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Biomedical subjects

T Ashton

Publications and source records attributed to T Ashton.

At least 37 records · Page 2Linked to original sources
PubMed1993

From evolution to revolution: restructuring the New Zealand health system.

After a number of years of evolutionary changes to the New Zealand health system, the government announced a radical restructuring of all publicly funded health services in July 1991, to be implemented on 1 July 1993. The primary features of these changes are a splitting of the purchaser and provider roles, and a restructuring of health services along more business-like lines. The proposals have been highly contentious and have attracted little support from within the health sector. This paper outlines the reasons for and nature of the reforms and explores some of the issues behind the changes. These include problems of pricing services for purchasing purposes, the potential conflict between financial and social objectives, and questions of accountability of purchasers and providers. Considerable uncertainty surrounding these and other issues means that any potential efficiency gains cannot be guaranteed. The costs of the reform process have, however, already been high, both in financial terms and in terms of their impact on the morale of health workers.

Competitive Medical Plans↗
PubMed1992

The purchaser-provider split: implications for dental services.

In July 1991, the National Government announced proposals for a radical restructuring of the New Zealand public health system, a central feature of which is the separation of the purchasing and providing roles currently performed by area health boards. While the competitive market model suggests that the split should improve the efficiency of public health services by effectively creating a market system, this paper suggests that, in practice, there are likely to be a number of obstacles. Other potential sources of efficiency are improved accountability, improved management, and integration of primary and secondary care. For dental health services, the separation of purchaser and provider should introduce greater flexibility into State-funded dental services by opening up options for alternative providers and methods of provision. Factors such as the number and structure of provider units; the contractual arrangements between these units and the RHAs, especially in respect of payment mechanisms; and the regulatory regime which covers these contractual arrangements will all affect service delivery. If real choices between types of providers and methods of provision eventually emerge, a major challenge for RHAs will be to monitor and enforce at reasonable cost any quality measures built into contracts.

Contract Services↗
PubMed1991

Cost-effectiveness of alternative medications in the treatment of duodenal ulcer.

This study examines the differential costs of various medications in the treatment of duodenal ulcer. Two approaches are taken. The first estimates the (differential) cost per year of life before relapse can be expected to occur, for five different medications. The second approach estimates the cost of treating a duodenal ulcer over a 5-year period during which ranitidine, cimetidine, or colloidal bismuth subcitrate (CBS) is used in the initial course of treatment. Expected rates of relapse and the probability of receiving maintenance therapy are taken into account. The results of both approaches suggest that CBS costs considerably less than other medications to achieve a similar outcome. It is concluded that, as well as the clinical benefits associated with slower relapse, the potential economic benefits of CBS are substantial.

Anti-Ulcer Agents↗
PubMed1990

A cost effectiveness analysis of the treatment of end stage renal failure.

An economic evaluation of continuous ambulatory peritoneal dialysis (CAPD), home haemodialysis, incentre haemodialysis and transplantation was carried out using cost effectiveness analysis to evaluate the cost per life year saved. The probability that a person with end stage renal failure would change treatment modalities was used to calculate an average five year treatment profile. The present value of the cost per life year saved (expressed in 1988 $NZ) was $35,270 for incentre dialysis, $28,175 for home haemodialysis, $26,390 for CAPD at Middlemore Hospital, $25,395 for CAPD at Auckland Hospital and $18.463 for transplantation. This ranking was unchanged after various sensitivity analyses. This apparent ranking of the cost effectiveness of the different modalities cannot, however, be used to support a decrease in haemodialysis in favour of an increase in transplants and CAPD until marginal cost factors have been studied. It must also be recognised that social and medical characteristics define which treatments are appropriate for any patient so that the different modalities are not perfect substitutes for each other.

Cost-Benefit Analysis↗
PubMed1989

Trends in antihypertensive medication costs in a cohort of Aucklanders 1982-87.

This study examines the trends in drug treatment and costs of hypertension in a cohort of 1600 adult Aucklanders between 1982 and 1987. In 1987 prices the average daily cost of antihypertensive drug treatment per person increased from 42 cents to 74 cents over the five year period. The increase in cost seen in antihypertensive therapy in this cohort is explained by the introduction of new and more expensive drugs rather than by increases in the proportion of the population being treated for hypertension, daily dosage, number of antihypertensives per individual or in real prices of antihypertensives.

Adult↗
PubMed1989

Alcohol taxes: do the poor pay more than the rich?

