Integrated care in New Zealand

<p><strong>Background</strong>: New Zealand's health system has long been seen as providing highly fragmented, poorly co-ordinated services to service users. A continuing policy challenge has been how to reduce such fragmentation and achieve more 'integrated' care, that is, 'co-ordinated' care that provides a 'smooth and continuous' transition between services, and a 'seamless' journey as service users receive health, support, and social welfare services from a range of health and other professionals.</p><p><strong>Description of policy practice</strong>: The paper takes as its starting point the view that achieving integrated care needs to be supported by a 'coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels' [1]. The paper considers how fragmentation in financing, planning, funding, and service delivery have contributed to poorly co-ordinated care in New Zealand; discusses how integrated care was to be supported by recent major reforms to the health system and whether such reforms have succeeded or not in achieving more integrated care for service users; and discusses the challenges New Zealand still faces in achieving more integrated care over the next few years. </p><p><strong>Discussion and conclusion</strong>: The paper concludes that although key financing, planning, funding and service delivery reforms aimed at delivering more integrated care to service users have succeeded in integrating planning and funding functions, few changes have occurred in the ways in which services are provided to users. It is only now that significant attention is being paid to changing how services are actually delivered in order to achieve more integrated care, but even then, change appears to be slow, and significant challenges to integrating care in New Zealand remain to be resolved.</p

Health policy

Improving health and well-being and promoting equity in outcomes are long-standing goals of New Zealand governments (for example, Department of Health, 1989; King, 2000; Ryall, 2007; Ministry of Health, 2016a, 2016b).1 New Zealand’s publicly funded health system delivers millions of high-quality services each year to achieve these goals. Our level of expenditure per capita on health care is slightly below the OECD average, but our health care system provides good overall health outcomes for the money we spend (OECD, 2015). Both our life expectancy and health expectancy (the years we live in good health) are increasing, although the former is increasing faster than the latter, leading to an increase in the number of years New Zealanders spend in poorer health; a key challenge is to improve our quality of life as people age (Ministry of Health, 2017a). Sadly, however, there are significant inequities in health, with Mäori, Pasifika and lower-income people having poorer health than other New Zealanders

Evaluation of the 20,000 days campaign

The aim of Counties Manuaku District Health Board (CMDHB) 20,000 Days Campaign was to give back to the community 20,000 healthy and well days to avoid predicted growth in hospital bed days. After tracking the difference between projected demand and actual use, at the end of the Campaign on 1st July 2013, CMDHB reported that 23,060 bed days were given back to the people of Counties Manukau. This evaluation report explains how using the Institute of Healthcare Improvement Breakthrough Series the Campaign was run with the expectation that small immediate changes to practical problems (in this case the work of 13 Collaborative teams), will accumulate into large effects (a reduction of 20,000 bed days against predicted bed days use by July 2013). The evaluation found the Campaign did save bed days, though attributing causality was always going to be difficult, and overall the Campaign was very successful in keeping the energy and motivation of participants

Reforming primary health care: is New Zealand's primary health care strategy achieving its early goals?

BACKGROUND: In 2001, the New Zealand government introduced its Primary Health Care Strategy (PHCS), aimed at strengthening the role of primary health care, in order to improve health and to reduce inequalities in health. As part of the Strategy, new funding was provided to reduce the fees that patients pay when they use primary health care services in New Zealand, to improve access to services and to increase service use. In this article, we estimate the impact of the new funding on general practitioner and practice nurse visit fees paid by patients and on consultation rates. The analyses involved before-and-after monitoring of fees and consultation rates in a random sample of 99 general practices and covered the period from June 2001 (pre-Strategy) to mid-2005. RESULTS: Fees fell particularly in Access (higher need, higher per capita funded) practices over time for doctor and nurse visits. Fees increased over time for many in Interim (lower need, lower per capita funded) practices, but they fell for patients aged 65 years and over as new funding was provided for this age group. There were increases in consultation rates across almost all age, funding model (Access or Interim), socio-demographic and ethnic groups. Increases were particularly high in Access practices. CONCLUSION: The Strategy has resulted in lower fees for primary health care for many New Zealanders, and consultation rates have also increased over the past few years. However, fees have not fallen by as much as expected in government policy given the amount of extra public money spent since there are limited requirements for practices to reduce patients' fees in line with increases in public funding for primary care

Priority Setting Meets Multiple Streams: A Match to Be Further Examined? Comment on “Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory”

