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

Abstract

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]

Addressing alcohol and other drug use among young people from migrant and ethnic minority backgrounds: Perspectives of service providers in Melbourne, Australia

“…Service providers recognised sustained engagement is needed to build relationships and facilitate conversations about AOD use with young people and their broader communities. A previous program that targeted young men from African backgrounds who were disengaged from education and employment identified that short-term programmes do not enable adequate time for building relationships and addressing complex challenges (Turnbull & Stokes, 2011) These constraints reflect challenges in the broader AOD sector with short-term and irregular funding recognised as barriers to service delivery (van de Ven et al, 2020). Additionally, demonstrating progress towards outcomes can be challenging when greater value is placed on abstinence or reduced consumption as opposed to improvements in health and quality of life (Savic & Fomiatti, 2016).…”

Are market mechanisms associated with alcohol and other drug treatment outcomes?

“…One consequence of competitive tendering is service providers having multiple funders. Views of Australian treatment providers were mixed regarding having multiple funders—on one hand, having multiple funders was seen to protect agencies from ‘political whim’ ([9], p. 194); on the other hand, it was regarded as a ‘drain on organizational resources’ ([9], p. 194). Multiple contracts for a single provider are also seen in the Nordic countries.…”

“…In Australia, both service providers and treatment purchasers have expressed similar concerns about the ubiquity of competitive tendering as a selection process for service providers [9]. One consequence of competitive tendering is service providers having multiple funders.…”

Problematisk opioidanvändning: om opioidrelaterade dödsfall och LARO i södra Sverige

“…Studies on market-orientation in the field of substance use have been conducted in a number of countries, primarily in Europe and Australia. These studies tend to direct their principal focus at organisational policies linked to payment or reimbursement systems (Jones et al, 2018;Nesvaag & Lie, 2010;Roman et al, 2006;Shepherd et al, 2014;van de Ven et al, 2020), although some studies have focused on the effect of NPM on staff working in substance use treatment (Lewiskin, 2018). Few studies have focused on examining different forms of substance use care delivery from a staff or patient perspective however (van de Ven et al, 2020).…”

“…These studies tend to direct their principal focus at organisational policies linked to payment or reimbursement systems (Jones et al, 2018;Nesvaag & Lie, 2010;Roman et al, 2006;Shepherd et al, 2014;van de Ven et al, 2020), although some studies have focused on the effect of NPM on staff working in substance use treatment (Lewiskin, 2018). Few studies have focused on examining different forms of substance use care delivery from a staff or patient perspective however (van de Ven et al, 2020). The delivery forms that often constitute the focus of studies in the field of marketbased service provision are results-oriented models, such as payment by results, or public procurement, i.e.…”