Improving prioritisation of health services

Friday 26 November 2010

Improving prioritisation of health services

The National Health Committee (NHC) should consider using a ‘traffic light’ approach to enable District Health Boards to set healthcare priorities more explicitly, according to an article in today’s New Zealand Medical Journal.

Last March, Government signalled its intention to strengthen the National Health Committee to enable it to play a major role in prioritisation, but little progress has been made since that time.

“Much of the delay stems from politicians’ reluctance to be associated with cutbacks or reductions in services, and from uncertainty about how NHC’s decisions would affect DHB decision-making,” says lead author Dr David Hadorn, director of the Centre for Assessment and Prioritisation at the University of Otago, Wellington.

The proposed traffic light approach addresses both these issues and could enable New Zealand to move forward on healthcare prioritisation.

On the recommended approach, the National Health Committee would periodically prepare three separate funding lists:

• A ‘green list’, containing new or expanded services that would represent good investments for DHBs if money were available

• An ‘amber list’, containing services that could safely be reduced or eliminated if needed to achieve cost savings

• A ‘red list’, containing services that should be reduced or eliminated regardless of financial considerations due to the absence of expected benefits to patients.

Ideally, the cost of new or expanded green-listed services would be offset by savings achieved through reductions in amber- and red-listed services.

A key feature of the suggested system is that the Minister of Health and cabinet would either accept or reject all three lists in their entirety, but would not be able to fine-tune or interfere with the specific contents.

“This protects politicians from lobbying by proponents of individual services, which would keep the Minister and cabinet at arm’s length from the nitty-gritty of decision-making, as with PHARMAC and pharmaceutical choice,” he says.

The proposed all-or-nothing feature was incorporated into recent health reform legislation in the United States, which created a new Independent Medicare Advisory Board (IMAB) to achieve cost savings in the US Medicare programme.

Congress must accept or reject IMAB’s advice without ‘fiddling’ with the specific recommendations. A similar method was also used some years ago to close US military bases despite politically undesirable consequences, such as unemployment and damage to local economies.

Dr Hadorn concluded: “Just as PHARMAC makes difficult decisions that politicians often disagree with, so NHC would make decisions to balance individual patient expectations against affordability and overall public good.”

David Hadorn worked as an emergency physician for 10 years before working with the Core Services Committee in 1993-97. He served in that capacity for four years, mostly working on clinical priority assessment criteria, after which he was appointed chief advisor to the Health Funding Authority. He is currently the director of the Centre for Assessment and Prioritisation and the University of Otago, Wellington.

ENDS

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