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

Financial Risks ◽

Primary Health ◽

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.

Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

10.26686/wgtn.16945855.v1 ◽

2021 ◽

Author(s):

◽

Carolyn Joy Cordery

Keyword(s):

Health Care ◽

Primary Health Care ◽

New Zealand ◽

Service Providers ◽

Balance Control ◽

Multiple Stakeholders ◽

Public Funds ◽

Primary Health ◽

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.

Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

10.26686/wgtn.16945855 ◽

2021 ◽

Author(s):

◽

Carolyn Joy Cordery

Keyword(s):

Health Care ◽

Primary Health Care ◽

New Zealand ◽

Service Providers ◽

Balance Control ◽

Multiple Stakeholders ◽

Public Funds ◽

Primary Health ◽

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.

The primary health care: true advocate of health

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20204398 ◽

2020 ◽

Vol 7 (10) ◽

pp. 4211

Author(s):

Chippagiri Soumya

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health Care System ◽

Care Delivery ◽

Health Care Delivery System ◽

Economic Aspects ◽

Primary Health ◽

The People ◽

Care System

The health care delivery system in India faces challenges due to disparity in geographical, cultural and economic aspects. Nonetheless, health is an issue which brings all humans under one umbrella. It is primary health care that lays the foundation on which health of the people are built and protected. Realizing the strengthens of the primary health care system is of utmost importance especially in the era of vaccinations and disease eliminations. This requires for the health system to move towards mass approach and heath protection concept sooner than later. And what better way than the primary health care system?

Multidisciplinary collaboration in primary care: through the eyes of patients

Australian Journal of Primary Health ◽

10.1071/py12019 ◽

2013 ◽

Vol 19 (3) ◽

pp. 190 ◽

Cited By ~ 11

Author(s):

Lynn H. Cheong ◽

Carol L. Armour ◽

Sinthia Z. Bosnic-Anticevich

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Chronic Illness ◽

Health Care Professionals ◽

Care Delivery ◽

Structured Interviews ◽

Multidisciplinary Collaboration ◽

Primary Health

Managing chronic illness is highly complex and the pathways to access health care for the patient are unpredictable and often unknown. While multidisciplinary care (MDC) arrangements are promoted in the Australian primary health care system, there is a paucity of research on multidisciplinary collaboration from patients’ perspectives. This exploratory study is the first to gain an understanding of the experiences, perceptions, attitudes and potential role of people with chronic illness (asthma) on the delivery of MDC in the Australian primary health care setting. In-depth semi-structured interviews were conducted with asthma patients from Sydney, Australia. Qualitative analysis of data indicates that patients are significant players in MDC and their perceptions of their chronic condition, perceived roles of health care professionals, and expectations of health care delivery, influence their participation and attitudes towards multidisciplinary services. Our research shows the challenges presented by patients in the delivery and establishment of multidisciplinary health care teams, and highlights the need to consider patients’ perspectives in the development of MDC models in primary care.

Indigenous Medical Plants: Of what Value to Primary Health Care in Rural Ghana?

Southern African Journal for Folklore Studies ◽

10.25159/1016-8427/4301 ◽

2018 ◽

Vol 28 (1) ◽

Author(s):

Kofi P. Quan-Baffour

Keyword(s):

Health Care ◽

Primary Health Care ◽

Medicinal Plants ◽

Health Care Delivery ◽

Rural Areas ◽

Care Delivery ◽

Pharmaceutical Drugs ◽

Care Programme ◽

Primary Health ◽

Ghana was colonised in 1482 when Europeans, accompanied by a number of missionaries, arrived at a small coastal town called Edina in the present day Central Region. Colonialism brought with it Western education, religious values, and medical care. The missionaries opened schools, clinics, and hospitals in several parts of the country but these facilities were not available in many remote areas. Before colonisation Ghanaians made medicines from plants to cure sicknesses and diseases. Although the missionaries and the colonisers regarded African medicine as fetish and attempted to annihilate it—Ghanaians—especially those living in areas without hospital facilities, continued to rely on local medicines for curing illnesses. Medicinal plants such as the neem tree, lemon, moringa, ginger etc., are used as concoctions to alleviate the symptoms of malaria, headaches, boils, diabetes, high blood pressure, and stomach pains. When the government recently introduced primary health care, indigenous medicines became a de facto partner in health care delivery, particularly in the rural areas where hospitals and medical facilities are inadequate. This study employed qualitative methods to explore the value of indigenous medicinal plants in the country’s primary health care programme. The study found that indigenous medicine plays an important role in health care delivery because it is accessible and affordable. Even people who visit hospitals still use indigenous medicines side by side with the pharmaceutical drugs offered by medical practitioners.

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

10.21203/rs.3.rs-91573/v1 ◽

2020 ◽

Author(s):

Adepeju Lateef ◽

Euphemia Mbali Mhlongo

Keyword(s):

Health Care ◽

Qualitative Research ◽

Primary Health Care ◽

Healthcare Service ◽

Patient Centered Care ◽

Patient Centered ◽

Primary Health ◽

Centered Care ◽

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.