A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment

Ritter, Alison; Hull, Peter; Berends, Lynda; Chalmers, J. P.; Lancaster, Kari

doi:10.1016/j.addbeh.2016.04.017

Cited by 7 publications

(17 citation statements)

References 80 publications

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“…Governments across the globe invest considerable amounts of funding in alcohol and other drug (AOD) treatment. The way governments disperse funds has a significant impact on what treatment is provided, by whom and in what organisational context . The source of funding (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…While much research has focussed on the amount of funding available, value‐for money or the cost effectiveness of treatment, there has been less attention to the various provider selection (i.e. purchasing) and payment mechanisms for AOD treatment . The aim of this study was to explore the perceptions of Australian AOD treatment purchasers and treatment providers regarding various purchasing and payment approaches.…”

Section: Introductionmentioning

confidence: 99%

“…AOD treatment in most countries is provided across diverse settings including hospitals, outpatient clinics, primary care settings and community non‐government organisations (NGO), which all come with their own set of purchasing and payment mechanisms . In Australia, each state and territory has its own unique blend of AOD treatment services driven by state government policies regarding government versus non‐government treatment, historical arrangements and the extent to which AOD is regarded as and managed within health systems .…”

Section: Introductionmentioning

confidence: 99%

“…With reference to AOD, Ritter et al . provide a conceptual schema outlining the main processes used to select AOD providers (competitive tendering, historical or negotiated processes and third‐party outsourcing). Competitive tendering processes are ubiquitous as a mechanism by which governments select the providers of social services and increasingly of AOD treatment services (particularly non‐government) .…”

Section: Introductionmentioning

confidence: 99%

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Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment

Ven

Ritter

Berends

et al. 2020

Drug and Alcohol Review

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Introduction and Aims. Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms. Design and Methods. Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes. Results. Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources. Discussion and Conclusions. In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach. [van de Ven K, Ritter A, Berends L, Chalmers J, Lancaster K. Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment. Drug Alcohol Rev 2020;39: [189][190][191][192][193][194][195][196][197]

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment

Ven

Ritter

Berends

et al. 2020

Drug and Alcohol Review

Self Cite

View full text Add to dashboard Cite

show abstract

“…Other aspects of funding might also impact on service performance, quality and outcomes—such as the way providers are chosen and the ways services are paid for, e.g. block grant, capitation, payment for activity or payment for outcome [160], although the evidence of how the funding provisions influence outcomes is mixed [161–163]. Additionally, disaggregated spending records could indicate whether programmes invest in adequate numbers of well-trained staff and procure quality commodities that meet the needs of the people accessing the service—all related to the quality of service provision.…”

Section: Discussionmentioning

confidence: 99%

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

et al. 2017

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Background and aimsDespite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality.Methods and resultsThe framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included ‘coverage’, ‘waiting list time’, ‘dosage’ and ‘availability in prisons’. For the specific NSP indicators, the priority indicators included ‘coverage’, ‘number of needles/syringes distributed/collected’, ‘provision of other drug use paraphernalia’ and ‘availability in prisons’. Among the generic or cross-cutting indicators the priority indicators were ‘infectious diseases counselling and care’, ‘take away naloxone’, ‘information on safe use/sex’ and ‘condoms’. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries.ConclusionsThe establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

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Is it feasible to pay specialty substance use disorder treatment programs based on patient outcomes?

Hodgkin

Garnick

Horgan

et al. 2020

Drug and Alcohol Dependence

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Background: Some US payers are starting to vary payment to providers depending on patient outcomes, but this approach is rarely used in substance use disorder (SUD) treatment. Purpose:We examine the feasibility of applying a pay-for-outcomes approach to SUD treatment. Methods:We reviewed several relevant literatures: (1) economic theory papers that describe the conditions under which pay-for-outcomes is feasible in principle; (2) description of the key outcomes expected from SUD treatment, and the measures of these outcomes that are available in administrative data systems; and (3) reports on actual experiences of paying SUD treatment providers based on patient outcomes. Results:The economics literature notes that when patient outcomes are strongly influenced by factors beyond provider control and when risk adjustment performs poorly, pay-for-outcomes will increase provider financial risk. This is relevant to SUD treatment. The literature on SUD outcome measurement shows disagreement on whether to include broader outcomes beyond abstinence from substance use. Good measures are available for some of these broader constructs, but the need for risk adjustment still brings many challenges. Results from two past payment experiments in SUD treatment reinforce some of the concerns raised in the more conceptual literature. Conclusion:There are special challenges in applying pay-for-outcomes to SUD treatment, not all of which could be overcome by developing better measures. For SUD treatment it may be necessary to define outcomes more broadly than for general medical care, and to continue conditioning a sizeable portion of payment on process measures.

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A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment

Cited by 7 publications

References 80 publications

Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment

Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

Is it feasible to pay specialty substance use disorder treatment programs based on patient outcomes?

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