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Organisational Governance and Performance Management Assessment Answer

Workbook 3

Tasks for submission via Turnitin (maximum 1000 Words)

1. Identify which of the four funding models defined by Egar et al. (2013) are used by the public hospitals in Australia and briefly describe its use.

In the public hospitals in Australia, the four funding models, according to Eagar et al. (2013) are Best Practice Pricing, Normative Pricing, Quality Structures Pricing, and Payment for Performance (P4P), also known as Safety and Quality Pricing. Best Practice Pricing is an evidence based model. This type of model can only be used for a few medical conditions, not all. It is applied and formed based on two factors: concrete evidence and information from expert medical professionals, to form a standard pricing system only for specific conditions (Eagar, Sansoni, Loggie, Elsworthy, McNamee, Cook, & Grootemaat, 2013) Eagar et al. (2013) also mentioned that prices are determined and are paid irrespective of whether the care for the particular condition was delivered. Therefore, the expense is based on following the pathway of treatment instead of based of quality and safety. As a result, rewards are given to hospitals with the best performance outcomes. This model is also known as “tournament-based pay” (Eagar, Sansoni, Loggie, Elsworthy, McNamee, Cook, & Grootemaat, 2013). 

In normative pricing, the delivery of care is effected by the prices, allowing further in-home care for specific conditions. This model encourages and influences the delivery of care in order to make it more profitable. It supports more home care services and day surgery procedures rather than outpatient services and overnight stays, according to Eagar et al. (2013). According to Steele and Wright (2012), this concept was used in the health system in the UK and is supposed to be established in the Queensland health system, however a thorough review and analysis is yet to be published.  

According to Eagar et al. (2013), quality structures pricing model correlates pricing to the quality and safety of care. Here, only hospitals which are accredited are funded more than the ones who are not accredited. This funding of this model is associated with participation in hospital activities and clinical registries, also known as “payment for participation” where it is linked to funding in the private hospital system (Eagar, Sansoni, Loggie, Elsworthy, McNamee, Cook, & Grootemaat, 2013). Payment of Performance (P4P) is also known as quality pricing models. Here, quality, safety, and funding are all interlinked in order to produce the optimum level of performance and delivery of care. They provide incentives for positive performance and disincentives for poor performances (Eagar, Sansoni, Loggie, Elsworthy, McNamee, Cook, & Grootemaat, 2013). 

2.. To what extent do you agree or disagree that the National Efficient price may provide an incentive to improve the health status of any selected segment of the Australian population. Remember to use relevant references to back up your arguments

The National Efficient Price (NEP) is not able to provide incentive to improve the health status of the Australian population. This is because they have not established the NEP in regards to focusing on safety and quality of health care for the general population of Australia. The NEP is a framework for pricing which is published annually by the Independent Hospital Pricing Authority (IHPA) and it is published to determine the Activity Based Funding for hospitals which are public (Anonymous, 2012). The NEP is used to allocate funding for these hospitals from the Commonwealth government and establish standard pricings and costs of public hospital services being provided. Although, in plain sight, it may seem like an ideal system, the model is based on Activity Based Funding (ABF). This means that funding is given to hospitals according to the number and the mix of patients admitted to the hospital. In other word, the more patients being treated, the more funds the hospital will receive (Collier, 2008).  ABF is supposed promote adequate and timely access to health care in a fair and equitable manner to the general population (Palmer, Agoritsas, Martin, Scott, Mulla, Miller, Merglen, 2014). 

According to Palmer et al. (2014), implementing Activity Based Funding in the system may cause an increase number of readmissions and discharges to post-acute care. Based on his findings, incorporating ABF into the health system would be considered as a “leap of faith”. According to Sutherland et al. (2011), introducing ABF into the system did not influence the length of stay in hospital, increase volume or reduce the cost and the rate of mortality remained the same. ABF is also disadvantageous to hospitals in remote areas as they have fewer patients and cases. Because of this, those hospitals receive fewer funding, which could result in unfairness to the population in that area.The complicated cases would require more money which the hospital would not have. This system of health delivery system causes unfairness to hospitals in the outskirts of the country. It also creates an incentive to admit and perform unnecessary surgeries and treatment on patients to show an increase number in order to gain more funds from the government.  In the paper published by Eagar et al. (2013), they expressed, in numerous occasions, the lack of concrete evidence and information regarding the outcome of the four models, including P4P which is the model currently being used in Australia. Based on the conclusion of the study, Best Practice Pricing and Normative Pricing are more effective than P4P as it creates more incentive for quality and safety in health care and P4P is more “narrow in scope”. It is imperative to consider all the advantages and disadvantages of all four of the models before incorporating them into the national health system. It would also be more effective to consider other international health systems and search for more effective evidences regarding health structure models. Because of these reasons, the National Efficient price does not provide an incentive to improve the health status of any selected segment of the Australian population.


