Public purchasing and private priorities for healthcare in New Zealand

Collaborative purchasing of complex technologies in healthcare

Purpose

– The purpose of this paper is to investigate how buyers and the vendors pursue alignment in collaborative purchasing (CP) of complex medical technologies.

Design/methodology/approach

– Through a literature review in CP, the paper identify factors for shareholder alignment (i.e. aligning the needs of the buyers within the purchasing group) and customer alignment (i.e. aligning buyers’ needs with the vendors offering strategies) and investigate how they manifest in the case of CP of complex technology in the Danish National Healthcare System.

Findings

– Shareholder alignment requires appropriate management of the relationships, expertise and guidance in simplifying procedures and effective management of the purchasing group. Customer alignment is facilitated by buyers’ understating of the vendor’s design options, which are moderated by the vendor’s design strategies.

Research limitations/implications

– The findings and generalizations from a single case study are limited to the complexity of the purchased technology and the specific cultural context. However the paper represents the first explorative study that poses the attention on the relevance of shareholder and customer alignment in CP.

Practical implications

– The study can offer hospitals, vendors, governmental and regional institutions a better understanding about the alignment mechanisms for successful implementation of CP and how to avoid pitfalls.

Originality/value

– Literature on CP is scarce as there are virtually no contributions that debate the key elements and tradeoffs that need to be considered for strategic alignment. The study addresses this gap.

Effects of health policy reforms on nursing resources and patient outcomes in New Zealand

Health policy reforms in New Zealand during the 1990s impacted on hospital operations, on the nursing workforce, and on patients. This study analyses changes in rates of 20 adverse patient outcomes that are potentially sensitive to nursing (OPSNs) before (1989-1993), during (1993-2000), and after (2000-2006) the policy reforms, using all New Zealand public hospital inpatient discharge data for this period. Comparisons of changes in mean annual rates across periods revealed the expected trajectory of acceleration during the reform period relative to the prereform period, and a subsequent deceleration in the postreform period. This S-shaped pattern was clearly evident in 16 of the 20 OPSNs, and partially evident in the remaining 4. These results are interpreted as evidence that the 1990s policy reforms inspired by managerialism had deleterious effects on patient outcomes, and that these effects coincided with changes in nursing resources and the work environment.

Healthcare policies over the last 20 years: reforms and counter-reforms

The case argued in this article is that the last two decades have been characterised by distinct waves of healthcare reforms. The first, in the early 1990s, aimed to introduce more patients' choice and greater competition between the components of the healthcare system. The second, from 1995 to 2000, had the opposite aim of introducing greater integration and regulation. From 2000 onwards, the policy issue more in vogue has been the strengthening of patients' rights. Looking for the motives behind these reform strategies, this article aims to show how the ideological leaning of the governments in power affects the content of reform initiatives. The analysis presents evidence drawn from six OECD countries: France, Germany, the Netherlands, New Zealand, Sweden and UK.

Priority setting in health care: Lessons from the experiences of eight countries

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities.We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider (1) the process each country used, (2) criteria to judge the success of these efforts, (3) which approaches seem to have met these criteria, and (4) using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making.

Effects of New Zealand??s Health Reengineering on Nursing and Patient Outcomes

BACKGROUND

In 1993, New Zealand (NZ) implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The cost control focus was similar to reengineering efforts implemented by other countries struggling with escalating health care costs, particularly the United States.

OBJECTIVE

The study's purpose was to examine the effects hospital reengineering may have on adverse patient outcomes and the nursing workforce.

RESEARCH DESIGN

The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis.

SUBJECTS

All medical and surgical discharges from NZ's public hospitals (n = 3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n = 65,221 nurse responses) from 1993 through 2000 were examined.

MEASURES

Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix.

RESULTS

After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant.

CONCLUSIONS

In the chaotic environment created in NZ by reengineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organizational change plays in patient outcomes, the unintended consequences of health care reengineering and market approaches in health care, and nursing's unique contribution to quality of care.