Table 16: Description of components in rural adjuster models Component Offshore islands Rural GP/PHO Travel and Inter-hospital Community services Facilities payments accommodation transfers Size (millions) $3.5 $21.5 $21 $28.4 $60 $35.1 Description Extra costs faced by comprising a rural DHBs reimbursement The cost of The extra costs of The diseconomy cost DHBs in providing bonus/remote rural of eligible patients for transporting patients providing community of providing a full role health services to practice area funding travel and between facilities services to small and/or delineation model offshore islands payment; a rural accommodation sparse populations level 3 service to a – workforce retention either services in the small population premium; a home, integrated family reasonable roster health clinics or small amount; and a rural rural hospitals after-hours payment Data DHB supplied 2014 Ministry Payment system data Expenditure recorded National Cost Data and National Cost Data stocktake of rural extracted for against GL codes four DHB case studies payments plus funding validated by 4950 (Ambulance) and (Northland, Bay of devolved since that DHBs 4955 (Air Ambulance) Plenty, Waikato, Nelson date (2011/12–2013/14 Marlborough) years), supplied by DHBs Pool calculation DHB-supplied costs Total payments Total payments less Total payments less Comprising an Estimation using cost less amounts covered the national population the national population estimated top-up per data and a diseconomy in other components times the Auckland times the Auckland person for the highly model of the DHB cost per person metro cost per person rural population and the diseconomy for rural population with low inpatient, emergency urban influence department, assessment treatment and rehabilitation and mental health Distribution enhanced to to to to to to DHBs’ contribution DHBs’ contribution DHBs’ contribution DHBs’ contribution DHBs’ contribution DHBs’ contribution status quo pool calculation pool calculation pool calculation pool calculation pool calculation pool calculation Distribution weighted to Weighted rural Weighted rural Weighted rural Weighted rural to DHBs’ contribution DHBs’ contribution rural population index pool calculation population index population index population index population index pool calculation Distribution weighted contribution to Weighted rural density Weighted rural density Weighted rural density Weighted rural density to DHBs’ DHBs’ contribution density index pool calculation index index index index pool calculation Figure 31: Process flow chart for options for calculating rural adjuster
Table 16: Description of components in rural adjuster models Component Offshore islands Rural GP/PHO payments Travel and accommodation Inter-hospital transfers Community services Facilities Size (millions) $3.5 $21.5 $21 $28.4 $60 $35.1 Description Extra costs faced by DHBs in providing health services to offshore islands comprising a rural bonus/remote rural practice area funding payment; a rural workforce retention premium; a reasonable roster amount; and a rural after-hours payment DHBs reimbursement of eligible patients for travel and accommodation The cost of transporting patients between facilities The extra costs of providing community services to small and/or sparse populations – either services in the home, integrated family health clinics or small rural hospitals The diseconomy cost of providing a full role delineation model level 3 service to a small population Data DHB supplied 2014 Ministry stocktake of rural payments plus funding devolved since that date Payment system data extracted for validated by DHBs Expenditure recorded against GL codes 4950 (Ambulance) and 4955 (Air Ambulance) (2011/12–2013/14 years), supplied by DHBs National Cost Data and four DHB case studies (Northland, Bay of Plenty, Waikato, Nelson Marlborough) National Cost Data Pool calculation DHB-supplied costs less amounts covered in other components Total payments Total payments less the national population times the Auckland DHB cost per person Total payments less the national population times the Auckland metro cost per person Comprising an estimated top-up per person for the highly rural population and the rural population with low urban influence Estimation using cost data and a diseconomy model of the diseconomy for inpatient, emergency department, assessment treatment and rehabilitation and mental health Distribution enhanced status quo DHBs’ contribution to pool calculation DHBs’ contribution to pool calculation DHBs’ contribution to pool calculation DHBs’ contribution to pool calculation DHBs’ contribution to pool calculation DHBs’ contribution to pool calculation Distribution weighted rural population index DHBs’ contribution to pool calculation Weighted rural population index Weighted rural population index Weighted rural population index Weighted rural population index DHBs’ contribution to pool calculation Distribution weighted density index DHBs’ contribution to pool calculation Weighted rural density index Weighted rural density index Weighted rural density index Weighted rural density index DHBs’ contribution to pool calculation Figure 31: Process flow chart for options for calculating rural adjuster
population-based-funding-formula-review-2015-technical-report-mar2016.docx