scholarly journals Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

2021 ◽  
Author(s):  
◽  
Carolyn Joy Cordery
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Service Providers ◽  
Balance Control ◽  
Primary Health Care System ◽  
Multiple Stakeholders ◽  
Public Funds ◽  
Primary Health ◽  
The Government

<p>Cooperative activity necessitates participants acknowledging joint goals, often delegating resources, consequent performance, tailored accountability reporting and feedback (Levaggi, 1995). Thus, accountability is a process reflecting the interdependence of social relationships (Roberts, 1991). Such interdependence is evident in publicly funded health care systems where governments contract with autonomous providers, as occurs in the New Zealand primary health care system. Primary health care (as patients' first point of contact with the health system) was reformed significantly with the launch of the Primary Health Care Strategy [(Minister of Health, 2001) effective from May, 2002]. Increased government funding became available to Primary Health Organisations (PHOs), new entities that were to act as intermediaries between the government on the one hand, and primary health care practitioners on the other. PHOs became responsible for designing and contracting for the delivery of primary health programmes so as to improve their communities' health (Minister of Health, 2001). Consequent upon increased public funding distributed through these organisations, the government requires all PHOs to be 'fully and openly accountable' for all public funds they receive. O'Dwyer and Unerman (2006) term this 'holistic' accountability. Further, PHOs must be private not-for-profit organisations, reducing the likelihood that public funds will be diverted to shareholder dividends paid out by profit-oriented providers (Minister of Health, 2001). Despite the promise of accountability, the challenges of meeting the expectations of multiple stakeholders and choosing effective accountability mechanisms potentially mitigate against PHOs discharging accountability adequately. Accordingly, this research is an interpretive study into the understanding of PHOs and their stakeholders of 'to whom', 'for what', 'why' and 'how' accountability is discharged and how these challenges are mana ged. Four PHOs consented to be included as case studies during the 2006 and 2007 financial years. This ethnographic research collected financial and non-financial data, observed community meetings, interviewed key stakeholders and integrated research participants' feedback to reflect on current theory. It was found that stakeholders expect PHOs to prioritise either community or their funding and service providers, giving rise to possible conflicting demands. PHOs appear to manage this conflict internally, although the manner in which they do so evokes particular external images. Some District Health Boards (DHBs), as PHOs' funders, seek to manage PHOs' prioritisation by positing themselves as the arbiters of community needs. Further, while the Primary Health Care Strategy appears to require accountability to counter-balance control of PHOs with enhancing trust in DHB/PHO relationships, in this research it was found that PHOs subjected to strong funder control experience reduced autonomy and, by extension, fewer opportunities to learn. A further finding of this research was that 'mapping' the observations of stakeholders' expectations and the operation of control and/or trust against each other enables the identification of deficits in the process of holistic accountability. Accordingly, suggestions for mechanisms that will enable PHOs to balance multiple stakeholders and discharge holistic accountability are derived.</p>

scholarly journals Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

2021 ◽  
Author(s):  
◽  
Carolyn Joy Cordery
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Service Providers ◽  
Balance Control ◽  
Primary Health Care System ◽  
Multiple Stakeholders ◽  
Public Funds ◽  
Primary Health ◽  
The Government

