Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy
Notice bibliographique
Résumé
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.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,012 |
| Communication savante | 0,014 | 0,009 |
| Science ouverte | 0,002 | 0,005 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».