Funding and Pricing Models in Australian Healthcare System
The Australian public hospitals are directed and governed by the state-run healthcare system but are financed by the government (Agarwal, Green, Agarwal & Randhawa, 2016). According to the researches done by Robinson and Norman, the Australian healthcare system is funded by both the territory and federal funds (Norman & Robinson, 2015). The territory funds are used for the hospital care while the federal funds are useful for the primary care. The Commonwealth funds the health services for the emergency department and the inpatient. The IHPA coordinate other healthcare services such as mental health services, community programs, outpatient clinics, and rehabilitation. The Australian government developed different mechanisms for funding the health care systems so that to enhance the quality of the patient outcomes reduce the complications and improve the quality of healthcare services. Some of the best-implemented funding and pricing models include; normative pricing model, pay as per the performance model and quality structures pricing model (Activity-based funding for Australian public hospitals: Towards a pricing framework, 2012).
The best pricing practice considers placing practice for the best clinical practice. In the domain of stroke myocardium infarction and in the broken Hip, the Western Australian established the inventiveness of best practice as the user program of premium payment (Department of Health Western Australia, 2016). The standard model of pricing was helpful for the Independent Hospital Pricing Authority (IHPA) that affected the healthcare delivery like pricing the particular procedure to inspire on a daily basis as an alternative of patient’s admission (Dowine, 2017). Quality pricing structures connect the safety and quality methods by financing the attributed hospitals more than the hospitals that are not accredited. All the government hospitals certified the National Quality and Safety Health Standard Services (NQSHSS) to ensure quality and safety services of the system (eager et al, 2013). A performance-based financing scheme enables the smooth delivery of healthcare and services that are provided by the healthcare center using positive incentives to ensure achieving of the defined goal of ameliorating the quantity and quality of the health facilities (Bonfrer et al, 2014).
Moreover, it was recommended that the primary purpose of establishing the pay for performance in the in all the healthcare systems around the world such as in Australia, Canada, United Kingdom and USA is to raise the quality of the healthcare services provided to the patients that are significant for better health outcomes (Mason, Yiu-Shing Lau & Sutton, 2016). There are reports of sham activities as a result of Australian hospital financing incentives. The hospitals in Victoria and NSW manipulates and reclassifies data including the patient’s number for the patients who are in the list waiting for the elective surgery so that to avoid penalties and enable the amounts of performance funding bonus. The effects of financial incentives and performance-based funding scheme have both negative and positive impacts (Ashcroft, Menear, Silveira, Dahrouge, & McKenzie, 2016).
Activity-Based Funding Scheme and National Efficient Price
A new basis for the funding of public hospitals was implemented on the basis of organizing for the introduction of the case mix (Duckett,1998). The case mix funding was established in Victoria government hospital in 1993 which received variable and fixed payments rendering to the number of patients’ in the particular hospital, the severity of the treated cases and the emergency department performance (Nocera, 2010). These types of payment were used for budgeting processes by several Australian states. The Australian pricing Authority was responsible for the determination of the effective prices of the reports from the public hospitals around all the states (Hall, 2015).
To what extent do you agree or disagree that the National Efficient price may provide an incentive to improve the health status of any selected segment of the Australian population. Remember to use relevant references to back up your arguments.
The Australian healthcare system experienced the unpredictable inequities in the accessibility of the health services and their outcomes in the past. Some of the challenges faced by the healthcare services include; increase of the health care cost, the increase of interest of quality and safety services, complex health issues, high consumers expectations, chronic illnesses, the stress of health manpower and demand escalations of healthcare as a result of the aging population (Bennett, 2009). The government of Australia developed the new law of National Health Reform Act in 2011 that recommended for the activity-based financing scheme through the use of case mix. The scheme was meant for paying on the basis of the outcomes through the provision of health care to outpatients and the inpatient and also for the emergency department care. This activity-based funding scheme provides funds for the appropriate services as provided by public hospitals by enhancing the funders to associate the price of various health services that are offered by different hospitals. The (IHPA) recommended for the efficient national price for the activities run in the hospital such as treatment and procedures that sometimes substitute the grants block provided to the local and public health networks. The activity-based scheme of funding assigns the health funds through the provision of a set of prices for every clinical activity such as surgery, knee and hip replacement and other diagnostic related groups while the funds are controlled by a partnership with the state government and Commonwealth (Rosen, Mcgorry, Hill & Rosenberg, 2012).
