Review of the policy of some DHBs no longer paying for laboratory tests referred by Private Specialists: Final Report

Review of the policy of some DHBs no longer paying...
02 Nov 2010
doc
Review of the policy of some DHBs no longer paying...
02 Nov 2010
pdf
In 2006, three District Health Boards (Hutt Valley and Capital and Coast, and then later Tairawhiti) were given permission to trial a policy to cease payments for laboratory tests ordered by private specialists ('the policy'). The Ministry of Health commissioned an independent review of the policy at the request of the Minister in April 2009.

The objective of the review was to provide a report analysing the costs and benefits of the policy and its impact on patients both public and private, the health sector and the wider population.

Methodology

The review included investigation of community laboratory utilisation data and DHB financial data, review of relevant background documents including a recent evaluation by Capital & Coast and Hutt Valley DHBs, submissions to DHBs from national organisations and professional associations, DHB documents, and Ministry background papers.

The review team also interviewed a total of 55 stakeholders including representatives from DHB Planning & Funding, Community and DHB laboratory managers, general practitioners, specialists, private hospital managers, Primary Health Organisation managers, Ministry of Health, professional bodies/associations, and health insurers.

Available data did not support a robust quantitative analysis of shifts in the utilisation of laboratory services ordered by private specialists. Accordingly, the review was strongly reliant on anecdotal feedback from stakeholders. This limited the extent to which definitive conclusions could be drawn.

Key data limitations included:

  • A lack of baseline data on PSRT volumes prior to the policy coming into effect;
  • Inability to distinguish tests ordered by specialists in private practice from those ordered in the public system;
  • The introduction of the PSRT policy coinciding with establishment of new laboratories and the replacement of fee-for-service funding with bulk funding arrangements; and A range of external factors likely to affect test volumes, such as the introduction of new guidelines, PHO initiatives and changes to in-house laboratory testing protocols.
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