BMJ  2003;327:439-443 (23 August), doi:10.1136/bmj.327.7412.439

Education and debate

Quality improvement perspective and healthcare funding decisions

¹ National Screening Unit, Ministry of Health, PO Box 5013, Wellington, New Zealand, ² National Health Committee, PO Box 5013, Wellington, New Zealand

Efforts to apply explicit prioritisation processes to healthcare funding decisions have had mixed results in New Zealand. But a quality improvement approach has advantages over existing prioritisation approaches

The first 150 words of the full text of this article appear below.

New Zealand, along with other countries, developed more transparency in making decisions about prioritising healthcare funding during the 1990s.^{1 2} In New Zealand, prioritisation approaches drew heavily on economic principles and used empirical evidence.

This paper reflects on experience with prioritisation of healthcare funding in New Zealand, identifying the benefits and also the shortcomings. It examines whether quality improvement, which is receiving increasing attention in New Zealand and internationally, is useful in making funding decisions both across and within services. We argue that a quality improvement approach has several advantages over existing prioritisation approaches, and we provide examples of how such an approach might be applied.

In the late 1980s and early 1990s, many developed countries restructured their healthcare systems, in part to improve efficiency and address rising costs. In New Zealand, major reforms in 1992 resulted in a purchaser-provider split with a strong emphasis on contracting and regulated competition. The . . . [Full text of this article]

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