DAP 2009/10 Final 1 - Taranaki District Health Board

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DAP 2009/10 Final6.0 FUNDING ACCOUNTABILITY6.1 How is Money Allocated to Taranaki District Health Board?Funding to District Health Boards is allocated on the basis of a Population BasedFunding Formula (PBFF). This is a mathematical formula that determines the shareof funding to be allocated to different districts in the country, based on the populationliving in each district. The aim of the PBFF is to fairly distribute available fundingbetween DHB’s, according to the relative needs of their populations and the cost ofproviding health and disability services to meet those needs. Each year the PBFF isreviewed to ensure that it fairly reflects the relative costs of providing health care todifferent populations.The key factor in PBFF is the size of the population. However, PBFF takes accountof population factors such as age, sex, ethnicity and levels of social deprivation andunmet need, and other factors such as rural areas and numbers of overseas visitors.Every year the population forecast is recalculated and used in the revised PBFF.Changes to PBFF and Taranaki’s slower than national average population growth haslead to a sharp reduction in our funding share for the year ahead. Forecast localdemographic changes will result in a continued reduction in funding share in thefuture. These economic factors mean that the District Health Board can no longerprovide high levels of sustainability funding to the hospital provider. Similarly healthservices across the sector will need to be reshaped to meet the needs of thepopulation within the funding available.Therefore planning and prioritisation has to take place to determine which health andsocial needs will be met by publicly funded services and which will remain unmet.Our clear focus is to allocate funding to achieve significant health gain in ourpopulation and reduce inequalities for those with the poorest health status.6.2 How Will the District Health Board Prioritise?Prioritisation is the allocation or reallocation of funding on the basis of evidence, toservices which are more effective in improving health and self-management andreducing inequalities.The health sector is continually changing, sometimes in accordance with changes inhealth needs, or accepted clinical practice or medical technology. Services whichwere funded with the intention of reducing health inequalities may not prove to be aseffective as originally anticipated. Established services can change, sometimesexpanding in an unplanned or uncontrolled way. Growth in expenditure in any serviceis always at the expense of other services, since health resources are constrained. Ifthe District Health Board does not intervene when unplanned changes areinconsistent with the strategic direction, this leads to prioritisation through inertia. Therisk is that major prioritisation decisions are made in this way rather than through aconsidered prioritisation process.Taranaki DHB faces the double challenge of delivering and contracting for serviceswhich will deliver health improvements for our communities and reduce inequalities,whilst bringing our overall costs within that affordable under our share of PBFF. Thiswill only be achieved through the systematic review of new and existing healthinvestments using an accepted prioritisation and inequalities tool. In 2009/10 the tool41
DAP 2009/10 Finalwill be used to identify $4 million disinvestment to enable the Funder to meet knowncost pressures.When considering prioritisation decisions Taranaki District Health Board will apply thefollowing criteria:Effectiveness: This relates to the extent to which services produceimprovements in health status or reduce or prevent a decline in health status.Higher priority will be given to services which produce the greatestimprovement to the health status at a population level.Affordability: This relates to the cost of services and the impact on overallhealth expenditure relating to achievement of that health gain, to ensure thatfunding achieves maximum gain.Equity: This refers to both access and outcome. Can the service be accessedby the target population and does it improve the health status of those with theworst health?Māori Health: This refers to the degree to which Māori will take up and benefitfrom the proposal, whether it is appropriate and acceptable to Māori andwhether it will reduce disparities between Māori and Non-Māori.Strategic Fit: This relates to the delivery of health gain in the strategic focusareas outlined in the Taranaki DHB District Strategic Plan 2005-2015, or withthe delivery of services required by the Ministry of Health under the ServiceCoverage Schedule.Timing of Benefits: This refers to how quickly the benefits will be realised.Highest priority will be given to those proposals which deliver benefits mostquickly.Taranaki District Health Board would like to make all decisions based on goodepidemiological data and evidence on outcomes. However, this type of information isnot always available and sometimes decisions will have to be made on the bestinformation available. In this situation the Board commits to ensuring fair andaccurate representation of the need and benefit; and reasonable estimation of therelative importance or value of proposals. It is also acknowledged that on occasionsprioritisation decisions will take place outside the control of the DHB. e.g. throughnational policy setting or direction from the Minister of Health.Through the consistent application of these criteria, to all funding decisions, TaranakiDHB aims to deliver both an improvement in health status of the population andaffordability of services within the PBFF. The Planning and Prioritisation Panel of theDistrict Health Board provide advice on investment and disinvestment decisions. TheChief Medical Advisor and Director of Nursing are members of this Panel and provideclinical leadership into the deliberations of the Panel.42
Page 4 and 5: DAP 2009/10 FinalMINISTERIAL LETTER
Page 6 and 7: DAP 2009/10 Final1.0 INTRODUCTION F
Page 8 and 9: DAP 2009/10 Final2.0 OBJECTIVESThis
Page 10 and 11: DAP 2009/10 Final3.0 APPROACHThis s
Page 12 and 13: DAP 2009/10 Final3.1 Older People7
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Page 16 and 17: DAP 2009/10 Final3.2.3 Oranga Kai O
Page 18 and 19: DAP 2009/10 Final3.3 Disability & A
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Page 26 and 27: DAP 2009/10 FinalDHB Local Activity
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Page 54 and 55: DAP 2009/10 Finalestimated at $0.23
Page 56 and 57: DAP 2009/10 Finale. Primary sector
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