Jacqueline Cumming

How New Zealand has contained expenditure on drugs

The approach of New Zealand’s Pharmaceutical Management Agency (PHARMAC) has much to commend it, say Jacqueline Cumming and colleagues

A review of economic evaluations of community mental health care

The authors review the methodology and findings of economic evaluations of 42 community mental health care programs reported in the English-language literature between 1979 and 2003. There were three substantial methodological problems in the literature: costs were often not completely specified, the quality of econometric analysis was often low, and most evaluations failed to integrate cost and health outcome information. Well-conducted research shows that care in the community dominates hospital in-patient care, achieving better outcomes at lower or equal cost. It is less clear what types of community programs are most cost-effective. Future research should focus on identifying which types of community care are most cost effective and at what level of intensity they are most effective.

Implementing new modes of governance in the New Zealand health system: an empirical study.

UNLABELLED Health governance internationally has become more complex, with both hierarchical and network modes of governance explicitly represented within single public systems. OBJECTIVE To understand the implementation of new modes and mechanisms of governance under New Zealand health reforms and to assess these in the context of international trends. Research methods sought data from key groups participating in governance policy and implementation. Methods included surveys of board members (N=144, 66% response rate), interviews with chairs (N=14) and chief executives (N=20), and interviews with national policy makers/officials (N=19) and non-government providers and local stakeholders (N=10). Data were collected over two time periods (2001/2002; 2003/2004). Analysis integrated the findings of both qualitative and quantitative methods under themes related to modes and mechanisms of governance. Results indicate that a hierarchical mode of governance was implemented quickly, with mechanisms to ensure political accountability to the government. Over the implementation period the scope of decision-making at different levels required clarification and mechanisms for accountability required adjustment. Non-government provider networks emerged only slowly whereas a network of statutory health organisations established itself quickly. CONCLUSION The successful implementation of a mix of governance modes in New Zealand 2001-2004 was characterised by clear government policy, flexibility of approach and the appearance of an unintended network. In New Zealand there is less tendency than in some other some other small countries/jurisdictions towards centralisation, with local elections and community engagement policies providing an element of local participation, and accountability to the centre enhanced through political rather than bureaucratic mechanisms.

What do Passengers do During Travel Time? Structured Observations on Buses and Trains

Structured observation is one way to assess how public transport passengers actually use their travel time. This study reports on 812 adult passengers in Wellington, New Zealand. Researchers recorded passenger characteristics and behavior over a 4-minute period, on a range of routes and times, using 12 pre-set codes. Most passengers (65.3%) were “looking ahead/out the window” at some point in the observation period, more on buses than on trains. About one-fifth of all passengers observed were seen reading, more on trains. Other activities included listening on headphones, talking, texting, and sleeping/eyes closed. Activities were compared on the basis of gender, age group, mode, and time of day. Comparisons are made with recent observational and survey studies, with discussion of both methods and results.

Defining Core Services: New Zealand Experiences:

A key aspect of the New Zealand health reforms was the proposed development of an explicit core of services to which all New Zealanders would have access. A range of approaches has been taken by the government, its advisers, purchasers and providers to describe sets of services to which New Zealanders are to have access. The development of an explicit core aims to promote equity of access to services, to ensure that those services available are those that are the most cost-effective and the services New Zealanders feel to be the most important, and to clarify entitlements to publicly funded health care. This paper describes the current approaches that are being used to define core services in New Zealand, discusses the reasons behind some of the choices made and notes some key issues for further policy debate.

A successful mix of hierarchy and collaboration?: Interpreting the 2001 reform of the governance of the New Zealand public health system

This article analyses the relationship between different modes of accountability in New Zealands publicly funded health sector since 2001. It adopts a ‘multiple modes of governance’ framework, drawing on the findings of an evaluation of health system restructuring conducted between 2001 and 2005. In broad terms, governance of the health system has moved from a combination of hierarchy and market to a mixture of hierarchy and collaboration. This article assesses the degrees to which hierarchical and collaborative accountability regimes have clashed with or complemented each other. We also identify areas in which none of these modes of accountability operate.

The impact of changes in private health expenditure on New Zealand households

The proportion of New Zealands total health expenditure financed by the public sector has fallen from 87% in 1983/84 to 77% in 1997/98 in real per capita terms. In the paper, we firstly describe changes in private health expenditure in New Zealand and compare these changes with trends in private and public health expenditure in a number of OECD countries. Secondly, we find that in New Zealand, there have been increases in both out-of-pocket payments and membership of private health insurance funds over the period from 1983/84 to 1997/98. We analyze the relationship between out-of-pocket expenditure, insurance expenditure, and household income across income deciles and across time. We find that out-of-pocket payments are regressive but the regressivity did decline in 1993/94 in response to a government initiative to improve the targeting of government subsidies towards lower income households.

The determinants of GP visits in New Zealand.

Objective: To identify the characteristics of New Zealanders who utilised primary healthcare services prior to the implementation of the New Zealand Primary Healthcare Strategy (PHCS).

An exploratory study of young carers and their families in New Zealand

Abstract The 2008 New Zealand Carers’ Strategy recognises the role that “young carers” play in supporting family members who are ill or disabled, but we know little about this group of family carers in New Zealand. In this study, utilising grounded theory methods, interviews were undertaken with 14 young carers and nine other members of nine families to explore their experiences of young caring. Young caring occurs in the context of family relationships and expectations, involving both choice and obligation, and for some, a strong sense of responsibility. Young carers contribute in a wide variety of ways and they report a range of responses to this role and its effects on their lives. Appropriate formal support services can reduce the level of family caring required, including that by young carers. Greater awareness of young carers is needed, along with adequate and acceptable support services for families.

Decentralizing resource allocation: early experiences with district health boards in New Zealand.

Objectives In New Zealand in 2001, a system of purchasing health services by a centralized purchasing agency was replaced by 21 district health boards (DHBs) which are responsible for both providing health services directly and for purchasing services from non-government providers. This paper describes the processes associated with the allocation of health resources in the decentralized system and considers the extent to which four of the governments stated objectives are likely to be achieved. Methods Two rounds of interviews with national stakeholders and senior DHB personnel plus case studies in five districts which included key informant interviews, observation at board meetings and document analysis. Results The re-structuring of the health sector in New Zealand appears to have simultaneously enhanced and inhibited the achievement of government objectives. Local decisionmaking has encouraged greater local responsiveness and new funding arrangements have allayed concerns about inter-regional equity. The system is less commercially oriented than it was during the 1990s and collaboration between DHBs is improving. However, the combination of increased integration of purchasing and provision within DHBs and the focus on financial deficits in the early years appears to have inhibited the development of partnership relationships between DHBs and non-government providers, and of longer-term funding arrangements for high quality providers. Non-government providers perceive that DHBs have a tendency to favour their own providers when allocating contracts. Conclusions Decentralized decisionmaking is starting to make some inroads towards achieving some of the governments objectives with respect to resource allocation and purchasing.