Concern has often been expressed that alcohol taxes bear more heavily on the poor than on the rich, especially if these taxes are based on quantity rather than price. However, surprisingly little is known about how the tax burden is distributed across different income groups. Utilizing survey data from 3010 respondents in New Zealand, this study calculates exactly how much alcohol tax was paid by respondents in different income groups and in different types of households. These results were applied to household expenditure survey data to estimate the incidence of alcohol taxes across different households. The results suggest that, although in dollar terms the wealthiest households paid about four times as much alcohol tax as the poorest households, when expressed as a percentage of income, alcohol taxes are distributed proportionally across the lower income brackets but decline towards the upper end of the income scale. These taxes accounted for less than 1% of household income for all income groups. Households with children generally paid less alcohol tax than households without children. It is concluded that alcohol taxes in New Zealand do not seriously conflict with the broader equity objectives of government policy.

Alcoholic Beverages↗
PubMed1989

The efficacy of L-tryptophan in the reduction of sleep disturbance and depressive state in alcoholic patients.

Alcoholic male inpatients (N = 76) served as subjects in this study which examined the effect of L-tryptophan on depressive state and sleep disturbance. All subjects were residents of a 6-week alcohol treatment program at a Veterans Administration Medical Center. Subjects' degree of depression (Zung's Depression Scale) and sleep satisfaction (Webb's Post-Sleep Inventory) were measured four times during the study, just prior to and following ingestion of a substance that was either 3 gms L-tryptophan or 3 gms of an identical-appearing placebo. Subjects in the L-tryptophan/placebo condition received the active substance for 4 days followed by the placebo with a 4-day washout period in between. A second group of subjects received the same regimen of reverse order and a third received placebos on both occasions. There were two additional control groups that received no substances. All subjects in the study reported decreased levels of depression due to nonspecific treatment effects. The subjects who took L-tryptophan in either sequence reported even lower levels of depression. Sleep disturbance was not affected by L-tryptophan since it was barely present when the study began. A phenomenon referred to as the interval effect is discussed and an alternative explanation for this effect is offered.

Adult↗
PubMed1984

Estimated cost of alcohol to the New Zealand public hospital system.

The abuse of alcohol imposes a heavy burden upon our public hospital system. Although a lack of conclusive evidence precludes any accurate estimated of the costs that are incurred, our broad estimates do give some indication of the extent of these costs. Taking into account only those health problems where alcohol is recorded as a causal factor gives an estimated cost of public hospital services of approximately $21 million per year in excess of any costs which might otherwise be expected to arise in the absence of alcohol. Expanding the definition of alcohol-related disorders according to the results of survey data increases the estimated cost to at least $52 million per year and possibly to $115 million or more. These costs are far outweighed by the non-medical costs of excessive drinking such as lost production, crime and a deterioration in the quality of life of alcohol abusers and their families.

Accidents↗
PubMed1979

Attenuation factors for certain tissues when the body is irradiated omnidirectionally.

Experimental values of mean attenuation factors are reported for certain tissues in an anthropomorphic phantom irradiated omnidirectionally with gamma rays from sodium-24, radium-226, iodine-131 and xenon-133. The data are used to relate the mean absorbed dose to the whole body, bone marrow, gonads and skin to (a) the absorbed dose in air and (b) the exposure in air. Correlations are made for the degradation of the radiation by scatter and the photoelectron enhancement effect. It is proposed that for natural background gamma rays a mean attenuation factor of 0.7 may be used for bone marrow. The corresponding rad/R factor is 0.67. It is also estimated that the effective mean depth of bone marrow for omnidirectional irradiation is 5.0--5.5 cm.

Bone Marrow↗
PubMedDate not supplied

Market concentration in secondary health services under a purchaser-provider split: the New Zealand experience.

The separation of purchaser and provider in government-funded health systems enables competition to develop between providers. Competition is seen as a means to drive technical efficiencies by providers. While it is difficult to assess comprehensively the level of competition in a market taking into account contestability and substitutability effects, it is possible to measure the degree of market concentration. This paper employs the Hirschman-Herfindahl index to provide measures of market concentration in selected secondary health care markets in New Zealand immediately prior to (1992) and following (1994) implementation of a purchaser-provider split. The results show that, generally, the selected markets are highly concentrated and that there has been little change in the degree of concentration over the 2 year period under investigation. The paper also discusses some of the methodological problems associated with the measurement of market concentration and acknowledges the limitations of such measures as indicators of competition.

Catchment Area, Health↗
PubMedDate not supplied

Shopping for health: purchasing health services through contracts.

The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.

Budgets↗
PubMedDate not supplied

New Zealand: long-term care in a decade of change.

Long-term care in New Zealand incorporates a mix of public and private funding and provision. After a decade of structural change, the purchasing of almost all publicly funded health and social care is now the responsibility of one central agency. Services for older persons are poorly integrated, and there are problems of access to and quality of some services. Efforts are being made to address these problems. The challenge now is to ensure that this groundwork is not lost amid the turmoil of yet another round of restructuring by an enthusiastic, newly elected government.

Financing, Organized↗