Explicit rationing of elective services: implementing the New Zealand reforms

Dew, Kevin; Cumming, Jacqueline; McLeod, Deborah; Morgan, Sonya; McKinlay, Eileen; Dowell, Anthony; Love, Tom

doi:10.1016/j.healthpol.2004.12.011

Cited by 36 publications

(49 citation statements)

References 10 publications

(12 reference statements)

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“…This outcome was not anticipated for three reasons. First, the policy intention was that CPAC tools would aid decision making and as such would be used in the consultation as decisions were made (Dew et al . 2005).…”

Section: Methodological Approachmentioning

confidence: 99%

“…An evaluation of the elective services project, however, reported that surgeons claim to use the tools in a variety of ways – from deploying them as strict protocols, to filling them out once a decision had already been made (Dew et al . 2005).…”

Section: Introductionmentioning

confidence: 99%

“…2005). This research, based on interview data, suggested that ‘Much of the rationing is still implicit in that there is still a reliance on the discretion of clinicians to weight subjective criteria’ (Dew et al . 2005: 10).…”

Section: Introductionmentioning

confidence: 99%

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The (non) use of prioritisation protocols by surgeons

Dew

Stubbe

Macdonald

et al. 2010

Sociology Health & Illness

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Priority setting and rationing is a dominant feature of contemporary health policy. In New Zealand, clinical priority assessment criteria (CPAC) tools have been developed to make access to elective surgery more equitable and efficient.Research was undertaken to identify how surgeons used these tools in the consultation. Forty-seven consultations with 15 different surgeons have to date been video-and audio-recorded. There were no instances where CPAC tools were explicitly used in the consultation. Drawing on the methodology of conversation analysis and the concept of news delivery as developed by Maynard, this paper argues that the delivery of diagnoses and treatment plans can usefully be seen in part as the delivery of bad or good news. Using three case studies to illustrate the argument, it is suggested that the interactional work required in the delivery of such news challenges the ability of clinicians to use protocols such as CPAC. The analysis sheds light on important consultation processes that need to be more carefully considered when designing interventions to influence clinician behaviour. In order to influence the behaviour of clinicians to achieve policy goals, greater attention needs to be paid to the interactional demands of the consultation process.

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Section: Methodological Approachmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The (non) use of prioritisation protocols by surgeons

Dew

Stubbe

Macdonald

et al. 2010

Sociology Health & Illness

Self Cite

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show abstract

“…Explicit prioritisation has been implemented by means of scoring systems and point-count measures for the management of waiting lists, for instance for elective surgical patients in the UK, New Zealand and Canada [15][16][17][18][19]. In an evaluation study on the New Zealand health care reforms the prioritisation was found to be more explicit and access to treatment had changed, but there was some resistance to the use of the new methods [20].…”

Section: Description Of the Processmentioning

confidence: 99%

Child psychiatry in the Finnish health care reform: National criteria for treatment access

et al. 2010

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“…Whether or not this is a fair assessment, the focus on waiting lists has encouraged governments and hospitals to introduce processes to monitor and manage waiting lists for publicly funded health services. For example, in 1996, New Zealand trialled "financially sustainable thresholds" for elective surgery, where health services could determine the number of elective surgeries performed based on their ability to fund them [9,10]. In 2004, Australia introduced the national waiting time targets for elective surgery performed in public hospitals [11].…”

Section: Introductionmentioning

confidence: 99%

Expectations Confounded: Patients Are Satisfied with THR and TKR Delivery in Australian Public Hospitals—A Multisite Case Study

2012

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Background. The popular media infer that satisfaction with waiting lists for total hip or knee replacement surgery is poor; however, there is little supporting evidence for this. The purpose of this study was to describe patients satisfaction with the service they received for joint replacement surgery in a public hospital. Methods. A cross-sectional design was used to survey 450 patients. Data was analysed descriptively and chi-squared analyses (significance level of P < 0.05) were used to examine associations between variables. Results. The response rate was 71%. Nearly three-quarters (n = 312) of the sample were "very happy" with the service and 92.0% (n = 379) indicated that they would have their surgery again. Satisfaction was significantly associated with waiting time to the first appointment (chi-square; P = 0.002), whether the patients enquired about their waiting time (chisquare; P = 0.003), and the number of preoperative appointments (chisquare; P = 0.04). Most participants reported a maximum acceptable waiting period for initial appointment of less than 6 months but nearly half waited longer. Conclusions. The perception that patients are unhappy with elective surgery services in Australia may be unfounded despite many waiting longer than they consider appropriate.

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Explicit rationing of elective services: implementing the New Zealand reforms

Cited by 36 publications

References 10 publications

The (non) use of prioritisation protocols by surgeons

The (non) use of prioritisation protocols by surgeons

Child psychiatry in the Finnish health care reform: National criteria for treatment access

Expectations Confounded: Patients Are Satisfied with THR and TKR Delivery in Australian Public Hospitals—A Multisite Case Study

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