Health Performance Measurement
Why the United States Should Be Paying
Attention to New Zealand
Ian Axford Forum
CHPDM/UMBC
January 18, 2006
John O’Brien
Axford 2005
Comparative Policy Analysis
Some Thoughts
•Alternative Program Designs
•Responses to Similar Challenges
•Natural Policy Experiments
• Developed
country
• Closed system
• Small scale
• English speaking
Pay for Performance
The Solution Du Jour
• Financial Rewards tied to Quality Health
Services
• Lots of interest in the US
– Bridges to Excellence
– The Leapfrog Group
– CMS initiatives
• Lots of interest, limited proof
Primary Health
Organizations
Everyone is enrolled
Capitated Primary Care
Performance payments
PHO Performance Incentives
A Cleaner Approach
• Coordinated Funding
Streams
• Significant payments
• Improvement rewarded
New Zealand should soon have
insights on
• How do physicians respond to quality
performance incentives?
• Can a subset of measures truly promote good
quality?
• How are measures added to and updated?
Or not…
• The natural experiment
analogy often does not
hold.
– Assumption of financial
risk
– Hospital services
– Specialty services
One last view from the Tararua’s