A messy reality: an analysis of New Zealand's elective surgery scoring system via media sources, 2000–2006

Derrett, Sarah; Cousins, Kim; Gauld, Robin

doi:10.1002/hpm.2127

Cited by 9 publications

(12 citation statements)

References 16 publications

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“…86 Attempts in the U.S. to expand insurance coverage such as through the Affordable Care Act still fall far short of Aotearoa/NZ’s floor coverage for residents. 87 However, compared to the U.S., the national healthcare budget in Aotearoa/NZ determined through the political process imposes a stricter cap on spending, which limits access through rationing and queuing for nonurgent services, 57,88,89 and sometimes for urgent services. 59 New Zealanders with private insurance, and the wealthy, can largely bypass these queues.…”

Section: Resultsmentioning

confidence: 99%

Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States

et al. 2018

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Aotearoa/New Zealand (Aotearoa/NZ) and the United States (U.S.) suffer inequities in health outcomes by race/ethnicity and socioeconomic status. This paper compares both countries' approaches to health equity to inform policy efforts. We developed a conceptual model that highlights how government and private policies influence health equity by impacting the healthcare system (access to care, structure and quality of care, payment of care), and integration of healthcare system with social services. These policies are shaped by each country's culture, history, and values. Aotearoa/NZ and U.S. share strong aspirational goals for health equity in their national health strategy documents. Unfortunately, implemented policies are frequently not explicit in how they address health inequities, and often do not align with evidence-based approaches known to improve equity. To authentically commit to achieving health equity, nations should: 1) Explicitly design quality of care and payment policies to achieve equity, holding the healthcare system accountable through public monitoring and evaluation, and supporting with adequate resources; 2) Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors; 3) Share power authentically with racial/ethnic minorities and promote indigenous peoples' self-determination; 4) Have free, frank, and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programs explicitly address root causes.

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Section: Resultsmentioning

confidence: 99%

Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States

et al. 2018

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“…In theory, services are universally accessible. In practice, various barriers exist including geography and funding meaning that patients often wait a long time for non-urgent procedures or are denied care after referral from a GP as their condition may not be a high enough priority for specialists to treat within available resources (Derrett et al, 2013). Such patients then have an option of paying privately for care so long as they can afford it or have private health insurance.…”

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confidence: 99%

Clinical governance: an assessment of New Zealand’s approach and performance

Gauld

Horsburgh

2015

Clinical Governance: An International Journal

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If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this paper is to describe and reflect upon the approach taken in New Zealand. Design/methodology/approach -New Zealand's clinical governance policy of 2009 and its implementation through its public health care system are outlined. The authors' assessments, in 2010 and 2012, of this policy are described and key findings summarised. Findings -The implementation of the policy was swift, with considerable commitment across the public health care system to this. The quantitative assessments found reasonable developmental progress between 2010 and 2012. Case studies undertaken in 2012 indicated various areas that policy makers should attend to or build upon in order to better support clinical governance development.Research limitations/implications -Key lessons from New Zealand's clinical governance experience, based on the assessments, include the need for: a well-defined definition of clinical governance; resource materials that can be used by those involved in clinical governance development; recognition that clinical governance development is complicated and takes time; and commitment to new leadership and organisational arrangements. Originality/value -This paper provides useful lessons for policy makers pursuing clinical governance development, derived from two rounds of assessment in New Zealand.

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“…Furthermore, some DHBs are more affected than others in terms of affected surgical services, staff shortages, bed shortages, funding and management (Derrett et al, 2013). Despite significant funding injections into the management of waiting lists, there has not been any significant improvements in access to elective surgery (Derrett et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Three Essays in Health Economics

Panta¹

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This dissertation contains three essays on economic analysis of the New Zealand healthcare market particularly relating to publicly funded elective surgeries and the pharmaceutical industry. In Chapter 1, using administrative data on all patients booked for publicly funded elective surgery in 2014, we investigate whether ethnic disparities exist in waiting time for elective surgeries in New Zealand. Unlike existing studies on the topic, we extensively control for sample selection bias, clinical severity, and regional factors affecting resource supply and healthcare utilization. We find evidence of Maori, Pacific, and Asian patients waiting longer for elective surgery when com-pared to New Zealand Europeans. Our results indicate that Maori wait on average 3 percent longer for elective surgery, however, they are not consistent across all model specifications. We find that Pacific and Asian patients wait 8 - 9 percent longer for elective surgeries compared to NZE. Our results are considerably stronger for Pacific and Asian compared to Maori across all model specifications. Furthermore, these differences are pervasive across several surgical categories and are as high as 22 percent across angiography procedures. We also find evidence that waiting time in New Zealand is geographically inequitable. Although an increasing number of empirical studies find evidence of inequities in waiting time socioeconomic status, our analysis reveals no such effects once regional differences affecting waiting time are controlled for. In Chapter 2, using administrative data on patients who have been booked and treated for publicly funded elective surgeries over 2011-2015, we investigate how supply of and demand for elective surgeries respond to waiting times in New Zealand. Unlike existing studies, we endogenize waiting times in a system of three equations, which nests the conventional demand-and-supply model. Each structural equation is over-identified by excluded instruments, and the exclusion restriction is justified on a priori grounds while over-identifying restrictions are tested. The analysis finds that, in the case of New Zealand, the demand for elective surgery is inelastic, whereas supply is elastic. From a policy perspective, the results suggest that a long-term increase in supply will lead to a permanent reduction in waiting times and thus improving timely access to care. In Chapter 3, I develop an intuitive model based on the traditional newsvendor framework that enables pharmaceutical wholesalers to efficiently forecast demand and reduce inventory while adjusting for required customer service level (CSL) targets. First, using historical demand data for a major pharmaceutical wholesaler in New Zealand, I present several demand forecasting models and assess their performance in predicting demand, based on several forecast error metrics. I find that artificial neural network (ANN) models are generally stable for demand forecasting and sometimes outperform traditional demand forecasting methods. Second, using the demand fore-cast as an input, I derive a periodic review inventory model based on the newsvendor inventory framework. Numerical analysis of the proposed model shows that, compared to current practice, the model enables wholesalers to significantly reduce both inventory levels and ordering, while maintaining a very high non-stock-out probability constraint and CSL target close to 100 percent. I conduct separate analyses for both government subsidized low value-high demand drug and non-subsidized low demand-high value drug and find the results to be consistent across both types of drugs.

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A messy reality: an analysis of New Zealand's elective surgery scoring system via media sources, 2000–2006

Cited by 9 publications

References 16 publications

Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States

Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States

Clinical governance: an assessment of New Zealand’s approach and performance

Three Essays in Health Economics

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