<p>Cooperative activity necessitates participants acknowledging joint goals, often delegating resources, consequent performance, tailored accountability reporting and feedback (Levaggi, 1995). Thus, accountability is a process reflecting the interdependence of social relationships (Roberts, 1991). Such interdependence is evident in publicly funded health care systems where governments contract with autonomous providers, as occurs in the New Zealand primary health care system. Primary health care (as patients' first point of contact with the health system) was reformed significantly with the launch of the Primary Health Care Strategy [(Minister of Health, 2001) effective from May, 2002]. Increased government funding became available to Primary Health Organisations (PHOs), new entities that were to act as intermediaries between the government on the one hand, and primary health care practitioners on the other. PHOs became responsible for designing and contracting for the delivery of primary health programmes so as to improve their communities' health (Minister of Health, 2001). Consequent upon increased public funding distributed through these organisations, the government requires all PHOs to be 'fully and openly accountable' for all public funds they receive. O'Dwyer and Unerman (2006) term this 'holistic' accountability. Further, PHOs must be private not-for-profit organisations, reducing the likelihood that public funds will be diverted to shareholder dividends paid out by profit-oriented providers (Minister of Health, 2001). Despite the promise of accountability, the challenges of meeting the expectations of multiple stakeholders and choosing effective accountability mechanisms potentially mitigate against PHOs discharging accountability adequately. Accordingly, this research is an interpretive study into the understanding of PHOs and their stakeholders of 'to whom', 'for what', 'why' and 'how' accountability is discharged and how these challenges are mana ged. Four PHOs consented to be included as case studies during the 2006 and 2007 financial years. This ethnographic research collected financial and non-financial data, observed community meetings, interviewed key stakeholders and integrated research participants' feedback to reflect on current theory. It was found that stakeholders expect PHOs to prioritise either community or their funding and service providers, giving rise to possible conflicting demands. PHOs appear to manage this conflict internally, although the manner in which they do so evokes particular external images. Some District Health Boards (DHBs), as PHOs' funders, seek to manage PHOs' prioritisation by positing themselves as the arbiters of community needs. Further, while the Primary Health Care Strategy appears to require accountability to counter-balance control of PHOs with enhancing trust in DHB/PHO relationships, in this research it was found that PHOs subjected to strong funder control experience reduced autonomy and, by extension, fewer opportunities to learn. A further finding of this research was that 'mapping' the observations of stakeholders' expectations and the operation of control and/or trust against each other enables the identification of deficits in the process of holistic accountability. Accordingly, suggestions for mechanisms that will enable PHOs to balance multiple stakeholders and discharge holistic accountability are derived.</p>

scholarly journals Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy

2021 ◽  
Author(s):  
◽  
Bronwyn Howell
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Primary Health Care ◽  
New Zealand ◽  
Financial Risk ◽  
Care Delivery ◽  
Primary Health Care System ◽  
Financial Risks ◽  
Primary Health ◽  
The Government

<p>This thesis examines how funding changes in the New Zealand Primary Health Care Strategy (NZPHCS), introduced in 2002, altered the magnitude, locus and management of financial risk in the New Zealand primary health care sector, and the consequences for cost, equity and care delivery objectives. A simplified model of a primary health care system is developed to explore how the funding changes influenced, and were influenced by, existing institutions and arrangements in the New Zealand sector. Drawing on industrial organisation, transaction cost economics, health economics and health care policy literatures and analysis, financial risk sharing between the government and private entities before and after the NZPHCS implementation is assessed. The effects of the policy on a range of indicators assessing the relative, theoretically-expected changes in costs and equitable allocation of financial and health care resources are identified.  The NZPHCS was intended to reduce service user fees, foster an integrated multidisciplinary approach to primary care delivery, reduce health inequalities and encourage the promotion and maintenance of healthy populations. Progress towards thesem objectives was disappointing. The government abrogated responsibility for managing financial risks associated with uncertainty about funded individuals’ future care needs when replacing fee-for-service funding with capitation funding of individuals within a population. Very small, risk-averse care providers became the primary risk pool managers. Via legacy balance-billing arrangements, much higher risk management costs have likely been passed on to service users in either or both of higher-than-expected fees and more variable care quality. Those with the greatest needs for primary care, and those whose fees the government intended to reduce most, have most probably borne a disproportionately higher share of the additional financial risk management costs.  If the New Zealand primary health care system is to evolve towards the one envisaged by the NZPHCS, the government should assume a share of responsibility for managing financial risks associated with utilisation uncertainty. A mixed funding model, proposed and evaluated against the NZPHCS and three other policy options, provides risk management arrangements most likely to be conducive to delivering the desired cost and equity objectives. At the same time it provides a more stable path towards a fully government-funded New Zealand primary health care sector than the current arrangements.  The findings specifically address the New Zealand context. However, the model and analytical framework developed are applicable to a wide range of primary health care policies, notably where partial private funding is either utilised or contemplated, and changes from service-based to population-based funding are being considered.</p>

scholarly journals Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy

2021 ◽  
Author(s):  
◽  
Bronwyn Howell
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Primary Health Care ◽  
New Zealand ◽  
Financial Risk ◽  
Care Delivery ◽  
Primary Health Care System ◽  
Financial Risks ◽  
Primary Health ◽  
The Government

