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Consultation on a joint ACC and Ministry of Health Funding Model for Emergency Ambulance Services. Stakeholder Workshops November 2010. Welcome. Introductions Housekeeping Format of the meeting Goals for today Follow up . ACC and Ministry purchasing. National Ambulance Sector Office

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Consultation on a joint ACC and Ministry of Health Funding Model for Emergency Ambulance Services

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Consultation on a joint ACC and Ministry of Health Funding Model for Emergency Ambulance Services

Stakeholder Workshops

November 2010


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Welcome

Introductions

Housekeeping

Format of the meeting

Goals for today

Follow up


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ACC and Ministry purchasing

National Ambulance Sector Office

Looks after contracts for both ACC and the Ministry for emergency ambulance services (road, air, communications-111)

Aligns purchasing where possible

Reviews joint service specifications (road, air, communications-111)

Facilitates new initiatives

Administers the New Zealand Ambulance Services Strategy


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The Starting Point: NZ Ambulance Service Strategy

Initiative 2: Develop transparent, sustainable funding model(s) that link external drivers to agreed service expectations

Objective: a consistent agreed basis for funding Road and Air ambulance providers


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The case for change

Why do we need a new approach to funding emergency ambulance services?

ACC and the Ministry have different approaches to funding emergency ambulance services

Providers have consistently identified that having 2 funding models is an issue


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Critical issues

Different approaches lead to:

higher compliance costs for providers

perverse incentives associated with ACC’s fee-for-service

perverse incentives associated with Ministry contracts for air transports

a lack of ability to plan for the future


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Challenges with the current funding model

Question 1: Have we identified the critical issues with the current funding models? If not, what are they?


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The Emergency Ambulance Service


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Goals for a new funding model

The goals of the successful funding model are to:

deliver a single funding model for emergency ambulance services that meets the needs of both ACC and the Ministry

provide value for money for the Government, tax payers and levy payers

support decision making consistent with clinical priority and need

allow evolution into the future for the whole sector – the Government and providers (eg, allow for changes in purchasing of ambulance services across the wider health sector)

reduce compliance costs for providers and support longer term capacity building within the sector.


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Goals for a new funding model

Question 2: Do you support the goals for the new funding model? Do these goals address the critical issues?


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Assumptions

the model must work within current funding levels (taking into account inflationary pressures and any funding for one-off initiatives)

funding for Emergency Ambulance Communications Centres will continue on the current basis

the model will have no effect on ownership (ie, the Crown is not seeking to own the service)

the model will not include DHB funded inter-hospital transfers at this point in time as the first step is to align the ACC and the Ministry models.


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Range of funding models

Purely fee-for-service based funding

Blended bulk funded/ fee-for-service model

Status quo

Blended capacity/ fee‑for-service model

Bulk funding/block contracts

Pure capacity-based funding


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Proposed high level funding model

Blended funding model, combining bulk-funding or capacity funding with a fee-for-service component


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Proposed high level funding model

Question 3: Does the proposed high level model meet the needs of the Government, ACC, Ministry of Health, emergency ambulance providers, tax payers, levy payers and patients? Why or why not?

Question 4:

4(a) Does the proposed high level model address the problems with the current funding model?

4(b) Why or why not?

4(c) What are the benefits and risks, incentives and disincentives from your viewpoint?

Question 5: Are there any other funding model options you would have expected us to investigate? Please describe the model and how it will address the issues that have been identified.


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Three variations of the blended model


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Option 1: Bulk funding with a tolerance zone and fee-for-service above and below tolerance zone

Total ambulance funding

Funding capped at agreed level

FFS at agreed rate

Tolerance

Agreed bulk

No extra FFS payment

Volume

funding level

zone

Provider

-

sourced funding

Agreed bulk funding level

(eg, fundraising,

sponsorship, part

-

charges)

No wash up

Wash up payment

Provider returns agreed amount of funding

Funding floor at agreed level


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Question 6: What are the benefits and risks of this variation of the blended funding model (Option 1-bulk funding)? What incentives or disincentives are there in this model?

Question 7: What would need to be done to make this work in practice for emergency ambulance providers?


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Option 2: Capacity-funded fixed costs and fee-for-service variable costs


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Question 8: What are the benefits and risks of this variation of the blended funding model (Option 2)? What incentives or disincentives are there in this model?

Question 9: What should be classified as fixed costs and variable costs? Have we classified these correctly? What changes would you make? (see handout)

Question 10: What would need to be done to make this work in practice for emergency ambulance providers (Option 2)?


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Option 3: Capacity-funded fixed costs and fee-for-service variable costs with a maximum funding cap for fee-for-service


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Question 11: What are the benefits and risks of this variation of the blended funding model What incentives or disincentives are there in this model?

Question 12: What would need to be done to make this work in practice for emergency ambulance providers?


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Comparing the three variations on the high level blended funding model

Question 13: What should be the service components in a blended funding model (eg transport, call out, attendance, treatment etc)?

Question 14: Do you prefer variation 1 or 2 or 3? What is your first choice? Second choice? Third choice? Why?

Question 15: If you prefer Option 1(bulk-funding/fee-for-service) then what should be included in the bulk funded component? What service components should be fee-for-service?

Question 16: If you prefer Options 2 or 3 (capacity-funded/fee-for-service) then what should be included in the capacity funded component? What service components should be fee-for-service?


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Any further questions?

Question 17:Any other comments?


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Next steps

Key themes from Stakeholder meetings will be put onto NASO website (www.naso.govt.nz)

Consultation period closes 5pm 15 December 2010

Send your submission to NASOconsult@acc.co.nz

Funding model implementation anticipated through road and air ambulance contracts December 2012 


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