BFA534 Introduction To Corporate Governance

BFA534 Introduction To Corporate Governance

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BFA534 Introduction To Corporate Governance

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BFA534 Introduction To Corporate Governance

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Course Code: BFA534
University: University Of Tasmania

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Country: Australia

Questions:

Identify which of the four funding models defined by Egar et al. (2013) are used by the public hospitals in Australia and briefly describe its use.
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

Answers:

Introduction
This paper provides a thorough review of the quality and safety practices in the health care system for funding and pricing arrangements in Australia undertaken by the commission and IHPA. In this analysis, we shall look at the pricing framework which will inform the national efficient determination used in activity-based funding implementation in Australian public hospitals. Further, we shall see how the National Efficient Price system might provide the Australian population with incentives to improve their health status.
1. Funding models
There are four funding methods that Australian public hospitals use and are identified in the IHPA and commission literature review. They are; best practice pricing, quality structure pricing methods, normative pricing and payment for safety or performance and quality pricing. First, best practice pricing model can be defined as a funding model that uses care pathways based on widely accepted evidence where the best solution would be for the hospital to treat a particular health condition before the set fee is paid (Tompkins, Altman, & Eilat, 2016). Implementation price for this funding model, based on the clinical evidence available, is determined and then the additional incentive is paid to the hospital. Best pricing program started in four areas; cataract pathway, acute stroke care, cholecystectomy, and fragility hip fracture care. As this scheme represents money value, evaluating the literature on the efficacy of this funding model is still limited. The British health care system had “Best Practice Tariffs” scheme implemented, though the conclusive evidence was limited except for the UK’s National Hip Fracture Database findings (Eagar, 2014). As per the Independent Hospital Pricing Authority review, the best practice pricing funding model gains more with methodological inadequacies due to the implementation of care pathways based on the best evidence in limited conditions.
The other funding model is quality structure pricing which is linked to the participation in the activities of safety improvement, clinical benchmarking, and meeting of standards of accreditation and quality registries by the health care providers. And though the initial cost might be high, the aim of this model is to increase savings (Levaggi, 2015). This model might be high for the hospitals that are accredited than in the ones that are non-accredited, but according to the available evidence, this funding model leads to safety and quality improvement. The third funding model is normative pricing where delivery outcomes of care are influenced by prices. An example where outcomes are influenced by the prices are; patients seeking residential care, incentivizing day surgeries, and the need for more nurses at home in the cases of certain disabilities or illness (Black et.al, 2011).
However, there was an improvement that was noted by implementing the funding model in the radiology area. Also, due to the uncertainties of determining the implementation cost of this model, there is no conclusive evidence on its use. The last funding model is the payment for performance which involves pushing the care providers to behave in a certain manner thereby improving safety and quality. This model uses disincentives for poor services or financial incentives for positive outcomes. It also encourages the givers to improve quality by rewarding them or penalizing them if they fail (Martin & Guvatt, 2013). And even though there is no evidence of any beneficial outcomes of this model, Britain undertook an advancing quality initiative that showed improvements results through quality scores and the short-term in-hospital immortality reduction.
2. National Efficient price
National Efficient price (NEP) identifies commonwealth contribution to the funding of public hospitals in Australia. This system provides that each hospital be paid, for each episode of care, a fixed fee. IHPA determines the contribution to be paid by the Australian government, which should be around 40% of the hospital funding. If IHPA creates any incentives into quality and safety model, it influences the contribution made by the Commonwealth. There is no evidence on the funding models mentioned above regarding their efficacy to improve safety and quality of care services (Nieva & Sorra, 2013). Therefore, considering this literature, I agree that the National Efficient price might be unable to provide the required incentives that are aimed at improving the health status among the Australian population to a greater extent. This is due to the difficulties of determining how this system actually works as identifying the onset of certain health condition is challenging.
Misallocation of resources in the cases where the cost-effectiveness of services does not reflect the set price is a major limitation of the National Efficient price. Also, there is doubt as to whether the major changes can be stimulated in Australian public hospitals regarding safety and quality as the public hospital funds are not directed to specific hospital departments (Palmer et.al, 2014). Therefore, delivering the incentives to the clinical department level is a necessity if any effect is to be felt even though quality does not have any rewards as some rural hospitals are disadvantaged. Also, it is necessary to consider any potential that regional disparities have in improving healthcare quality to a greater extent. There are weaknesses in the manner the activity based funding scheme is designed even though it has the capability of making hospital functioning more efficient (Solomon,2014). Given these flaws, negative influence on the potential cost savings is a possibility, resulting in a poor change in health care quality and ineffective funding system. Providers change their behavior or care pathways if they realize that incentives are substantial. Otherwise, chances of clinicians responding to incentives are much less as pricing only affects some aspects of care. Therefore, stimulating behavior change of the health providers is the only way National Efficient price will ensure efficiency gains.
References
Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., … & Sheikh, A. (2011). The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS medicine, 8(1), e1000387.
Eagar, K. (2014). Implementation of a national case-mix classification and funding model into palliative care in Australia.
Levaggi, R. (2015). Hospital health care: pricing and quality control in a spatial model with asymmetry of information. International Journal of Health Care Finance and Economics, 5(4), 327-349.
Martin, D., & Guyatt, G. (2013). Prelude to a systematic review of activity-based funding of hospitals: potential effects on cost, quality, access, efficiency, and equity. Open Medicine, 7(4), e94.
Nieva, V. F., & Sorra, J. (2013). Safety culture assessment: a tool for improving patient safety in healthcare organizations. BMJ Quality & Safety, 12(suppl 2), ii17-ii23.
Palmer, K. S., Agoritsas, T., Martin, D., Scott, T., Mulla, S. M., Miller, A. P., … & Merglen, A. (2014). Activity-based funding of hospitals and its impact on mortality, readmission, discharge destination, the severity of illness, and volume of care: a systematic review and meta-analysis. PLoS One, 9(10), e109975.
Solomon, S. (2014). Health reform and activity-based funding. The Medical Journal of Australia, 200(10), 564.
Tompkins, C. P., Altman, S. H., & Eilat, E. (2016). The precarious pricing system for hospital services. Health Affairs, 25(1), 45-56.

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