With demand for health services continuing to grow as populations age and new technologies emerge to meet health needs, healthcare policy-makers are under constant pressure to set priorities, ie, to make choices about the health services that can and cannot be funded within available resources. In a recent paper, Smith et al apply an influential policy studies framework – Kingdon’s multiple streams approach (MSA) – to explore the factors that explain why one health service delivery organization adopted a formal priority setting framework (in the form of programme budgeting and marginal analysis [PBMA]) to assist it in making priority setting decisions. MSA is a theory of agenda-setting, ie, how it is that different issues do or do not reach a decision-making point. In this paper, I reflect on the use of the MSA framework to explore priority setting processes and how the framework might be applied to similar cases in future

A Realist Evaluation of Local Networks Designed to Achieve More Integrated Care

Introduction: Not surprisingly given their multi-component nature, initiatives to improve integrated care often evolve to find the best way to bring about change. This paper provides an example of how an evaluation evolved alongside such an initiative designed to better integrate care across primary, community and hospital services in South Auckland, New Zealand. Theory and methods: Using the explanatory power of a realist evaluative approach, theories of new ways of working that might be prompted by the initiative were explored in: (i) interviews with stakeholders in 2012 and 2015, (ii) online surveys of general practices and local care organisations, and (iii) a purposive sample of ten general practices. Results: The results highlighted the institutional contexts that led to difficulties in implementing population health initiatives. They also revealed that changes in work practices focussed mostly on activities that improved the coordination of care for individuals at risk of hospital admissions. Discussion: Multi-component complex interventions can vary in their delivery and be vulnerable to one or more components not being implemented as originally intended. In the case of this intervention, the move towards strengthening local relationships arose when contractual arrangements stalled. Realist evaluative approaches offer a logic that helps unpick the complexity of the relationships and politics in play, and uncover the assumptions made by those developing, implementing and assessing health service changes. Conclusion: Given the multi-component and evolving nature of initiatives seeking to better integrate care, the realist evaluative emphasis on surfacing early the theories to explain how change is expected to occur helps overcome the challenge of evaluating “a moving target”

Geologic storage field tests in multiple basins in Midwestern USA–Lessons learned and implications for commercial deployment

AbstractDuring the last three years, geologic storage of carbon dioxide (CO2) in saline formations has been demonstrated in three distinct geologic settings by the Midwestern Regional Carbon Sequestration Partnership (MRCSP), one of the seven regional partnerships funded by the U.S. Department of Energy. MRCSP (www.mrcsp.org) covers a large region across nine Midwestern and Mid-Atlantic states, with several geologic provinces including: The Michigan and Appalachian Basins, the Cincinnati Arch Province, and the coastal sedimentary layers. Given the long history of coal production, much of the region is heavily dependent on coal-fired plants for electricity, and, therefore, subject to significant economic impact from carbon-emission constraints. The sedimentary formations or geologic structures across the region provide diverse options to mitigate the emissions through geologic storage of CO2.The validation for the storage potential comes through field assessments of injectivity and containment at three locations: One each in the Appalachian and Michigan Basins and one in the uplifted Cincinnati Arch region. All three field projects were conducted in a series of steps that contribute towards development of best practices for carbon capture and storage (CCS) validation that are applicable to the MRCSP region and elsewhere. Although specific practices are highly site dependent, the general steps include initial regional geologic assessment, site characterization through seismic surveys and drilling of test wells, permitting, outreach, development of a CO2 supply system, injection and monitoring operations, and post-injection monitoring and site closure.Collectively, the regional mapping and three field demonstrations provide significant insight into geologic storage feasibility over a range of rock types and properties. Two of the tested sites indicate injection and storage rates exceeding 1000 tonnes/day/well. Such rates suggest that commercial-scale applications should be possible with a reasonable number of wells. The regional mapping of these zones also indicates that the tested layers are likely to be continuous over a large area, and, therefore, have potential for large-scale, long-term injection operations required for the numerous CO2 sources in the region

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

© 2013 The Author(s). Published by Taylor & Francis. This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.This article analyses reforms to contracting and accountability for indigenous primary health care organizations in Canada, New Zealand, and Australia. The reforms are presented as comparative case studies, the common reform features identified and their implications analysed. The reforms share important characteristics. Each proceeds from implicit recognition that indigenous organizations are ‘co-principals’ rather than simply agents in their relationship with government funders and regulators. There is a common tendency towards more relational forms of contracting; and tentative attempts to reconceptualize accountability. These ‘frontier’ cases have broad implications for social service contracting