Royal Columbian Hospital and Eagle Ridge Hospital

British Columbia's Pay-for-Performance Experiment: Part of the Solution to Reduce Emergency Department Crowding?

The purpose of this study is to analyze whether funding policies based on ED wait times are associated with decreases in ED transit times and ED length of stay.

Research Team:

  1. Dr. Amy Cheng, MD, FRCPC, dipABEM, MBA, Royal Columbian Hospital, Department of Emergency Medicine, UBC
  2. Dr. Jason M. Sutherland, PhD, Centre for Health Services and Policy Research, School of Population and Public Health, UBC



Emergency department overcrowding continues to be a problem in Canada and the United States. In Canada, where hospital care is funded publicly, a variety of policy responses have been implemented to address the long wait times in EDs. In British Columbia, an ED pay-for-performance (ED P4P) program was initiated in 2007. The program was designed to create financial incentives to hospitals to reduce patients’ ED length of stay.


The objective of this paper is to determine if the ED P4P program is associated with decreases in ED length of stay.