The encouragement of care of orphans and vulnerable children by non‐profit organisations (NPOs) is a major policy response to the HIV and AIDS epidemic in South Africa. The purpose of this article is to present a quality–cost model with five performance indicators for quality and two for costs and to test these against actual performance using data collected from nine rural and urban organisations in 2004 and 2005. Six NPOs had acceptable cost but all had unacceptable quality scores; three had unacceptable cost and unacceptable quality scores. Each rural caregiver had many more orphans and vulnerable children beneficiaries than their urban counterparts but made fewer total visits. As a result, urban beneficiaries received, on average, 3.5 times more visits than their rural counterparts. The results suggest the need for different performance indicators and expectations for rural and urban NPOs and that monitoring and evaluation using the model could improve horne community‐based care services.

Abstract. Quality measurement and benchmarking in aged care presents several challenges. A model which addresses this by linking four dimensions of outcomes has been developed ‐ the Clinical Value Compass (CVC). A CVC was developed for stroke rehabilitation and measured across four sites. The CVC was well accepted by the treatment teams and proved practical to measure. The results revealed differences in practices and client groups that led to a closer analysis of processes and subsequent changes in these processes. Remeasuring of the CVC is required to demonstrate improved outcomes arising from these process changes.

Expenditure on healthcare in Australia is increasing at an unprecedented rate as the population ages, chronic disease becomes more prevalent, and technological development accelerates. A small proportion of patients with complex, chronic health conditions utilize a hugely disproportionate burden.The current Australian healthcare system, with its fragmented structure and fee for service model, is reactive not proactive and rewards quantity not quality. It does not incentivise cost and utilisation management, nor does it focus on the consumer experience and engagement. It is failing in secondary prevention and cost effective management of chronic disease.CarePoint is a program designed test the effectiveness and efficacy of a care planning and facilitation model in primary care for patients with chronic disease resulting in poor health, frequent hospitalisations and high healthcare costs. Multiple interventions will be used at the General Practice level for patients with complex, chronic health conditions, including enhanced care planning use of a specialized IT platform, case managers, home assessments, improved communication between care providers, and increased education and engagement of General Practitioners.It is postulated that these interventions would result in a reduction in hospital admissions and readmissions by 25%, reduced length of stay, and a reduction in emergency department attendances. Better care coordination of care will improve patient experience, improve health outcomes and significantly reduce cost to the health system.