Is New Zealand according too much importance to continuous quality improvement in healthcare?

In late 2003, New Zealand's Ministry of Health published a 'systems approach' to help guide and plan quality improvements in the nation's health and disability sector. This approach emphasises a need for continuous quality improvement. We argue that the Ministry should align itself less exclusively with the 'the small steps of continuous quality improvement' and 'maintaining the gains'. Instead, it should encourage the adoption of a variety and combination of quality improvement strategies that include continuous quality improvement between the discontinuities that can occasion a need to re-engineer core processes for revolutionary, quantum gains in quality and safety.     

Dollars and sense. Is there a better way to determine private surgical fees in New Zealand?

In New Zealand, private insurers reimburse surgeons on a fee-for-service basis. Ideally, the level of reimbursements should reflect competitive market prices. Due to concerns such a market does not exist, other countries have adopted Relative Value Scales (RVS) to estimate a fair reimbursement level for different procedures. No such scale exists in New Zealand for surgeons, but it does for anaesthetists. This study compares reimbursements to surgeons and anaesthetists from private insurers using data from 3186 procedures performed between 1996 and 2002. We calculate an implicit hourly rate of reimbursement and compare the level of reimbursement between procedures and the variance of reimbursements within procedures for surgeons and anaesthetists. The results suggest that there are significantly greater deviations in average reimbursements between procedures for surgeons than for anaesthetists. Furthermore, the variability of reimbursements is greater for reimbursements to surgeons within specific procedures. While the results do not necessarily imply that surgical reimbursements are inconsistent with underlying market rates, the results are consistent with the hypothesis that anaesthetist's fees show greater stability because of the existence of a RVS. We conclude by discussing what would be required to implement a RVS for surgical fees in New Zealand.     

What explains the decline in adolescent binge-drinking in New Zealand?

BackgroundBinge-drinking prevalence among New Zealand adolescents has declined sharply since 2001, as it has in many other high-income countries. Other adolescent risk behaviours (e.g. smoking, cannabis use and precocious sexual activity) have also declined, raising the possibility of common underlying drivers. This study investigates potential contributing factors – both factors that predict risk behaviours in general, and alcohol-specific factors – and the extent to which they account for the decline in binge drinking.MethodsThe study used nationally representative survey data collected in 2001 (N = 6513), 2007 (N = 5934) and 2012 (N = 5489). The outcome measure was prevalence of past month binge drinking (5+ drinks/session). Predictor variables included factors that predict risk behaviours in general (parental monitoring, family attachment, school attachment, having a part-time job, time spent hanging out with friends); alcohol-specific factors (parental alcohol use, adolescent attitude toward alcohol use); and attitude toward and current use of tobacco and cannabis. Likelihood of binge drinking was modelled for each survey year (ref=2001), adjusting for demographic factors. Predictors were added to this base model, with the degree of attenuation of the odds ratio for year indicating the extent to which the included predictor(s) accounted for the trend.ResultsCompared with 2001 the odds of binge-drinking in 2012 were 0.33. The strongest independent contributor to the decline was adolescent attitude toward alcohol use, followed by current cannabis use, then current tobacco use. Collectively, general factors in home, school and leisure settings did not significantly contribute to the downward trend in binge drinking.ConclusionDecreasing acceptability of alcohol use among adolescents was the most important identified contributor to adolescent binge-drinking decline. Drinking, smoking and cannabis use trends were empirically linked, yet the decline in binge drinking was not significantly explained by the included predictors common to risk behaviours in general.