scholarly journals Activity-Based Costing and Inter-District Flows in the New Zealand Public Health Sector

2021 ◽  
Author(s):  
◽  
Matthew Peter van Kesteren
Keyword(s):  
Public Health ◽  
Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health Care Systems ◽  
Health Sector ◽  
Activity Based Costing ◽  
District Health ◽  
Public Health Sector ◽  
Social Pressures

<p>Changes in the New Zealand public health sector in recent years, such as heightened political, economic and social pressures to manage and reduce costs while improving the quality of care in conjunction with stringent health care guidelines, have forced district health boards (DHB) nationwide to reassess their approach to health care provision. This has chiefly involved evaluating current practices or institutions; revising health care systems, including locality of treatment; and assessing established accounting systems and mechanisms (or lack thereof) to understand the source of costs and resource consumption. Acknowledging that patient welfare has always held pre-eminence in the New Zealand public health sector, balancing the dual pressures to enhance the utilisation of limited resources and adhere to social pressures to provide sustained high quality health services has been a difficult exercise for DHBs. In recognition of the potential benefits of activity-based costing (ABC), and the fact that the New Zealand public health sector is severely underrepresented in current literature, this multi-site case study examines how sophisticated costing systems (such as ABC), are being used by DHBs. Using an institutional theory framework, this study posits that DHBs will use sophisticated costing systems to (1) improve cost understanding with the goal of managing and reducing their costs; and (2) contribute to more informed National Prices for Inter-District Flows (IDF), the aim of which is to plan and provide services to meet the directives and outcomes outlined by the Ministry of Health. Overall, the findings are compelling and reveal that costing systems are used on three levels to plan and provide health services, including unsophisticated costing systems that are not formally recognised; moderately sophisticated costing systems (such as CostPro) that are formally recognised; and sophisticated costing systems (such as PPM) that are formally recognised. Furthermore, the findings reveal that DHBs with sophisticated costing systems generate event-level information, which directly influences the calculation of National Prices for IDFs. The findings of this exploratory study also indicate a need to examine the nexus between ABC and IDFs in a New Zealand public health sector context further.</p>

scholarly journals Activity-Based Costing and Inter-District Flows in the New Zealand Public Health Sector

2021 ◽  
Author(s):  
◽  
Matthew Peter van Kesteren
Keyword(s):  
Public Health ◽  
Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health Care Systems ◽  
Health Sector ◽  
Activity Based Costing ◽  
District Health ◽  
Public Health Sector ◽  
Social Pressures

<p>Changes in the New Zealand public health sector in recent years, such as heightened political, economic and social pressures to manage and reduce costs while improving the quality of care in conjunction with stringent health care guidelines, have forced district health boards (DHB) nationwide to reassess their approach to health care provision. This has chiefly involved evaluating current practices or institutions; revising health care systems, including locality of treatment; and assessing established accounting systems and mechanisms (or lack thereof) to understand the source of costs and resource consumption. Acknowledging that patient welfare has always held pre-eminence in the New Zealand public health sector, balancing the dual pressures to enhance the utilisation of limited resources and adhere to social pressures to provide sustained high quality health services has been a difficult exercise for DHBs. In recognition of the potential benefits of activity-based costing (ABC), and the fact that the New Zealand public health sector is severely underrepresented in current literature, this multi-site case study examines how sophisticated costing systems (such as ABC), are being used by DHBs. Using an institutional theory framework, this study posits that DHBs will use sophisticated costing systems to (1) improve cost understanding with the goal of managing and reducing their costs; and (2) contribute to more informed National Prices for Inter-District Flows (IDF), the aim of which is to plan and provide services to meet the directives and outcomes outlined by the Ministry of Health. Overall, the findings are compelling and reveal that costing systems are used on three levels to plan and provide health services, including unsophisticated costing systems that are not formally recognised; moderately sophisticated costing systems (such as CostPro) that are formally recognised; and sophisticated costing systems (such as PPM) that are formally recognised. Furthermore, the findings reveal that DHBs with sophisticated costing systems generate event-level information, which directly influences the calculation of National Prices for IDFs. The findings of this exploratory study also indicate a need to examine the nexus between ABC and IDFs in a New Zealand public health sector context further.</p>

