre for Bioethics, Toronto, Canada

6 Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada

7 British Columbia Cancer Agency, Vancouver, Canada

8 Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, Canada

9 Yunus Centre for Social & Business Health, Glasgow Caledonian University, Glasgow, UK

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BMC Health Services Research 2013, 13:247  doi:10.1186/1472-6963-13-247

Published: 2 July 2013



Resource allocation is a key challenge for healthcare decision makers. While several case studies of organizational practice exist, there have been few large-scale cross-organization comparisons.


Between January and April 2011, we conducted an on-line survey of senior decision makers within regional health authorities (and closely equivalent organizations) across all Canadian provinces and territories. We received returns from 92 individual managers, from 60 out of 89 organizations in total. The survey inquired about structures, process features, and behaviours related to organization-wide resource allocation decisions. We focus here on three main aspects: type of process, perceived fairness, and overall rating.


About one-half of respondents indicated that their organization used a formal process for resource allocation, while the others reported that political or historical factors were predominant. Seventy percent (70%) of respondents self-reported that their resource allocation process was fair and just over one-half assessed their process as ‘good’ or ‘very good’. This paper explores these findings in greater detail and assesses them in context of the larger literature.


Data from this large-scale cross-jurisdictional survey helps to illustrate common challenges and areas of positive performance among Canada’s health system leadership teams.

Resource allocation; Priority setting; Survey research; Canada