<p>This thesis examines how funding changes in the New Zealand Primary Health Care Strategy (NZPHCS), introduced in 2002, altered the magnitude, locus and management of financial risk in the New Zealand primary health care sector, and the consequences for cost, equity and care delivery objectives. A simplified model of a primary health care system is developed to explore how the funding changes influenced, and were influenced by, existing institutions and arrangements in the New Zealand sector. Drawing on industrial organisation, transaction cost economics, health economics and health care policy literatures and analysis, financial risk sharing between the government and private entities before and after the NZPHCS implementation is assessed. The effects of the policy on a range of indicators assessing the relative, theoretically-expected changes in costs and equitable allocation of financial and health care resources are identified.  The NZPHCS was intended to reduce service user fees, foster an integrated multidisciplinary approach to primary care delivery, reduce health inequalities and encourage the promotion and maintenance of healthy populations. Progress towards thesem objectives was disappointing. The government abrogated responsibility for managing financial risks associated with uncertainty about funded individuals’ future care needs when replacing fee-for-service funding with capitation funding of individuals within a population. Very small, risk-averse care providers became the primary risk pool managers. Via legacy balance-billing arrangements, much higher risk management costs have likely been passed on to service users in either or both of higher-than-expected fees and more variable care quality. Those with the greatest needs for primary care, and those whose fees the government intended to reduce most, have most probably borne a disproportionately higher share of the additional financial risk management costs.  If the New Zealand primary health care system is to evolve towards the one envisaged by the NZPHCS, the government should assume a share of responsibility for managing financial risks associated with utilisation uncertainty. A mixed funding model, proposed and evaluated against the NZPHCS and three other policy options, provides risk management arrangements most likely to be conducive to delivering the desired cost and equity objectives. At the same time it provides a more stable path towards a fully government-funded New Zealand primary health care sector than the current arrangements.  The findings specifically address the New Zealand context. However, the model and analytical framework developed are applicable to a wide range of primary health care policies, notably where partial private funding is either utilised or contemplated, and changes from service-based to population-based funding are being considered.</p>

scholarly journals Rural health care in New Zealand: the case of Coast to Coast Health Centre, Wellsford, an early Integrated Family Health Centre

2015 ◽  
Vol 7 (4) ◽  
pp. 309 ◽  
Author(s):  
Antony Raymont ◽  
Mary-Anne Boyd ◽  
Timothy Malloy ◽  
Nancy Malloy
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Service ◽  
Rural Health ◽  
Service Providers ◽  
Health Centre ◽  
Service Utilisation ◽  
Primary Health ◽  
Wide Range

INTRODUCTION: Primary health care is critical, particularly in rural areas distant from secondary care services. AIM: To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. METHODS: Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. RESULTS: The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. DISCUSSION: A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area. KEYWORDS: Interdisciplinary; New Zealand; primary health care; rural health services

Domestic Violence again Women in Sri Lanka: The Role of Primary Health Care in Complementing Human Rights and Legal Responses

2007 ◽  
Vol 13 (1) ◽  
pp. 52 ◽  
Author(s):  
Loshan N Moonesinghe ◽  
Simon Barraclough
Keyword(s):  
Health Care ◽  
Domestic Violence ◽  
Human Rights ◽  
Primary Health Care ◽  
Sri Lanka ◽  
Violence Against Women ◽  
Service Providers ◽  
Legal Rights ◽  
Primary Health ◽  
The Government

Using an analysis of primary documents and secondary sources, the problem of domestic violence against women in Sri Lanka is surveyed from the perspectives of public health, as well as human and legal rights. The limited Sri Lankan literature on the measurements, context and prevalence of such violence, as well as legislation for its prevention, is reviewed. Responses to the problem by the government and non-government organisations are described. These include using international organisations, forums and conventions to further the human rights dimensions of the problem, the establishment of support services and domestic legal reforms to accord greater protection to women. While The Prevention of Domestic Violence Act 2005 gave legislative recognition to the problem and put into place some welcome reforms, it lacked a comprehensive response to the problem. It is argued that health service providers need to be trained to be aware of domestic violence as the potential cause of physical injuries and mental conditions and that the medical record should document the circumstances and nature of domestic violence. Hospital outpatient departments should offer counselling, referrals to crisis centres and shelters, and should collect sex disaggregated data on domestic assaults. Finally, primary health care workers can both support women in dealing with domestic violence as well as performing a sentinel role in prevention. Specific and comprehensive public policy on violence against women must be developed to allow the health sector to play its role within a context of inter-sectoral collaboration.

scholarly journals A Qualitative Study on Patient-Centered Care and Perception of Nurses in Primary Healthcare Practice

2020 ◽  
Author(s):  
Adepeju Lateef ◽  
Euphemia Mbali Mhlongo
Keyword(s):  
Health Care ◽  
Qualitative Research ◽  
Primary Health Care ◽  
Healthcare Service ◽  
Patient Centered Care ◽  
Primary Health Care System ◽  
Patient Centered ◽  
Primary Health ◽  
Centered Care ◽  
The Government

