ACT Health Policy and Analysis thanks to NZ Doctor Online
The Act Party wants to beef up the Mental Health and Wellbeing Commission.
The Ardern Government has established the commission to oversee mental health services and advise on improvements.
Under the Act policy, the commission would be renamed Mental Health and Addiction NZ (MHANZ) and it would gain the power to commission and fund services, although it would not be a provider.
Released under the name of Act health spokesperson Brooke van Velden, the policy document says there is currently inequity of access, too little choice of provider, and too much burden placed on primary care services which are not always equipped to deal with mental health care.
The MHANZ would assess individual need and contract the best providers for a person’s therapy and care.
Any provider that met strict criteria could register with MHANZ as a provider. Funding would be determined by and attached to the care of individuals and their needs.
“A person needing help would be able to choose any registered provider for their immediate care, giving autonomy to the person … or be referred to a specific provider by MHANZ in cases where a person lacks the capacity to do so or requires specialised treatment.”
People could choose a provider who offers treatment in a specific cultural context, language or region, or have MHANZ select a provider for them based on information supplied.
Schools, GPs, police and government social agencies would be able to refer people for treatment, work with MHANZ for assessments, and be involved in wrap-around care where it is in the person’s best interest.
VERDICT
From David Codyre, a psychiatrist and leader of the wellness support team at Tāmaki Health:
“Broadly speaking in healthcare there are at a system level, three approaches to individualised/personalised funding of healthcare by a third party:
Managed Care – level of service and response is matched to individual need, with a focus on early access to care and quality of care – and generally systems implementing this approach with fidelity, deliver cost-effective care. Examples include systems such as Kaiser Permanente and Group Health in the USA,
Managed Cost – the primary focus – albeit under the name “managed care”- is on restricting access to care and keeping costs down – though ultimate outcome over time is increased costs and poor quality, and this is seen in the worst of US ‘managed care’,
Unmanaged Care – care and referrals are made based on provider decisions, irrespective of need – and generally systems operating in this manner risk unnecessary care provision (the best examples in the literature being variance in surgical procedures in the USA pre-managed care), and also inevitably face cost blow-outs. The Australian medicare system in many ways exemplifies this approach; they can afford such a system, we cannot.
“So – this policy of moving to individualised/personalised funding is at a high level appealing.
"But, the devil is in the detail, and even more [in] the practice of individualised funding, the sophistication of assessing need and linking to the required level of care in a timely manner, then monitoring quality and outcomes.
"This approach would certainly disrupt the existing domination of DHBs, and would allow rational decisions re funding flows to, for example, fund much more preventive care, and could also drive quality improvement in the sector.
"However we only have to look across the Pacific to the USA to see that ‘managed care’ has many pitfalls as well as potential strengths, and doing this well requires a set of disciplines that do not currently exist in this country."