Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Publication of general insurance statistics

The Australian Prudential Regulation Authority (APRA) today released a discussion paper on proposed changes to its general insurance statistical publications. APRA proposes to publish more general insurance statistics, including data recently determined non-confidential. In doing so, APRA intends to improve the relevance of APRA’s statistics to users, and address feedback in stakeholder surveys and other formal and informal consultations.   In particular, APRA proposes to: publish more industry-level statistics each quarter; modernise the segmentation of industry-level statistics; publish more institution-level statistics each quarter and annually; and publish new industry-level claims development statistics by class of business All the proposals are based on data already reported to APRA by general insurers.  &nbsp

Don't judge a superannuation default investment option by its name

With the massive decline in savings arising from the Global Financial Crisis (GFC), it is timely to review superannuation fund investment and disclosure strategies in the lead-up to the crisis. Accordingly, this study examines differences among superannuation funds’ default investment options in terms of naming and framing over three years from 2005 to 2007, as presented in product disclosure statements (PDSs). The findings indicate that default options are becoming more alike regardless of their name, and consequently, members may face increasing difficulties in distinguishing between balanced and growth-named default options when comparing them across superannuation funds. Comparability is also likely to be constrained by variations in the framing of default options presented in investment option menus in PDSs. These findings highlight the need for standardisation of default option definitions and disclosures to ensure descriptive accuracy, transparency and comparability

Health Plan Payment in Australia

The Australian healthcare system is characterized by a mix of public and private financing and provision of healthcare services. The health insurance system consists of a National Health Insurance/Service and voluntary private health insurance (PHI). The latter is regulated through the Private Insurance Act (2007) which established a complex mix of subsidies and regulatory instruments (e.g., community rating, open enrollment, ad valorem premium-subsidies and tax-incentives), and provides for the operation and administration of the Risk Equalization Trust Fund. The Australian health plan payment scheme constitutes a combination of risk sharing and risk equalization. The duplicative nature of the current private/public mix (those with PHI remain covered by the national public system) and the potentially inefficient mix of subsidies have contributed to some important issues such as overinsurance, a high market concentration, risk selection, market segmentation, and a misallocation of subsidies. Increasingly, concerns are rising about the affordability, efficiency, and sustainability of the Australian healthcare system

Asset allocation policy, returns and expenses of Australian superannuation funds: Recent evidence based on default options

We examine the asset allocation, returns, and expenses of superannuation funds whose assets are mainly invested in default investment options between 2004 and 2012. A majority of these funds fail to earn returns commensurate with their strategic asset allocation policy. It appears that much of the variation of returns between the funds might be a result of their engaging in significant active management of assets. Our results indicate that returns from active management are negatively related to expenses. We also find strong evidence of economies of scale existing in these superannuation funds across different size categories

Why have Australian banks survived the recent global financial crisis?

Australia is a small developed country with a sophisticated, well regulated banking and financial system. Because of its smaller stock market turnover, lower capitalisation of its banking sector and smaller global interaction than other developed countries, the effect of the global financial crisis on the country has not been as great as in other developed economies. The banking regulatory framework has also had much to do with this insulation effect. This cross discipline study comments on the legal and institutional environment for banking in Australia and also reports empirical analysis of banking stock market data showing Australia’s interaction and involvement in a global context

Leveraged superannuation

Rules governing superannuation investments are made with respect to investment-specific risks, rather than overall portfolio risks. In particular, legislation prohibits borrowing except in specific circumstances and on a non-recourse basis. We model the distribution of leveraged portfolio outcomes for a representative investor, accounting for their age-earnings profile, differing taxation of dividends, capital gains and franking credits, and the volatility of equity returns and interest rates. With explicit portfolio modelling, there is no need to categorize specific investments as 'too risky' on a stand-alone basis. We show that leverage is likely to enhance retirement outcomes for investors with low risk aversion

In Praise of (Some) Red Tape: A New Approach to Regulation

Economic Record - Volume 92, Issue 299 (Dec. 2016), pages 631–647 "This paper is an extension of a Centre for International Finance and Regulation (CIFR) commissioned piece, Removing ‘Red Tape’ Regulation in an Uncertain Environment, requested by the 2014 Australian Financial System Inquiry (FSI or ‘Murray Inquiry ’) and prepared with their permission." page 631