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    Performance measures, reimbursement and behaviour of public health care providers in New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy at School of Economics and Finance, Massey University, Albany
    (Massey University, 2013) Shin, Somi
    This dissertation contains three empirical studies that examine the performance measures, reimbursement and behaviour of New Zealand public health care providers, the district health boards (DHBs). The first essay investigates whether highly skilled health care providers are at a disadvantage because they attract difficult cases, by examining over 10 million publicly funded patient discharges in New Zealand during the period from 1999 to 2011. Using a patient’s transfer status and the complexity and comorbidity level (CCL) indicator as the measure of task difficulty, I calculate the effects of task difficulty on performance indicators such as the length of hospital stay, and the probabilities of 30-day mortality and readmission while controlling for potential endogeneity. The results confirm that this disadvantage does exist. Transferred patients stay in hospital longer, and have higher probabilities of 30-day mortality and 30-day readmission. Overall, patients assigned to higher level of complexity and comorbidity indicators also have longer hospital stays and higher probabilities of mortality and readmission. The second essay examines how the public health care providers in New Zealand responded to the system reform that reintroduced a capitation scheme, which pays providers a fixed amount per enrollee, regardless of the actual service usage per enrollee. I find that the new capitation scheme decreased the movement of patients between districts, especially those whose conditions are more severe. The results indicate that sicker patients are less likely to be treated by specialist providers since the reform. Overall, the decrease in inter-district movement seems to have negative effects on health outcomes. The third essay examines the capitation funding system for New Zealand public health care providers, which allocates funds across districts based on the characteristics of district population. As the first step in understanding the adequacy of this payment system, this research examines how the actual usage by patients is associated with the funding, which is computed based on the characteristics of population. To examine the relation, I regress the government funding received by the DHBs on the characteristics of the population who actually received treatment over the period of 2003 to 2011. I find that the usage of health care services by certain population groups is higher than their population share.
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    Psychosocial factors relating to adaptive capacity in a New Zealand District Health Board : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2013) Ellis, Debra Elizabeth
    The purpose of the current research was to examine how factors identified in the Organisational Health Framework (Hart & Cooper, 2001) may relate to stress and wellbeing in a sample of the New Zealand health workforce. It was anticipated that the findings would provide information as to what adaptive strategies may be utilised in the health sector in both routine and emergency management contexts. The research focusses on the individual and situational factors identified as having the potential to contribute to positive outcomes. Salutogenesis (Antonovsky, 1979) is used as an overarching paradigm for the context of the research to understand mechanisms which promote adaptive capacity between individuals, teams and their organisation in relation to predictors of stress and growth in a large New Zealand District Health Board (DHB). Two New Zealand national emergency response exercises took place shortly before data collection for the studies. The exercises provided examples of realistic contexts within which to assess the individual and situational factors associated with positive outcomes and adaptive capacity given that the health sector will have a large part to play in the response and recovery to such emergency events. The methodology applied self-report surveys. The first study comprised 155 participants across clinical, medical and nursing professions and management and administration roles. Study 2 comprised 199 participants from the same role categories as Study 1. In both studies, stress and growth were related to both individual and situational factors but individual factors such as personality and coping strategies appeared to play a more significant role than situational factors. The emotion–focussed coping strategies adopted by these groups were positive rather than maladaptive. Results show that emotion–focussed coping strategies may contribute to adaptive capacity by successfully neutralising stressors in the sample. Implications of these findings are discussed.