Contracting with Regional Health Authorities for residential services for older people

Abstract

In 1993, New Zealand introduced a totally new structure to health spending which separated the government (funder) from the providers of services (purchasers). Four Regional Health Authorities (RHA) were appointed to administer this system, under Ministry of Health direction. Although the changes were accepted as a possible solution to the ever increasing health budget, this innovation was also seen as a threat to many providers unused to this form of funding allocation. The research therefore asks one section of providers of services for older people, members of the New Zealand Council of Christian Social Services (NZCCSS), about their first round of contract negotiating with RHAs in the Northern and Midland regions. A total survey of the members of the NZCCSS was carried out by questionnaire, followed by four telephone interviews. The response rate was very high, indicating the high level of concern of respondents. The findings show marked differences between the two regions with Northern respondents expressing anger and frustration about both the process and outcome of negotiations although the majority received slightly more funding than the previous year, and the majority of Midland region respondents expressing satisfaction with both the process and outcome but achieving slightly lower funding arrangements. Both regions expressed a strong commitment to quality of services, regardless of the contract outcome. Wages and other conditions of employment were also seen as separate issues by the majority, who felt that these would not be changed within this first year as a result of contracting. Findings are given separately for each region, concluding with a combined discussion chapter and recommendations. The findings of the research will provide significant basis for future discussion between government and the NZCCSS who lobby on behalf of their members for the well being of older people in care and for other disadvantaged people in our society.