RAJ REPORT

The focus should be on keeping patients out of Hospitals through more funding of Medicare Locals not DOCTORS CONTRACTS——————-There is often confusion in the public mind between health care, health and hospitals. Whilst hospitals are the public face of the healthcare system the majority of health is generated elsewhere. The wider determinants of health include housing, employment, education and wider societal factors. At its most extreme some healthcare groups such as Kaiser Permanente regard hospital admission as a failure of the system

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HEALTH CARE AND POPULATION HEALTH

There is often confusion in the public mind between health care, health and hospitals. Whilst  hospitals are the public face of the healthcare system the majority of health is generated  elsewhere. The wider determinants of health include housing, employment, education and  wider societal factors. At its most extreme some healthcare groups such as Kaiser  Permanente regard hospital admission as a failure of the system. Is it is against this backdrop  that the next steps should consider the role of wider health care goals and non-hospital-based  activity in relation to ABF/A BM.   There is a danger that activity based costing systems incentivise hospital activity as the  literature reviews above demonstrate. However this does not have to be the case. A strong

drive from a purchasing function can ensure that resources are shifted to out of hospital care.  This will need a clear direction in terms of performance management and “tuning” the  payment mechanism. Area health services are well placed to deliver the more high-tech and clinically advanced hospital at home initiatives. Consideration should be given to a wider  variety of community and third sector providers for the more community and social end of  care. As result of changes to payments beyond high boundary levels funds will become   available in the system. It is suggested that  these funds are directed towards out of hospital

care to prevent admissions, particularly around chronic care conditions. There exists an  opportunity to work with the embryonic Medicare locals to ensure the success of such  initiatives.  The question was raised whether activity based costing methods could be applied across all  health services. In particular public health activities were deemed to be a challenge for this  methodology. However it is possible to use a tariff-based system for public health and health  promotion. For the last year in the West Midlands of the English NHS a tariff-based system  has been used for smoking cessation. Providers are rewarded according to 4 week or 12  week quitters. More importantly the tariff is varied such that it rewards providers for  working with target groups. This includes people from ethnic minorities, those from  deprived communities, people with disabilities and women smoking during pregnancy. The     25

unit cost for work with his target groups can be more than double that for the average  member of the population.

 

 

 

 

 

 

 

 

www.health.wa.gov.au/activity/docs/review_abf_abm.pdf.

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