Abstract Background: Patient-centered care (PCC) approach has continued to gain recognition globally as the key to providing quality healthcare. However, this concept is not fully integrated into the management of primary health care (PHC) in existing nursing practice due to numerous challenges. Among these challenges is the perception of nursing on PCC in the Primary Health Care system. This study seeks to present the results of qualitative research performed at various selected PHC centers on nurses’ perceptions in PCC practice.Aim: This study aims at exploring the perception of nurses on PCC.Method: A qualitative research approach was adopted for this study. This study involved thirty local government PHC centers located in Osun State of southwest Nigeria. The sample comprised 28 female nurses and 7 male nurses. Data were collected through a semi-structured interview schedule in different sessions that were conducted on a one on one basis. Thereafter, data analysis was performed using thematic analysis and NVivo 12 software to generate themes, subthemes, and codes.Results: The findings of the study revealed a number of perceptions on PCC that were categorized into positive and negative themes. The negative themes include: Poor approach by the nurses and lack of enforcement agency. The positive themes that emerged include: Outcome-driven healthcare, valued care provider, communication to sharpen care, and driven healthcare service. In addition, the findings established a positive correlation between perception and years of working experience. 68.5 % of the participants, who had working experience in the range of 12 – 31 years, expressed a mixed perception of PCC practice. The remaining 31.5 % of the participants interviewed who had working experience in the range of 2, 6 – 11 years, expressed positive perceptions on the provision of PCC. Conclusion: From the findings of this study, there is a need for the government to enforce the utilization and provision of PCC in the PHC setting. This should be done through the provision of an enabling environment in the PHC setting. In addition, the government should provide regulations and monitoring mechanisms in the PHC institutions. Enforcement agencies should also offer opportunities for continuous training to enhance the nursing care skills of nurses to stimulate and sustain improved healthcare services. Lastly, the government should remunerate and promote nurses based on merit as another means of supporting improved healthcare service delivery by the nurses.

scholarly journals Providers' Definitions of Quality and Barriers to Providing Care: a Qualitative Study in Rural Mpumalanga Province, South Africa

2020 ◽  
Author(s):  
Rebecca L West ◽  
Sheri A Lippman ◽  
Rhian Twine ◽  
Meriam Maritze ◽  
Kathleen Kahn ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Service Providers ◽  
Quality Care ◽  
Primary Health Care System ◽  
Mpumalanga Province ◽  
Primary Health ◽  
National Quality

Abstract Background: Facing a quadruple burden of disease (infectious disease, non-communicable disease, maternal and child mortality, high levels of violence and injury), South Africa requires high-quality primary health care to retain patients and optimize outcomes. National health policy is focused on strengthening primary care. While prior research has identified implementation challenges within the primary health care system, there is less understanding of how providers define quality, their perceptions of barriers to providing quality care, and how they overcome these barriers. This study assesses provider views on quality at primary care clinics in a rural region of Mpumalanga Province. Methods: We conducted in-depth interviews with providers in Bushbuckridge sub-district in early 2019 on the value of quality metrics for providers and patients, what indicators they would use to assess clinic performance, and barriers and facilitators of delivering care. Interviews were conducted in Shangaan, audio-recorded, translated, and transcribed into English. A deductive approach was used to develop a provisional coding schema based on study questions, which was refined using an inductive approach in response to patterns and themes emerging from the data.Results: 23 providers were interviewed (83% female, 65% professional nurses). Definitions of quality were focused on clinic structure and resources. Few providers identified patient outcomes as indicators of quality. Providers linked deficiencies in infrastructure and support to deficits in care delivery, such as long wait times due to limited staffing, privacy breaches due to insufficient space, and a chronic lack of medication and equipment. Providers identified mitigating strategies including informal coordination across clinics to address medication shortages in individual facilities. Interwoven throughout the providers’ discussion was the poor communication between the district, PHC supervisors, and implementers at the facility level. Conclusion: Providers connected deficits in quality of care to inadequate infrastructure and insufficient support from district and provincial authorities; mitigating strategies across clinics could only partially address these deficits. The existence of a national quality measurement program was not broadly reflected in providers’ views on quality care. These findings underscore the need for effective district and national approaches to support individual facilities, accompanied by feedback methods designed with input from frontline service providers.

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