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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Format of the meeting
Goals for today
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
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
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
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
Question 1: Have we identified the critical issues with the current funding models? If not, what are they?
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.
Question 2: Do you support the goals for the new funding model? Do these goals address the critical issues?
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.
Purely fee-for-service based funding
Blended bulk funded/ fee-for-service model
Blended capacity/ fee‑for-service model
Bulk funding/block contracts
Pure capacity-based funding
Blended funding model, combining bulk-funding or capacity funding with a fee-for-service component
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?
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.
Total ambulance funding
Funding capped at agreed level
FFS at agreed rate
No extra FFS payment
Agreed bulk funding level
No wash up
Wash up payment
Provider returns agreed amount of funding
Funding floor at agreed level
Question 6: fee-for-service above and below tolerance zone 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?
Question 8: variable costs 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)?
Question 11: variable costs with a maximum funding cap for fee-for-service 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?
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?
Question 17:Any other comments?