Along with other developed countries, Australia’s health system is being challenged by the ageing of the population and related trends in demand for health care, such as the rise in chronic disease.
These changes will require our health system to focus on the delivery of coordinated care provided by multiple providers across different care settings. This will require a shift away from the current siloed and program-based health funding system towards new models of funding and service delivery.
Given that other countries are facing similar challenges, it makes sense to look internationally to assess the different approaches being taken in other countries seeking to meet their citizens’ needs for health care.
One relevant example for Australia is New Zealand. Culturally similar to Australia, since 2010 New Zealand has been using a regional pooled funding and local governance model to deliver most of the government-funded health care provided to its citizens.
The Deeble Institute has released a Perspectives Brief on this issue in which Professor Claire Jackson and Professor Robin Gauld analyse the learnings for Australia from this model.
The main issues raised in the brief are summarised below.
Jennifer Doggett writes:
The need to explore options for funding reform within the Australian health system was agreed by members of the Council of Australian Governments (COAG) in 2016. This agreement established a series of bilateral agreements enabling governments to work across jurisdictions to determine the best model of care for Australians with chronic and complex diseases.
The Health Care Homes pilot program is one initiative that has resulted from this agreement. Other issues being explored by governments in this context include: the coordinated planning and collaborative commissioning of services between Primary Health Networks (PHNs) and Local Hospital Networks (LHNs); arrangements for the sharing of patient information; and implementation of collaborative funding arrangements to support better coordination of care for patients at risk of avoidable public hospital admission.
Key themes
The key themes linking these activities include: whole-of-system planning, funding and service delivery; linking incentives with desired structure and function; strong integration across health and social care sectors; advanced care delivery access within the community; and innovative use of e-health.
There is a range of possible funding and governance models that could support these activities. Pooled funding is one model which seems well suited to delivering more coordinated and integrated care and reducing fragmentation across jurisidictional and health sector boundaries. However, this model challenges many of the established mechanisms for funding and delivering health care in Australia and is potentially confronting to Australian health and hospital providers.
A population-based governance model, focussed on consumer-centred visions of healthcare, would also offer greater opportunities to deliver the COAG reform agenda. However, it too would require radical changes to our current system of governance.
Alliance contracting
Both these models are already in existence in New Zealand, via the ‘Alliance Contracting’ system. This system was implemented in 2010 and involves ‘alliances’ between the country’s twenty publicly-funded District Health Boards (responsible for hospitals and regional services) and thirty Primary Health Organisations (the coordinators of general practice and primary care).
There have been mixed results from evaluations of this model however it has the support of all major stakeholders and the New Zealand government who believe that over the longer term it is the best available option.
Some of the key learnings from New Zealand’s experience of transitioning to Alliance Contracting, include:
- it is important to harness and coordinate all stakeholders at the local level to ensure they develop shared, patient-centred approaches to delivering care;
- governance frameworks and key performance indicators should include a shared commitment to relevant population-based funding and service redesign priorities, and efficient service delivery;
- new forms of clinical and executive leadership are required to facilitate the cultural changes involved with this model.
As we progress the Health Care Homes pilot and other important initiatives to explore health forum options it is important that Australia learn from New Zealand’s experience of Alliance Contracting and any other relevant international examples of health system reform.
