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NEW ZEALAND management (e.g., cleaning), which accounts for less than one-third of home support funding, is income-tested. Personal care (e.g., showering) is provided free of charge. Home care services are all provided by nongovernment agencies. What are the key entities for health system governance? As the health system is primarily public, government-funded and -appointed entities dominate governance structures. Some, like the health and disability commissioner (whose function is to champion consumers’ rights in the health sector), sit at arm’s length from the central government. Others are “crown entities,” with their own boards, and are required to follow government policy through letters of expectation. Key national arrangements, all of which have a role in providing information to, and engaging with, the public, are: • the Ministry of Health, which has overall responsibility for the health and disability system. The ministry acts as the Minister of Health’s principal advisor on health policy and maintains a role as funder, monitor, purchaser, and regulator of health and disability services. While it sets capitation rates paid to GPs, it has no role in regulating patient copayments. • the National Health Board (NHB), which aims to improve the quality, safety, and sustainability of health care by actively engaging with clinicians and the wider health sector. The NHB provides advice to the health minister and the director-general of health on all of the aforementioned matters. It has two subcommittees: the Capital Investment Committee, which provides advice on matters relating to capital investment and infrastructure in the public health sector, in line with the government’s service planning direction; and the National Health IT Board, which provides advice on the implementation and use of IT systems across the sector. • NZ Health Partnerships, established in July 2015 to support DHBs in delivering shared services and reduce costs by identifying opportunities for savings in administrative, support, and procurement. • the Pharmaceutical Management Agency of New Zealand, which assesses the effectiveness of drugs, distributes prescribing guidelines, and determines inclusion of drugs on the national formulary (with relative cost-effectiveness being one of nine criteria for inclusion). In addition, certain medical devices have been added to its schedule (Gauld, 2014). As of late 2015, a new set of “factors for consideration” will be used to underpin decisions: need; health benefit; costs and savings; and suitability. • the Health Quality and Safety Commission, which ensures that New Zealanders receive the best health and disability care possible given available resources. It is also working toward what is known as the New Zealand “triple aim”—improved quality, safety, and experience of care; improved health and equity for all populations; and better value for public health system resources. • the National Health Committee (NHC), which advises government on priorities for new and existing health technologies. All new diagnostic and nonpharmaceutical treatment services and significant expansions of existing services are referred to the NHC for evaluation and advice. The committee also provides advice on what technologies are obsolete or no longer provide value for money. What are the major strategies to ensure quality of care? The aforementioned health and disability commissioner investigates patient complaints, reports directly to Parliament, and has been active in promoting quality and patient safety. DHBs are held formally accountable to government for delivering efficient, high-quality care in hospitals, as measured by the achievement of targets across a range of indicators. These include six “health targets,” published quarterly, that aim to stimulate competition among DHBs and are enforced by financial sanctions if not met. In addition, DHB performance with regard to waiting times, access to primary care, and mental health outcomes is publicly disclosed. Also publicly reported are data comparing the performance of PHOs, 126 The Commonwealth Fund
NEW ZEALAND Organization of the Health System in New Zealand ACC levies Accident Compensation Corporation (ACC) Contracts Ownership and formal accountability Funding for nonearners Health Benefits Ltd Provides shared support and administration and procurement services Health Quality and Safety Commission NZ Improves quality and safety of services Other Health Crown entities Various relationships with other entities Service agreements for some services Central Government Minister of Health Annual Purchase Agreement Reporting Ministry of Health Policy Regulation National Health Board business unit National services, DHB funding and performance management, and capacity planning Health Workforce New Zealand Workforce issues Tax payments Formal accountability National Health Board Board Health Workforce New Zealand Board National Health Committee Prioritization of new technologies and services Other Ministerial Advisory Committees Reporting for monitoring Reporting for monitoring Negotiation of accountability documents 20 District Health Boards (DHBs) Reporting for monitoring Service agreements Private and NGO providers Reporting for monitoring DHB provider arms Service agreements Private health insurance Pharmacists, laboratories, radiology clinics PHOs, GPs, midwives, independent nursing practices Voluntary providers Community trusts Private hospitals Māori and Pacific providers Disability support services Services Predominantly hospital services, and some community services, public health services, and assessment, treatment and rehabilitation services Some fees/ copayments Services New Zealand health and disability support service users New Zealand population and businesses Source: New Zealand Ministry of Health, 2015. International Profiles of Health Care Systems, 2015 127
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JANUARY 2016 2015 International Pro
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2015 International Profiles of Heal
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Table 1. Health Care System Financi
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Table 3. Selected Health System Per
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The Australian Health Care System,
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AUSTRALIA low-income adults, childr
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AUSTRALIA In 2013, the federal gove
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What is being done to reduce dispar
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References AUSTRALIA Australian Bur
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CANADA What is covered? Services: T
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CANADA funding to 145 not-for-profi
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CANADA Organization of the Health S
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CANADA provides recommendations to
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CANADA Health Council of Canada (20
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CHINA Private health insurance: Com
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CHINA is not substantially more exp
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CHINA Organization of the Health Sy
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CHINA References Chen, X. (2014).
