2026-09-25T20:02:35Zhttps://mro.massey.ac.nz/server/oai/requestoai:mro.massey.ac.nz:10179/51792025-11-11T14:19:02Zcom_10179_294col_10179_296
DSpace at Massey University
author
Shin, Somi
2014-03-27T21:33:58Z
2014-03-27T21:33:58Z
2013
http://hdl.handle.net/10179/5179
Q112447334
https://www.wikidata.org/wiki/Q112447334
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.
en
The Author
District Health Boards
New Zealand health services
Publich health care providers
Public health care performance
Patient transfer
Capitation scheme
Health care funds
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
Thesis
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