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

2020 ◽  
pp. 152715442096553
Author(s):  
Sue Adams ◽  
Jenny Carryer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Nurse Practitioner ◽  
Central Government ◽  
Health Sector ◽  
District Health ◽  
Policy Context ◽  
Primary Health

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand’s strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a “hands-off” approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

What is the healthcare carbon footprint? A collaborative analysis of current literature

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Di Fonzo ◽  
S Rivolta ◽  
E Mazzolai ◽  
F Turatto ◽  
L Mammana ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Carbon Footprint ◽  
Health Care Systems ◽  
Health Sector ◽  
Current Data ◽  
Universal Healthcare ◽  
Operating Theatres ◽  
Care Systems ◽  
Universal Health

Abstract Background Climate change (CC) is a public health (PH) issue of growing concern. Health care systems in every country have a significant impact in terms of greenhouse gas emissions (GHGE) causing global warming, but there seems to be a general lack of knowledge about this. As members of the junior study group on CC and PH of the Italian Society of Hygiene (SItI), we launched a project of shared education and literature research about the carbon footprint of healthcare (HCCF). We believe such an effort to be useful in spreading awareness and promoting change both in clinical practice, health care management and at policymaking level. Objectives To answer these questions: What is the estimated national and global HCCF? Which activities contribute to HCCF? What are the possible actions and policies to reduce HCCF while providing universal health care of good quality in all countries? From Dec 2019 to Feb 2020 we used databases and backward citation searching to retrieve references which we split among individuals to process, then we shared summaries of the material with the group. Results HCCF makes about 4.4% of all GHGE, with important variations among countries. We found estimates on emissions for various activities (e.g. operating theatres) and items (e.g. inhalers), as well as proposed solutions for practitioners, managers, manufacturers and policymakers (e.g. low-impact technologies, advocacy, health promotion to reduce healthcare volumes). Conclusions HCCF is complex, attributable to many components and amenable to mitigation through actions at all levels, with additional benefits for efficiency and public health. These conclusions are relevant for all countries as they imply joint international and transversal efforts throughout the world's health care sector. Key messages Current data and analysis, available for several services and in many countries, show healthcare carbon footprint is significant. Emissions from health sector can be reduced while granting universal healthcare globally.

Reform and counter reform: How sustainable is New Zealand&s latest health system restructuring?

2002 ◽  
Vol 7 (1_suppl) ◽  
pp. 46-55 ◽  
Author(s):  
Jackie Cumming ◽  
Nicholas Mays
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New Zealand ◽  
Health Services ◽  
Community Health Services ◽  
Public Hospitals ◽  
District Health ◽  
Potential Conflict ◽  
Feasible Option ◽  
New System

New Zealand's health care sector has undergone almost continual restructuring since the early 1980s. In the latest set of reforms, 21 district health boards (DHBs) have been established with responsibility for promoting health, purchasing services for their populations and delivering publicly owned health services. Boards will be governed by a mix of elected and appointed members, will be responsible for arranging the delivery of primary and community health services, and will own and run public hospitals and related facilities. We clarify the differences and continuities between earlier reforms and the 2000/01 structures, as well as the current reforms’ potential strengths and weaknesses. The paper discusses whether the DHB model was the only feasible option for restructuring and whether the dynamics of the new system may lead to further changes, particularly on the purchaser side of the system. Given that DHBs face potential conflict between their purchasing and provision roles, and given the potential advantages that primary care organisations may have as purchasers, we conclude that it is possible that all or part of the purchasing function of DHBs might eventually shift to primary care organisations, leaving the DHBs as hospital-based provider organisations.

scholarly journals Assessing the legislative and regulatory framework supporting the management of records in South Africa’s public health sector

2016 ◽  
Vol 18 (1) ◽  
Author(s):  
Shadrack Katuu ◽  
Thomas Van der Walt
Keyword(s):  
Public Health ◽  
Health Care ◽  
Literature Review ◽  
Expert Knowledge ◽  
Health Sector ◽  
Regulatory Framework ◽  
Background Information ◽  
Health Records ◽  
Public Health Sector ◽  
Regulatory Instruments

