It is possible that this could fund a full time nurse and pay for all his or

It is possible that this could fund a full time nurse

This preview shows page 55 - 57 out of 84 pages.

reductions the practice implements. It is possible that this could fund a full-time nurse and pay for all his or her associated overheads, plus a car. In this practice, resources could be provided to significantly improve the quality of care being delivered to the patient. Thus the extent to which improved quality of care is delivered depends on the balance between these competing uses for the funding: how much of the extra resource provided by Care Plus is used to reduce co-payments, increase profit or provide increased resources. Because increased funding for primary health care is provided from other sources (eg, extending increased subsidies to adults aged 45 64), we would expect to see increased opportunities for more fully implementing those aspects of Care Plus that relate to improved quality of clinical care. Evaluation of the roll out of Care Plus p 49 CBG Health Research August 2006
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Increased funding is also available from Services to Improve Access funding and other sources. The policy environment is quite fluid. The capitation funding formula is being reviewed, and there are opportunities to consider the best ways to deliver Care Plus-type services in the future. This section reviews the major findings presented previously and suggests some implications for the future of Care Plus. The role of the Ministry of Health and DHBs It is clear from the interviews held with various stakeholders that there is a wide range of perceptions of what exactly Care Plus is. At a Ministry and DHB level there is a clear view that Care Plus is an attempt to improve chronic care management, reduce inequalities, improve primary health care teamwork, and reduce the cost of services for high-need primary health users. The manner in which Care Plus has been implemented in a given DHB is very much determined by the attitude of PHOs in that DHB to the opportunities Care Plus presents, and the willingness of practices to implement it. This variation presents an equity dilemma. It is undesirable for patients in one area to have access to different publicly funded services from patients living in another area. The solution to this may be to require practices to deliver Care Plus services if they receive capitation funding. Obviously this would have to be discussed with provider representatives. One way to implement this would be to include the Care Plus budget in the base capitation funding, and modify the schedule of services required from providers to include providing intensive clinical management services to qualifying patients. Recommendation 1: The Ministry could consider the structure of Care Plus funding with a view to ensuring all patients have equal access to services, as far as possible. There was a recurring theme throughout the interviews that Care Plus seems to work best when linked to existing chronic care programmes. Representatives from PHOs that had been able to do this felt these systems gave a sense of purpose and direction for Care Plus. Also, the
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