Transcript CMDHB-Chronic Care Management Programme

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 ($US PPP)
Real growth in public health
expenditure 1950 - 2010
Inputs
New Zealand
Netherlands
% GDP on health (2010)
10.1
12.0
Expenditure per capita
(US$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
Outputs
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
Source: OECD Health Data 2012
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

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
Ministry
of Health
Population-based
Funding
Accident
Compensation
Corporation
“Service
agreements”
PHOs, NGOs,
Other private
providers
20 District Health
Boards
Ownership
Public
Hospitals
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
“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
Integrated Family Health
Centres: The practice



Development patchy – and slow
Lack of start-up capital
Collaboration more important than
co-location
Meso (organisational) level



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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
Doctors and nurses
Med and Surg outputs
Productivity
“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


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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
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%
Source: OECD
Long-term care

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
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“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!