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DENMARK In addition, nearly 1.5 mil
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DENMARK Social psychiatry and care
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DENMARK Quality data for a number o
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DENMARK portion is small, it makes
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48
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ENGLAND immunization, and vaccinati
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ENGLAND Hospitals: Publicly owned h
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ENGLAND Organization of the Health
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ENGLAND How are costs contained? Ra
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ENGLAND Organisation for Economic C
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FRANCE VHI finances 13.8 percent of
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FRANCE The average income of primar
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FRANCE What are the key entities fo
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FRANCE inequities in prevention rel
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FRANCE Nolte, E., C. Knai, and M. M
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GERMANY There were 42 substitutive
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GERMANY The 16 state governments de
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GERMANY management system, by the s
Page 76 and 77: GERMANY What major innovations and
Page 78 and 79: INDIA Private health insurance: The
Page 80 and 81: INDIA provide after-hour care, reim
Page 82 and 83: INDIA are provided by other ministr
Page 84 and 85: INDIA How are costs contained? Ther
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Page 88 and 89: ISRAEL Together, these two types of
Page 90 and 91: ISRAEL Primary care physicians are
Page 92 and 93: ISRAEL Organization of the Health S
Page 94 and 95: ISRAEL • Using electronic health
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Page 98 and 99: ITALY during hospitalization (Thoms
Page 100 and 101: ITALY Some regions are promoting ca
Page 102 and 103: ITALY Organization of the Health Sy
Page 104 and 105: ITALY although the degree of evolut
Page 106 and 107: ITALY The author would like to ackn
Page 108 and 109: JAPAN What is covered? Services: Al
Page 110 and 111: JAPAN incentives for providers to c
Page 112 and 113: JAPAN Organization of the Health Sy
Page 114 and 115: JAPAN The author would like to ackn
Page 116 and 117: THE NETHERLANDS receive faster acce
Page 118 and 119: THE NETHERLANDS Hospital payment ra
Page 120 and 121: THE NETHERLANDS Organization of the
Page 122 and 123: THE NETHERLANDS References Organisa
Page 124 and 125: NEW ZEALAND provided in GP clinics.
Page 128 and 129: NEW ZEALAND including such informat
Page 130 and 131: NEW ZEALAND largely through efficie
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Page 134 and 135: NORWAY Primary, preventive, and nur
Page 136 and 137: NORWAY Patients are free to choose
Page 138 and 139: NORWAY What are the major strategie
Page 140 and 141: NORWAY The National System for the
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Page 144 and 145: SINGAPORE Medifund is the governmen
Page 146 and 147: SINGAPORE Public hospital funding i
Page 148 and 149: SINGAPORE Public consultation: The
Page 150 and 151: SINGAPORE To keep demand for servic
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Page 154 and 155: SWEDEN What is covered? Services: T
Page 156 and 157: SWEDEN Hospitals: There are seven u
Page 158 and 159: SWEDEN Care, which promotes use of
Page 160 and 161: SWEDEN What major innovations and r
Page 162 and 163: SWITZERLAND Insurers offer premiums
Page 164 and 165: SWITZERLAND Hospitals: About 70 per
Page 166 and 167: SWITZERLAND Organization of the Hea
Page 168 and 169: SWITZERLAND To control pharmaceutic
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Page 172 and 173: UNITED STATES What is covered? Serv
Page 174 and 175: UNITED STATES Administrative mechan
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UNITED STATES The Institute of Medi
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UNITED STATES adopted at least a ba
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The COMMONWEALTH FUND Affordable, q
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