Health Needs Assessment: Impact on Planning and Purchasing in the Public Health Sector in New Zealand

Abstract

Health needs assessment (HNA) is one of the features of the New Zealand health system established by the New Zealand Public Health and Disability Act 2000. District Health Boards (DHBs) are to conduct HNAs, and planning of health services is intended to take into account the health needs of the population. Key questions for research relate to the impact of HNA on DHB planning and purchasing in a political/bureaucratic model of governance. This research was undertaken within a public policy framework that focused on evaluating the reforms against policy goals and expectations, and particularly against the influences that might be predicted from the HNA and prioritisation policy. Consideration was given to the range and effectiveness of past HNAs as well as the expectations and experiences of the DHB model in regard to HNA. Document analysis and 34 interviews were conducted regarding 50 HNAs conducted in the public health sector from 1991-2000 to assess their impact on service delivery, decision-making, and policy. Document analysis was undertaken on DHB HNAs, prioritisation frameworks, board priorities, District Strategic Plans, and District Annual Plans for each of 20 DHBs. Planning and Funding managers were interviewed using semi-structured interview techniques to ascertain their experiences and views regarding the use of HNAs in planning. Grounded theory approaches were mainly used for the interview analysis. Case studies of five DHBs provided an in-depth understanding of the connections between health needs assessment, prioritisation, District Strategic plans and District Annual Plans. Collection of contextual data provided an understanding of the influence of other policy decisions made locally or nationally. Using triangulation, conclusions were drawn regarding the effectiveness and impact of HNA and prioritisation on planning and health service purchasing by DHBs. The implications for public policy were then considered. Recent needs assessments conducted by DHBs mostly met the minimum requirements of the Ministry of Health, but the quality was variable. DHB Planning and Funding Managers were unanimously positive regarding the usefulness of HNAs, and felt that there were good connections between them and the planning process (Connection Score). However, the impact of HNAs on planning and purchasing measured using document analysis (Impact Factor) was lower than expected. A number of barriers to effective use were identified. More focused HNA by DHBs is recommended with the use of mixed scanning approaches and service development groups directed towards specific service planning areas. Recommendations are made regarding future policy for HNA and prioritisation.