The main aim of the efficient national price in the public hospitals which was newly implemented in healthcare reforms was to increase the service accessibility and to improve the competence in the public hospital through the activity-based funding. The effective price such as cost, benefits, and outcomes of the services that determine the crucial funds in the public hospitals are estimated by the approaches of the risk-adjusted cost-effectiveness (RACE) (Karnon et al, 2011). The activity-based funding scheme uses the system of classification for the patient together with the effectual national price to evaluate the process of financing in regard to the inteded activities. This system of classification is related to the Australian advanced group, Classification of Australian both non-Acute and sub-acute patients, classification of the emergency care, Teaching, Training Tier 2 non-admitted service, and research (I. H. P.A. 2015). The ABF acts as inducements in all hospitals to reduce cost and admission period whereas the uplifting number of patients’ admissions generate more profit which can be useful for buying equipment and hiring new staffs for enhancement of the accessibility (Sutherland, Crump, Repin & Hellsten, 2013).
Impact of National Efficient Price on Health Outcomes
Through this act, the hospitals will minimize the long waiting list for elective treatments which will be of more profit to the public hospitals. The act gives a strong incentive for the hospital to expand and evaluate its services more efficiently from the funds they get. Funding provides useful info4mation concerning the services delivered and the cost in different hospitals encouraging the understanding of the hospitals. Also, funding increases the hospital’s transparency by showing clear criteria used in funding of the distribution of care facilities and the autonomy in the care provision within the agenda of responsibility (Activity-based funding for Australian public hospitals: Towards a pricing framework, 2012).
Reference
Activity based funding for australian public hospitals: Towards a pricing framework. (2012). The Queensland Nurse, 31(2), 7.
Agarwal, R., Green, R., Agarwal, N., & Randhawa, K. (2016). Benchmarking management practices in australian public healthcare. Journal of Health Organization and Management, 30(1), 31-56
Ashcroft, R., Menear, M., Silveira, J., Dahrouge, S., & McKenzie, K. (2016). Incentives and disincentives for treating of depression and anxiety in ontario family health teams: Protocol for a grounded theory study. BMJ Open, 6(11
Bonfrer, I., Soeters, R., Van, d. P., Basenya, O., Longin, G., van, d. L., & van Doorslaer, E. (2014). Introduction of performance-based financing in burundi was associated with improvements in care and quality. Health Affairs, 33(12), 2179-2187
Bennett, C. C. (2009). A healthier future for all Australians: an overview of the final report of the National Health and Hospitals Reform Commission. Medical Journal of Australia, 191(7), 383.
Department of Health Western Australia (2016) WA health funding and purchasing guidelines 2016.
Duckett, S. J. (1998). Casemix funding for acute hospital inpatient services in Australia. The Medical Journal of Australia, 169, S17-21.
Downie, J. (2017). More than just activity: pricing and funding for quality and safety.
Eagar, K., Sansoni, J., Loggie, C., Elsworthy, A., McNamee, J., Cook, R., & Grootemaat, P. (2013). A literature review on integrating quality and safety into hospital pricing systems.
Hall, J. (2015). Australian health care—The challenge of reform in a fragmented system. New England Journal of Medicine, 373(6), 493-497.
H. P.A., (2015). The Pricing Framework for Australian Public Hospital Services 2016-17.
Karnon, Jonathan, BA,M.Sc, PhD., Ben-Tovim, D., Pham, Clarabelle T,B.Sc, G.D.P.H., Caffrey, Orla,B.A., M.Sc, Hakendorf, Paul H,B.Sc, M.P.H., Crotty, Maria, MPH, PhD,F.A.F.R.M.(R.A.C.P.), & Phillips, Paddy A, MBBS, DPhil,F.R.A.C.P., F.A.C.P. (2011). The efficient price: An opportunity for funding reform. Australian Health Review, 35(4), 501-6.
Mason, T., Yiu-Shing Lau, & Sutton, M. (2016). Is the distribution of care quality provided under pay-for-performance equitable? evidence from the advancing quality programme in england. International Journal for Equity in Health, 15.
Norman, R., & Robinson, S. (2015). Lessons from albion. Journal of Health Organization and Management, 29(7), 925-932
Nocera, A. (2010). Performance-based hospital funding: a reform tool or an incentive for fraud?. Medical Journal of Australia, 192(4), 222.
Rosen, A., McGorry, P. D., Hill, H. R., & Rosenberg, S. P. (2012). The Independent Hospital Pricing Authority and mental health services: It is not a case of” one size fits all”. Medical Journal of Australia, 196(11), 675.
Sutherland, J. M., Crump, R. T., Repin, N., & Hellsten, E. (2013). Paying for hospital services: A hard look at the options. Commentary – C.D.Howe Institute, (378), 0_1,0_2,1-28.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
