Funding Prioritisation Policy


Purpose

This policy makes explicit the criteria and processes which will be used by Taranaki District Health Board when making decisions on the prioritisation and rationing of funding and services.

Scope

This policy will guide all prioritisation and rationing decisions made across the organisation.

Compliance

Compliance with this policy will be reported annually to the Community and Public Health Advisory Committee by the General Manager Planning, Funding and Population Health. 

Context

The prioritisation and rationing decision making takes place in the context of:

  • Limited funding
  • Cost structure of TDHB services exceeding PBFF share
  • Crown Funding Agreement obligations
  • Government strategies and requirements
  • Health needs assessment of our population
  • Limited epidemiology data
  • Local priorities as specified in the Annual Plan
  • Current Services
  • Community perceptions and expectations

Levels of prioritisation

Prioritisation of health funding occurs at many levels:

At a Government level

  • Determining the amount of funding allocated to “Vote Health”
  • Determining the allocation of funding to individual DHB’s (Population based funding formula)
  • Specifying the range of services provided by DHB’s(Operating Policy Framework, MoH Policy)

At Taranaki District Health Board level

  • Setting local strategic priorities

At a DHB Planning & Funding level

  • Allocation of resources according to the requirements of the Ministry of Health and the strategic direction set by the Board.

At a Clinician level

  • Allocation of procedures/treatments between patients 
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Decision making criteria/principles

Taranaki District Health Board will use the following criteria to guide decision making.

  • Effectiveness
    The extent to which services produce improvements in health status; or prevent a decline in health status.  Highest priority will be given to services which produce the greatest improvement to the health status at a population level.

  • Affordability
    Relates to the cost of services and the impact on overall health expenditure relating to the achievement of that health gain, to ensure that funding achieves maximum gain.

  • Equity
    Refers to both access and outcome.  Can the service be accessed by the target population and does it improve the health status of those with the worst health?

  • Māori health
    Refers to the degree to which Māori will take up and benefit from the proposal; whether it is appropriate and acceptable to Māori and whether it will reduce health disparities between Māori and non- Māori.

  • Strategic Fit
    Relates to the delivery of health gain in the strategic focus areas outlined in the  Taranaki District Health Board District Strategic Plan 2005 – 2015;  or with delivery of services required by the Ministry of Health under the Service Coverage Schedule.
  • Timing of benefits
    Refers to how quickly the benefits will be realised.  Highest priority will be given to those proposals which deliver benefits most quickly.

Taranaki District Health Board would like to make all decisions based on good epidemiological data and evidence on outcomes.  However this type of information is not always available and sometimes decisions will have to be made on the best information available.  In this situation the Board commits to ensuring fair and accurate representation of the need and benefit; and reasonable estimation of the relative importance or value of proposals.  It is also acknowledged that on occasions prioritisation decisions will take place outside the control of the DHB e.g. through direction from the Minister of Health. 

Decision making process

Annual Funding Allocation

  • Board sets strategic direction via the District Strategic Plan and District Annual Plan.
  • The General Manager Planning, Funding and Population Health will advise the Board on the appropriate level of funding for personal health, mental health, disability support services, Māori health and funding and governance, following discussion with the Planning and Prioritisation Panel.
  • The Board will determine the annual funding allocation to each of the five funding streams.

Changing existing funding allocations

  • The Planning and Prioritisation Panel will advise the GM Planning, Funding and Population Health on service areas where existing funding allocations should be reviewed in the light of the strategic direction set by the Board.
  • The GM Planning, Funding and Population Health is responsible for prioritisation decisions, taking account of advice from the Planning and Prioritisation Panel, strategic direction from the Board and  Ministry of Health policy; and remains responsible for complying with the requirements of DHB’s under the Operating Policy Framework.

Allocation of New Funding

  • Planning and Prioritisation Panel will advise the GM Planning, Funding and Population Health on allocation of new funding to progress the strategic aims set by the Board within the funding conditions set by the Ministry of Health.
  • The GM Planning, Funding and Population Health remains responsible for prioritisation decisions, taking account of: advice from the Planning and Prioritisation Panel, strategic direction from the Board, Ministry of Health policy and the requirements of DHB’s under the Operating Policy Framework.

Prioritisation Scoring Matrix

  • For all proposals over $10,000 the Prioritisation Scoring Matrix will be used to provide an objective assessment of relative priority to inform decision-making. 
  • The information used to complete the Prioritisation Scoring Matrix will be resubmitted with the Matrix to provide a clear record of the basis of decision-making.
  • The Health Impact Assessment tool is to be used as evidence to support equity score.
  • Where proposals are sought and received from providers, the providers will be asked to complete a Prioritisation Scoring Matrix and submit it with the evidence to the Planning and Prioritisation Panel.  A Matrix will also be completed separately by the relevant Portfolio Manager.
  • Where there are significant differences between the Matrices submitted by providers and Portfolio Managers, independent advice will be sought from the relevant professional advisor of the DHB and the Specialist in Public health medicine.  This will then be considered by the Panel.
  • Where proposals are unsuccessful, feedback will be provided to all stakeholders by the Portfolio Manager, detailing the reasons why the proposal was not funded.
  • The success of funding proposals is clearly influenced by the availability of funding. If funding becomes available during a financial year, all proposals submitted in the previous 12 month period will be considered alongside new proposals.
Chief Advisor Māori Health
  • Where funding relates to services targeted specifically at addressing Māori health needs, approval by the Chief Advisor Māori Health is required in addition to approval by the GM Planning, Funding and Population Health.
Provider Selection
  • Provider selection is outside the scope of this policy.

Decision Making Tools

 

Last updated: Tuesday, April 24, 2018

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