Measuring Productivity in the Health Sector

Over the next few decades governments will increasingly need to balance the new and growing demands facing the health system with a tighter fiscal outlook. The best way to protect standards while responding to these pressures will be to lift productivity. This article draws on a recent New Zealand Productivity Commission inquiry into state sector productivity and discusses the implications of this work for the health sector. It begins by highlighting the importance of health sector productivity, particularly given the fiscal outlook. It then discusses recent efforts to measure productivity in the health system, before outlining possible next steps in measuring the sector’s productivity.

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Change through continuity:a quiet revolution in primary health care in New Zealand

Australian Health Review ◽

10.1071/ah050380 ◽

2005 ◽

Vol 29 (4) ◽

pp. 380 ◽

Cited By ~ 2

Author(s):

Toni Ashton

Keyword(s):

New Zealand ◽

Health System ◽

Structural Changes ◽

Health Sector ◽

Major Change ◽

System Reform ◽

Whole Process ◽

And Performance ◽

High Level ◽

Key Aspects

IN A RECENTLY PUBLISHED paper entitled Continuity through change: the rhetoric and reality of health reform in New Zealand, I and my co-authors Nick Mays and Nancy Devlin pointed out that, in spite of a series of major health sector reforms during the 1990s and early 2000s, some key aspects of the system have endured.1 Moreover, many incremental changes to existing processes and systems that occurred during the reform period have, arguably, been more important to improving the functioning and performance of the system than the more high level (and more visible) structural changes. Since that paper was written, many further changes have occurred in the organisation, funding and management of the New Zealand health system. However, in contrast to the 1990s, the focus now is on continuity and stability rather than on any need for further major change. Indeed, terms such as ?reform? or ?restructuring? have now all but vanished from any debate about health policy in New Zealand. Perhaps the reformers have learned that health system reform is akin to training for the Olympics. The whole process takes a fair bit of time and effort, and results are unlikely to be achieved in the short term. Further major reform is also not regarded as politically viable. As noted in an article in the New Zealand Herald just before the general election in September, there is ?. . . considerable public sensitivity over any whiff of restructuring in health?.2

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A national quitline service and its promotion in the mass media: modelling the health gain, health equity and cost–utility

Tobacco Control ◽

10.1136/tobaccocontrol-2017-053660 ◽

2017 ◽

Vol 27 (4) ◽

pp. 434-441 ◽

Cited By ~ 10

Author(s):

Nhung Nghiem ◽

Christine L Cleghorn ◽

William Leung ◽

Nisha Nair ◽

Frederieke S van der Deen ◽

...

Keyword(s):

New Zealand ◽

Mass Media ◽

Cost Saving ◽

Health System ◽

Tobacco Control ◽

Health Equity ◽

Health Gain ◽

Health Sector ◽

Cost Utility ◽

The Mass Media

BackgroundMass media campaigns and quitlines are both important distinct components of tobacco control programmes around the world. But when used as an integrated package, the effectiveness and cost-effectiveness are not well described. We therefore aimed to estimate the health gain, health equity impacts and cost–utility of the package of a national quitline service and its promotion in the mass media.MethodsWe adapted an established Markov and multistate life-table macro-simulation model. The population was all New Zealand adults in 2011. Effect sizes and intervention costs were based on past New Zealand quitline data. Health system costs were from a national data set linking individual health events to costs.ResultsThe 1-year operation of the existing intervention package of mass media promotion and quitline service was found to be net cost saving to the health sector for all age groups, sexes and ethnic groups (saving $NZ84 million; 95%uncertainty interval 60–115 million in the base-case model). It also produced greater per capita health gains for Māori (indigenous) than non-Māori (2.2 vs 0.73 quality-adjusted life-years (QALYs) per 1000 population, respectively). The net cost saving of the intervention was maintained in all sensitivity and scenario analyses for example at a discount rate of 6% and when the intervention effect size was quartered (given the possibility of residual confounding in our estimates of smoking cessation). Running the intervention for 20 years would generate an estimated 54 000 QALYs and $NZ1.10 billion (US$0.74 billion) in cost savings.ConclusionsThe package of a quitline service and its promotion in the mass media appears to be an effective means to generate health gain, address health inequalities and save health system costs. Nevertheless, the role of this intervention needs to be compared with other tobacco control and health sector interventions, some of which may be even more cost saving.

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Corporate governance of public health services: Lessons from New Zealand for the State sector

Australian Health Review ◽

10.1071/ah000009 ◽

2000 ◽

Vol 23 (1) ◽

pp. 9 ◽

Cited By ~ 3

Author(s):

Rod Perkins ◽

Pauline Barnett ◽

Michael Powell

Keyword(s):

Public Health ◽

Corporate Governance ◽

New Zealand ◽

Health Sector ◽

Public Hospitals ◽

Business Sector ◽

Public Health Services ◽

Business Systems ◽

Related Services ◽

State Sector

New Zealand public hospitals and related services were grouped into 23 Crown HealthEnterprises and registered as companies in 1993. Integral to this change was the introductionof corporate governance. New directors, largely from the business sector, were appointed togovern these organisations as efficient and effective businesses. This article presents the resultsof a survey of directors of New Zealand publicly-owned health provider organisations.Although directors thought they performed well in business systems development, theyacknowledged their shortcomings in meeting government expectations in respect to financialperformance and social responsibility. Changes in public health sector provider performanceindicators have resulted in a mixed report card for the sector six years after corporategovernance was instituted.

