A Report on The Impact of the Current Funding Environment on Service Design and Delivery - Management Assignment Help

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A Report on The Impact of the Current Funding Environment on Service Design and Delivery
BHW700 Quality Services for the Future: Funding, Design and Evaluation

New Zealand funding environment system has, for many years, been seen to provide highly fragmented, poorly coordinated services to service users. Over the 20th century, the New Zealand government slowly took up the financing of hospitals. The aim was to introduce a national health service that was both comprehensive and integrated (Love, 2008). The transformation was from the 1983 where Area Health Boards were established, then 1993 Regional Health Authorities and Crown Health Enterprises, 1997 Health Funding Authority and Hospital and Health Services and then in 2000 the District Health Boards which is still being used today. There were major changes and separations in the planning, funding, and provision of care. These funding environments remains a challenge with respect to achieving integrated care in New Zealand. The following report will analyse the current funding environment and discuss its impact on the service design and delivery within the social health and wellbeing sector.
 

Funding Environment and its operation.
The current funding environment has many challenges which are demand and supply pressures. The population growth, diversity and redistribution are creating a variety of pressure for the services. Statistics New Zealand, (2007) projected changes in New Zealand population 2009-2026 by DHB/Region will comprise 31 percent up from 23 percent. The rate of growth is becoming unsustainable. The current funding will need to increase, or to be redistributed between appropriate service areas. Nearly 50 percent of health care expenditure is forecast to be required for the care of those aged 65 and over by 2028, compared with 37 percent in 2006 (Ministry of Health, 2016). The pressure of the ageing population, new technology model of care and commoditisation of health workers is causing increased pressure on individual organisations to offer competitive wages. This impacts on management bodies to consider alternative approaches in their use of technology and their workforce and to make the most efficient use of their resources.
There have been changes in the way the government procures non-government services, voluntary provisions and how state agencies operate. The current funding uses contracts which are the primary funding mechanism of the community NGOs. The emphasis is on the measurement of outcomes. Contracts remain the main source for the government to transfer funds to social health and wellbeing service providers. The New Zealand Productivity Commission (2015) acknowledges that the commission has encountered lots of dissatisfaction with the funding of social services and government seem to underfund some contracts with non-government providers for the delivery of specified social services. The Kaupapa M?ori NGOs have been disadvantaged to be able to deliver more equitable health outcomes for M?ori (Abel, et al., 2005).
There have been concerns over funding allocations and this has a disproportionate share of funding spent on hospital services. This has left little for other services as the primary health services. Funding is not being equitable on population groups of high needs. The current social health and wellbeing system is complicated and fragmented. The system currently allocate funds and manages through vote health to DHBs. The allocation is done to 51 appropriations with the vote Health that defines what public money can be spent on and each DHB has its own appropriation, but there also appropriations for non DHB services as a national disability service and population health services (The Treasury, 2009). The impact with the vote health is that it has a fixed nominal baseline which is the amount of funding received each year and it does not automatically increase to match population, volume, or cost increases. Instead, for each Budget, the Minister of Health submits bids requesting additional funding for new initiatives or to help provide existing services given population and cost pressures. The process of allocating funding to DHBs is complicated and has many different stages. A population and needs based method of allocating funding is supported, and this leads to an equitable share of funding to different areas based on population size and need. This system is difficult to understand and DHBs feel they are not receiving equitable share funding. DHBs also receive funding through contracts with the Ministry of Health or services such as electives and population health, direct contracts with ACC and other government entities, and other sources such as donations (Cumming and Mays, 2011). Limited transparency of what data is used and how it is used, leads to concerns that the allocation can be flawed. In mental health and addiction services the DHBs support majority of the services in hospitals and NGOs. This includes the alcohol and drug services, mental health of older people, primary mental health services. For example, in mental health and addiction services the complexity is reflected due to the impact of completeness of data for older people. The funding for older people in Northern and Midlands region is funded under mental health and addiction services while in southern and central regions they are funded as disability support services. PRIMHD will mainly capture mental health and addiction services and occasionally capture data on disability support services. This means data on healthcare users aged 65 is incomplete.
 

Links between the funding environment and service design and delivery
When DHBs were established, the focus was to set a direction of integrated care and equity widening the focus from treating illness to improving health and wellbeing and addressing health inequities (Cumming, et al., 2014). Health inequalities, population changes, public expectations, workforce shortage and new technologies are placing pressure on different parts of the system. These pressures often interface between different service settings, providing strong impetus change. Health service redesign and new models of care are emerging within a policy framework in response to pressures and certain enablers (technology advances). This puts pressure on the funding allocation when care is home based, and specialised. There is increased integration of services where traditional community, primary, secondary, and specialised/tertiary services are becoming better linked. This will enable families and patients to experience health care as a single system rather than a series of poorly coordinated settings.
Commissioning in social health and wellbeing sector is essential and it consists of five phases understanding needs and opportunities, planning, procuring, and contracting, monitoring and evaluation and revising and adapting (The New Zealand Productivity Commission (2015). The New Zealand model of care focuses on the client than the institution as the centre of service delivery. This aims to promote a more seamless client journey across community, hospital, and primary care. There is a greater use of primary and community care. In mental health and addiction services alliances contracting can help to provide and support a good trust environment for funders and providers. Community and NGO providers can work together on systems goal by sharing, risks, and gains. Mental Health and Addiction Funding, (2010) alliancing can support outcome-focused approaches for mental health and addiction by supporting groups of NGOs, primary care providers and social services to work together on common goals and incentivise collaborative approaches to achieving these goals.
In the current system the alliances are developing new collaborations to plan and deliver services. For example, in Canterbury mental health and addition services, alliance group liaise with clinical networks and alliance leadership teams. They also involve the family, consumers, clinicians, managers from across the alcohol and other drugs and mental health to support. With this system in place usually solutions are found within existing funding and contracting arrangements, with changes made through being flexible and supporting people and organisations to work as required. The contracting framework also assist government agencies to work in a collaborative and more efficient coordinated and connected way (Addicott, 2014). This assists the funding environment to achieve greater consistency across government agencies. There is an ongoing viability to NGOs, particularly those with high focus on inequalities M?ori, Pasika and high needs populations (Ryan, et al., 2019). In primary care patients are finding it difficult to access general practices. This is due to increased access, ageing and the growth in chronic conditions. Also related to the funding environment and workforce supply issues. Some practitioners are closing books to new patients and access to afterhours care in some primary care is problematic and expensive.
New Zealand has long focused on attempting to deliver a more integrated care across a wide range of health, social services, and support. The reforms have focused on reorganising planning and funding environment to strengthen the role of primary care services in service delivery (Ministry of Health, 2019). Improving the planning of services and having all funds together reduce silos, thereby promoting the allocation of resources to cost effective services and providing flexibility in service provision to meet health needs. Despite the focus on significant policies, frameworks, and model of care within primary and secondary care. The impact is being felt by the public pressure is evident in some small centre’s tertiary or specialist services due to demographic change, workforce shortages and quality or safety concerns. Many health and disability support services are delivered by NGOs. This includes the Pasifika and M?ori organisations operating on a not-for-profit basis. In these organisations pressure for further specialisation is driven by technical and therapeutic development, workforce specialisation public expectations and outcome evidence. However, it is exacerbated by funding path constraints. In the current system tightly prescribed government contracts reduce the flexibility of providers to tailor services to meet their needs of clients. The lack of agreed measures of value which has led to little measurements and reporting of the achieved outcomes from NGO and social services programs.
 

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