Organisational Governance and Performance Management

1. Identifying the four funding models by Egar Et al. (2013), those are used in public hospitals in Australia

The funding models help in raising the needs of individual public hospital to provide better services to service users. The funding models which are used in government hospitals of Australia; they are Payment of Performance, normative pricing, Best Practise Pricing and quality Structures. The best model used in a hospital is Practice Pricing model. The model is only needed to deal with a few medical conditions. Hence, it is based and applied in two factors one is real indication and evidence from medicinal experts to deal with standardising valuing system by utilising particular conditions (Eagaret al. 2013). Egar also stated that the price is determined or paid irrespective of whether the care for the specific circumstance was brought. Hence, expenses are based on dealing with the ways of treatment which is founded on excellence as well as safety. The rewards were assumed to clinics for their best presentation. The model is also recognised as tournament-based pay. 

The normative pricing is mentioned as the delivery of care which is affected by price as well as further home care is provided for any specific conditions. It also encourages as well as influences the care system in order to gain maximum profits. It also supports both day surgery procedures and home-based care services with causality services (Elshauget al. 2017).The normative pricing system is also used in the health system in the UK which is hypothetical to establish in Queensland fitness organization. It is also needed for gathering review and analysis when it is published. 

The quality structure model is related to both pricing to quality as well as service care. Therefore, it has been engaged in generating more funds more than one who is not accredited. It is one of the findings which also need to deal with models that are related through contribution in clinical registries and hospital actions which are also termed as imbursement for contribution. It can be related with the private hospital system as well. In according to Cooper et al. (2018), the payment of performance is also considered for dealing with the quality pricing model in which funding, quality and safety are taken into consideration. It helps in producing delivery of care and optimum level of performance. It also helps in providing incentives by dealing with positive performance as well as disincentives for dealing with poor performance. 

2. To what extent do you agree with Efficient National Price that provides incentives for improving the health status of any selected segments of the Australian population

According to the opinion, the Efficient National Price was not able to providing an incentive that helps in improving health care status in the Australian population. It was also not recognized with NEP in respects that help in concentrating on safety as well as the quality of health care that has been dealing with the general population in Australia. As stated by O’NeillSohal &Teng (2016), the NEP is a framework that has been dealing with the pricing which is needed to be available by the Independent Hospital Pricing Authority. The Activity Based Funding publishes the pricing aimed at determining in community hospitals. The NEP also focuses on dealing with the hospital's funds which are related to public health services. It is one of the ideal systems founded on Activity Based Funding (ABF). It means that backing is provided to hospitals rendering to their numbering as well as mix in service users admitted to hospitals (Alteren & Tudoran, 2016). It means that more funds will be generated by treating more service users. ABF has also focused on promoting adequate as well as timely access for health care and equitable manner for general populations. 

The number of readmission and discharge of service users can be increased by using activity-based funding. The findings are also based on the incorporating ABF into health care system which would likely be needed for considering a leap of faith. Whereas the ABF system does for influences the length of stay in hospitals, reducing the cost, increasing volume, as well as the rate of humanity, remained the same. In according to Cooper et al. (2018), the hospitals located in rural areas face disadvantages in receiving a few numbers of service users. The complicated cases need more care which is not provided with these systems. The system of delivering health care causes injustice to infirmaries in the outskirt of the republic. It also makes bias by conducting unwanted treatment and surgeries among service users. Hence, it makes to receive maximum funds from the government. Eager has also stated that numerous occasions due to lack of tangible indication as well as material regarding frequent times. The lack of concrete pieces of evidence as well as information is needed to be managed in regarding outcomes for four models which are including P4P, are used in Australia. 

As a result, Normative Pricing and Best Practice pricing is one of the effective than P4P, which helps in creating more incentives for quality as well as safety in dealing with the health care system. In according to Price & Sun (2017), the four models is also considered by making it utilised which has been needed in making it considered by analysing the needs based on it further functioning can be managed. The international health system, as well as search for effectual pieces of evidence, is needed for healthy structure models. The National efficient price does not provide various incentives that help in getting better the health status by selecting a segment of an Australian in better ways. 

In conclusion, the models are needed in public health care organisation in Australia as this is needed for managing the system which can be engaged by making their functioning in better ways. The model is more incorporating, which is dealing with a national health system that has been engaged by appropriately analysing the needs. The effectiveness of models helps in providing better health care facilities to service users in an appropriate way. The consideration for implementing models is also engaged by analysing the needs of service users in better ways.

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