New Zealand already implementing Berwick’s proposal
Rapid response to:
Papers
Getting more for their dollar: a comparison of the NHS with California's Kaiser PermanenteCommentary: Funding is not the only factorCommentary: Same price, better careCommentary: Competition made them do it
New Zealand already implementing Berwick’s proposal
The extensive, largely critical commentary on the article by Feachen
et al1 has almost completely ignored Berwick’s proposal to pilot a more
fully integrated NHS2 through a strategic health authority. However
experience in New Zealand of such authorities as purchasers does not give
me much confidence in this approach. It was abandoned in 2000 in favour of
a fully integrated district health board (DHB) as both purchaser and
provider. DHBs are accountable for better health outcomes for their
defined populations.
This is being achieved through integrating the effort of all
providers, government and non-government, primary and secondary, hospital
and community, public health and disability. This model is even more
comprehensive than Kaiser. It may be the experiment that Berwick is
looking for.
A study of 10 DHBs, completed earlier this year, showed the building
of a new partnership between clinical leadership and managers, with
increasing accountability by clinicians for both quality and cost3. Of
particular importance has been the development of primary care
organisations (PCOs) which are now accepting accountability for all GP
related expenditure and promoting quality primary care3,4. They are also
building a new partnership between primary and secondary care. For
example, within the DHB framework, Pegasus Health in Christchurch, with a
membership of 230 GPs and global budget of $80 million, is significantly
reducing acute admissions through alternative community-based care.
Our PCOs would appear to be much more advanced than the NHS
PCG/Ts3,4. They now have the advantage of becoming fully integrated into
the DHB system. Building new and trusting relationships within a lead
organisation, especially between primary and secondary care as in Kaiser,
will more successfully achieve the cultural and organisational changes
needed than failed purchasing strategies.
References
1. Feachem RGA, Sekhri NK, White KL. Getting more for their dollar: a
comparison of the NHS with California's Kaiser Permanente. BMJ 2002;
324:135-43.
3. Malcolm L, Wright L, Barnett P, Hendry C. (2002) Clinical
leadership and quality improvements in district health boards in New
Zealand. Clinical Leaders Association of New Zealand, Auckland. www.clanz.org.nz and www.moh.govt.nz
4. Malcolm L, Mays N. New Zealand’s independent practitioner
associations: a working model of clinical governance? BMJ 1999; 310: 1340-
1342.
Rapid Response:
New Zealand already implementing Berwick’s proposal
The extensive, largely critical commentary on the article by Feachen
et al1 has almost completely ignored Berwick’s proposal to pilot a more
fully integrated NHS2 through a strategic health authority. However
experience in New Zealand of such authorities as purchasers does not give
me much confidence in this approach. It was abandoned in 2000 in favour of
a fully integrated district health board (DHB) as both purchaser and
provider. DHBs are accountable for better health outcomes for their
defined populations.
This is being achieved through integrating the effort of all
providers, government and non-government, primary and secondary, hospital
and community, public health and disability. This model is even more
comprehensive than Kaiser. It may be the experiment that Berwick is
looking for.
A study of 10 DHBs, completed earlier this year, showed the building
of a new partnership between clinical leadership and managers, with
increasing accountability by clinicians for both quality and cost3. Of
particular importance has been the development of primary care
organisations (PCOs) which are now accepting accountability for all GP
related expenditure and promoting quality primary care3,4. They are also
building a new partnership between primary and secondary care. For
example, within the DHB framework, Pegasus Health in Christchurch, with a
membership of 230 GPs and global budget of $80 million, is significantly
reducing acute admissions through alternative community-based care.
Our PCOs would appear to be much more advanced than the NHS
PCG/Ts3,4. They now have the advantage of becoming fully integrated into
the DHB system. Building new and trusting relationships within a lead
organisation, especially between primary and secondary care as in Kaiser,
will more successfully achieve the cultural and organisational changes
needed than failed purchasing strategies.
References
1. Feachem RGA, Sekhri NK, White KL. Getting more for their dollar: a
comparison of the NHS with California's Kaiser Permanente. BMJ 2002;
324:135-43.
2. Berwick DM. Commentary: same price, better care. BMJ 2002; 324:142
3. Malcolm L, Wright L, Barnett P, Hendry C. (2002) Clinical
leadership and quality improvements in district health boards in New
Zealand. Clinical Leaders Association of New Zealand, Auckland.
www.clanz.org.nz and www.moh.govt.nz
4. Malcolm L, Mays N. New Zealand’s independent practitioner
associations: a working model of clinical governance? BMJ 1999; 310: 1340-
1342.
Competing interests: No competing interests