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Employment Relations in the New Zealand Public Health Sector - A Survey

Labour Employment and Work in New Zealand ◽

10.26686/lew.v0i0.981 ◽

1970 ◽

Author(s):

Michael Pye ◽

Joanna Cullinane

Keyword(s):

Public Health ◽

New Zealand ◽

Workforce Development ◽

Care Delivery ◽

Industrial Relations ◽

Health Sector ◽

Employment Relations ◽

State Sector ◽

Public Health Sector ◽

The Impact

The New Zealand Public Health sector has undergone significant political, Legislative and managerial changes since 1986. These changes have had a major impact on the nature of employment relations in the sector. The unified, state sector industrial relations regime has been restructured and replaced a by diverse set of practices. Many of the changes of the last decade have had time to 'mature' and become embedded into the system and it now seems appropriate to start to identify issues that have arisen from the impact of the new regime of employment relations. This paper presents the results of a survey of related public health sector organisations including employers, unions, professional organisations, statutory bodies and funding agencies. Five distinct areas for future employment relations research, with varying Levels of priority, were identified by the respondents including; 1) Workforce development and planning. 2) The nature, scope and negotiation of employment contracts. 3) The problematic of people management of largely 'professional ' group of workers. 4) Relationships with external organisations such as the 'NZQA 'and the 'Health and Disability Commissioner' and the impact on internal employment relations. 5) The effects of uncertainty about current health care delivery structures and possible further politically directed restructuring are having on employment relations.

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Care coordination and health sector reform

Australian Health Review ◽

10.1071/ah040253 ◽

2004 ◽

Vol 28 (3) ◽

pp. 253

Author(s):

Judith Dwyer ◽

Sandra G Leggat

Keyword(s):

Health Care ◽

Health System ◽

Care Coordination ◽

Care Delivery ◽

Improve Patient Safety ◽

Health Sector ◽

Health Sector Reform ◽

Sector Reform ◽

Structural Problems ◽

Productivity Commission

THE PRODUCTIVITY COMMISSION (Productivity Commission 2004) has nominated nationally coordinated health sector reform as one of two top priorities (along with natural resource management) for extending the industry reform agenda under the aegis of National Competition Policy. This is in recognition of the importance of these areas for the wellbeing of Australians, and the level of resources they will require in future years. The Commission states that ?an independent review of Australia?s health system as a whole is a critical first step in achieving cooperative solutions to deep-seated structural problems? (p. XI). The fragmentation in health system governance that results from the national? state split is mirrored in the lack of coordinated care at many levels throughout the system. The Commission?s proposal has been welcomed by many in the health industry, no doubt with some nervousness, because of the broad and deep conviction that something has to change in the apparently intractable problem of split funding responsibilities. ?Today?s health-care delivery systems are not organized in ways that promote best quality. Service delivery is largely uncoordinated, requiring steps and patient ?hand-offs? that slow down care and decrease rather than improve patient safety? (OECD 2004). Improving care coordination is high on the list of issues to be addressed in any reform of the health sector. This issue of the journal features a collection of papers which address the sometimes jagged ?seams? in the current system. They offer insights into some of the consequences of the structural problems the Productivity Commission would like to see addressed, and document an energetic search for methods of enhancing the effectiveness of health care.

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The Voluntary Health Sector in the Health System: Understanding the Contributions

PsycEXTRA Dataset ◽

10.1037/e506832013-095 ◽

2001 ◽

Author(s):

Judy M. Birdsell

Keyword(s):

Health System ◽

Health Sector

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The impact of the 1993 Colombian health sector reform on the overall performance of the health system

10.25148/etd.fi15101359 ◽

2002 ◽

Author(s):

Jesus D. Felizzola

Keyword(s):

Health System ◽

Health Sector ◽

Health Sector Reform ◽

Sector Reform ◽

Overall Performance ◽

The Impact

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Governance

10.1093/oso/9780190662455.003.0013 ◽

2017 ◽

Author(s):

Joia S. Mukherjee

Keyword(s):

Global Health ◽

Health System ◽

Global Governance ◽

Health Sector ◽

Nation State ◽

System A ◽

Health Strategy ◽

External Forces ◽

Globalized World ◽

Global Governance For Health

This chapter focuses on governance, a key building block of a health system. A government is responsible for the health of its people. It sets the health strategy and oversees the implementation of health programs. External forces and actors influence the governance of the health sector. This chapter explores governance of health from the perspective of the nation-state coordinating its own health system (sometimes called governance for global health). The chapter examines the internal and external forces that influence national governance for global health. The chapter also looks beyond the level of the nation-state to explore the concept of global governance for health. In the interconnected and globalized world, global governance for health is needed to coordinate the geopolitical forces that impact health and its social determinants.

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Culturally competent, safe and equitable clinical care for Ma¯ori with bipolar disorder in New Zealand: The expert critique of Ma¯ori patients and Wha¯nau

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211031490 ◽

2021 ◽

pp. 000486742110314

Author(s):

Tracy Haitana ◽

Suzanne Pitama ◽

Donna Cormack ◽

Mau Te Rangimarie Clark ◽

Cameron Lacey

Keyword(s):

Bipolar Disorder ◽

New Zealand ◽

Cultural Competence ◽

Health System ◽

Clinical Care ◽

Clinical Work ◽

Culturally Competent ◽

Structured Interviews ◽

Clinical Culture ◽

Competence Framework

Objective: Research designed to increase knowledge about Māori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Māori patients with bipolar disorder and their whānau regarding the nuances of cultural competence and safety in clinical encounters with the health system. Methods: A qualitative Kaupapa Māori Research methodology was used. A total of 24 semi-structured interviews were completed with Māori patients with bipolar disorder and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Results: Three themes were evident from participants’ critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Māori patients and whānau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Māori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whānau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whānau as well as patient wellbeing. Conclusion: The standard of clinical care for Māori with bipolar disorder in New Zealand does not align with practice guidelines, Māori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Māori patient and whānau experiences of care.

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