Background: The process of improving the quality of health care delivery requires that health systems function efficiently and effectively. A key component of health care systems’ efficiency is the administration of records that are often poorly managed. Any improvement in the management of records has to be done in full cognisance that records are generated in an organisational setting and based on a national legislative and regulatory framework.Objectives: The purpose of this article is to assess the contextual legislative and regulatory framework of South Africa’s health care system and its impact on the effectiveness of records management in public health care institutions.Method: Data for the study were obtained from two sources. On the one hand, the study conducted a review of literature that not only provided background information but also informed the research process. On the other hand, a varied number of respondents were identified through purposive sampling, and their expert knowledge solicited through semi-structured interviews.Results: The literature review, as well as the interviews, revealed that findings on the legislative and regulatory environment are multi-layered. For instance, respondents echoed observations made from the literature review that, whilst South Africa had a complex array of legal instruments, compliance levels at public health institutions were very rudimentary and contrary to the levels of sophistication expected by the legal instruments. A number of respondents noted the lack of specific guidelines for health records and that in most government departments there was ‘a very low key focus on the regulatory issues’. Several respondents stated that even when there were general guidelines for managing records, very few public institutions were compliant. A majority of the respondents noted a lack of an integrated approach in the different legislative and regulatory instruments, for instance, on the issue of records retention.Conclusion: The study revealed three related observations: firstly, that there is substantial legislative and regulatory dissonance in the management of health records in the country’s public health sector; secondly, understanding the complex interplay of different legal and regulatory instruments in the country’s public health sector is a critical first step, but it remains the beginning of the process; thirdly, there are lessons to be drawn from the extensive experiences of other countries such as the United Kingdom in addressing the legislative and regulatory challenges.

scholarly journals Comparative analysis of health institutions, personnel and service in private and public health sector in Serbia in 2009

2011 ◽  
Vol 58 (4) ◽  
pp. 216-228 ◽  
Author(s):  
Milena Gajic-Stevanovic ◽  
Snezana Dimitrijevic ◽  
Nevenka Teodorovic ◽  
Slavoljub Zivkovic
Keyword(s):  
Public Health ◽  
Health Care ◽  
Public Sector ◽  
Private Sector ◽  
Health Care System ◽  
Health Sector ◽  
Public Health Sector ◽  
Private Health Sector ◽  
Hospital Days ◽  
Care System

Introduction. Collecting data about the structure and function of private health care sector in Serbia and its inclusion in joint health care system is one of the most important issues for making decisions in health care and getting more accurate picture about the possibilities of health care system in Serbia. The aim of this analysis was to compare health institutions, personnel, visits, number of hospital days and morbidity by ICD-10 classification of diseases in public and private health sector in South Backa, Nisava, Toplica and Belgrade district in 2009. Material and Methods. A retrospective comparative analysis was performed using data about private providers of health services obtained from the Institute of Public Health Novi Sad, the Institute of Public Health Nis and the City Institute of Public Health Belgrade. Data about personnel and morbidity in public health sector in Serbia for 2009 was obtained from the Center for Information Technology of the Institute for Public Health of Serbia. Data about public health facilities in South Backa, Nisava, Toplica and Belgrade district in 2009 was obtained from Serbian Chamber of medical institutions. Results. The results showed that health care was provided in Belgrade district in 2009 by total of 1,051 employees in private sector and 31,404 in public sector. We found that public sector had a far wider range of health facilities than private sector, which was mainly due to the number of clinics. In South Backa district private sector had 323 practices, the district of Belgrade 655 and Nisava and Toplica district 173. Seventeen times more visits to households (4,650,423 vs. 267,356) and 111 times greater number of hospital days was provided in public health sector as compared to private health sector (781,083 vs. 7,023) in South Backa district. Conclusion. The conclusion of this analysis was that public health sector has remained the foundation of health care system in Serbia. Private health sector is expanding, but its structure and scope of services is still undervalued as compared to public sector.

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