Doing more with less new zealand s response to the health care sustainability challenge
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Doing more with less: New Zealand’s response to the health care sustainability challenge. Toni Ashton Professor in health economics School of Population Health, University of Auckland. School of Population Health. Average spending on health per capita ($US PPP).

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Doing more with less: New Zealand’s response to the health care sustainability challenge

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Doing more with less new zealand s response to the health care sustainability challenge

Doing more with less: New Zealand’s response to the health care sustainability challenge

Toni Ashton

Professor in health economics

School of Population Health, University of Auckland

School of Population Health


Average spending on health per capita us ppp

Average spending on healthper capita ($US PPP)


Real growth in public health expenditure 1950 2010

Real growth in public health expenditure 1950 - 2010


Inputs

Inputs

Source: OECD Health Data 2012


Outputs

Outputs

Source: OECD Health Data 2012


Nz health system

NZ health system

  • 82% public funding (74% tax, 8% SI)

  • Risk-adjusted population-based regional funding

  • Free care in public hospitals - specialists salaried

  • GPs paid by capitation + copayments

  • Supplementary private insurance

  • Strong central guidance


Waves of reform in nz

Waves of “reform” in NZ

  • 1938:

    • Introduction of public health system

    • Locally-elected hospitals boards

  • 1993:

    • Purchaser/provider split and provider competition

    • Commercialisation of hospitals

  • 2000:

    • Back to locally-elected district health boards

    • Emphasis on primary health care


Doing more with less new zealand s response to the health care sustainability challenge

Ministry

of Health

Population-based

Funding

Accident

Compensation

Corporation

20 District Health Boards

“Service agreements”

Ownership

PHOs, NGOs, Other private providers

Public

Hospitals


Budget may 16 2013

Budget May 16 2013

“While many developed countries are freezing or reducing health funding, this government is committed to protecting and growing our public health services.........”

NZ$1.6 billion extra over next 4 years


Doing more with less new zealand s response to the health care sustainability challenge

“We need to see further improvement in efficiency gains and containing costs..... We must do more with less”


Doing more with less macro policy level

Doing more with less: Macro (policy) level

  • Regionalisation/centralisation

    • Regional planning

    • Regional provider networks

    • Regional procurement of supplies

    • Centralisation of DHB ‘back office’ functions, IT, workforce

    • Fewer DHBs??

  • HTA and prioritisation

  • Extension of PHARMAC to medical devices


Impact of pharmac on drug expenditure

Impact of PHARMAC on drug expenditure


Meso organisational level

Meso (organisational) level

  • Concentration of specialised hospital services

  • Shift of care from hospitals into the community

  • Improved integration of services


  • Integrated family health centres the vision

    Integrated Family Health Centres: The vision

    Co-location of a wide range of services provided by multi-disciplinary teams

    • Minor surgery

    • Walk-in clinic

    • Nurse-led clinics for chronic care

    • Full diagnostics

    • Specialist assessments

    • Allied health services

    • Some social care


    Integrated family health centres the practice

    Integrated Family Health Centres: The practice

    • Development patchy – and slow

    • Lack of start-up capital

    • Collaboration more important than co-location


    Meso organisational level1

    Meso (organisational) level

    • Concentration of specialised hospital services

  • Shift of care from hospitals into the community

  • Improved integration of services

  • Productivity of hospital wards


  • Productivity of public hospitals

    Productivity of public hospitals

    Doctorsand nurses

    Med and Surg outputs

    Productivity


    Releasing time to care

    “Releasing time to care”

    • Time spent with patients increased by over 10%. Sometimes doubled.

    • Cost savings: eg: reduced stock levels, laundry

    • Fewer patient complaints, increased patient safety, improved staff morale


    Meso organisational level2

    Meso (organisational) level

    • Concentration of specialised hospital services

  • Shift of care from hospitals into the community

  • Improved integration of services

  • Productivity of hospital wards

  • Long term care


  • Long term care

    Long-term care

    Source: OECD


    Long term care1

    Long-term care

    • “Aging in place”

    • Standardised needs-assessment

    • Assisted living arrangements??

    • Stricter income and asset testing??

    • Increase pre-funding??

      • Compulsory insurance

      • Incentives for private saving


    Micro level doctors and patients

    Micro-level (doctors and patients)

    • Task-shifting

      • Nurses, pharmacists, physician assistants

    • Improve patient self-management

    • Prevention

      • CVD and diabetes risk assessment

      • Immunisation

      • Smoking


    What is not being discussed

    What is NOT being discussed?

    • Increasing copayments

    • Greater use of private insurance

    • Increasing competition and choice

    • Methods of reducing “unneccessary” care


    Doing more with less new zealand s response to the health care sustainability challenge

    Dank u wel!


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