doing more with less: new zealand’s response to the health care sustainability challenge
DESCRIPTION
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 ($US PPP). - PowerPoint PPT PresentationTRANSCRIPT
Doing more with less: New Zealand’s response to the
health care sustainability challenge
Toni AshtonProfessor in health economics
School of Population Health, University of Auckland
School of Population Health
Average spending on healthper capita ($US PPP)
Real growth in public health expenditure 1950 - 2010
New Zealand Netherlands
% GDP on health (2010) 10.1 12.0
Expenditure per capita (US$PPP )
3022 5056
Annual growth rate 2000- 2010
5.5% 5.4%
Physicians per 1000 2.6 2.9
Nurses per 1000 10 8.4
Hospital beds per 1000 2.7 4.7
Pharm. Expenditure per cap (US$PPP)
285 481
Source: OECD Health Data 2012
Inputs
New Zealand Netherlands
Doctor consults per year 2.9 6.6
MRI exams per 1000 3.6 49.1
CT scans per 1000 22.4 66.0
Hospital discharges per 1000 1469 1158
Caesarean sections per 1000 235 148
Outputs
Source: OECD Health Data 2012
NZ health systemNZ 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 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
PublicHospitals
Ministryof Health
20 District Health Boards
“Service agreements”
Ownership
AccidentCompensation
Corporation
PHOs, NGOs, Other private
providers
Population-basedFunding
“While many developed countries are freezing or reducing health funding, this government is committed to protecting and growing our public health services.........”
Budget May 16 2013
NZ$1.6 billion extra over next 4 years
“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
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
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
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
Development patchy – and slow Lack of start-up capital Collaboration more important than
co-location
Integrated Family Health Centres: The practice
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 Productivity of public hospitalshospitals
Productivity
Med and Surg outputs
Doctors and nurses
“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) 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
New Zealand Netherlands
Pop >65 years 13.5% 15.2%
Pop >80 years 3.4% 3.9%
65+ in residential care 3.6% 6.7%
65+ receiving home care 11.6% 12.9%
%GDP on long-term care 1.4% 3.5%
Long-term care
Source: OECD
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)
Task-shifting– Nurses, pharmacists, physician assistants
Improve patient self-management Prevention
– CVD and diabetes risk assessment– Immunisation– Smoking
What is NOT being discussed?
Increasing copayments Greater use of private insurance Increasing competition and
choice Methods of reducing
“unneccessary” care
Dank u wel!