Towards an outcomes-based system

Abstract

THE DILEMMA over how best to satisfy unlimited demand with limited resources is the core problem of health care funding, management and politics. Governments and health authorities have struggled with the conflict throughout history and dealt with it with varying degrees of sophistication and success. Current strategies in Australia predominantly involve limiting supply by limiting access, most commonly by limiting workforce, physical facilities, equipment, pharmaceuticals and operating funding, in any combination. Application of these strategies inevitably results in delays in service or non-provision of service for some. While such a pragmatic approach to the problem is effective for the purpose of financial control, it causes funding tensions and is a weak system for ensuring that the limited resources are used to best effect. Casemix funding is well established in Australia, but is primarily used in an attempt to equitably distribute available resources. Although it is touted as a system for funding output, it is a simplistic and inaccurate system based on weighted throughput of patients and makes no attempt to take into account the effectiveness of services provided.