Influence of Performance Monitoring on Rural Services
The performance-monitoring regime can exert considerable influence on CHE behaviour. It is a frequent, highly visible (although not always to the public) exercise which provides a strong focus for CHE management. In addition, the salaries of CHE CEOs are linked to their performance as measured by the 23 indicators.
However, the monitoring is of services at the CHE level, which generally involves an aggregate of two or more hospitals or other providers. Other than for some small CHEs such as Wairarapa Health, the services provided by rural hospitals will tend to be dominated by those provided by their larger cohorts within the CHE. For example, the rating of services at Dannevirke or Pahiatua hospitals will have little influence on the performance results for MidCentral CHE services overall. To this extent it might be expected that performance monitoring will not directly affect the conduct of smaller hospitals.
It is also true, especially without weighting by case mix, that services provided by smaller hospitals may score quite well Measures are included for customer satisfaction and public perception, which may be higher for smaller hospitals with loyal communities and a perceived more personal approach. Where rural hospitals have a high percentage of daypatient and out-patient work, this will cause them to score well in these categories also. There is no explicit measure for accessibility of services, although this could come into the public perception measure, which should include whether the CHE is seen to be meeting the needs of its community.
Nevertheless, the monitoring will put pressure on CHEs to perform. Many inherited heavy debt loads from the AHB structures. At the time of the Post Election Briefing, the Ministry of Health noted that the efficiency gains necessary to reduce these debts would likely involve some reconfiguration of services. "For some, this will involve reducing or closing uneconomic satellite hospitals, particularly in rural areas" (Ministry of Health, 1993:31). Since this, the Government has announced increased funding and debt write-downs which should relieve some of this pressure; however, the push for efficiency gains is likely to continue.
Contact for Enquiries
Rural Affairs Coordinator
Sector Performance Policy
MAF Policy
Ministry of Agriculture and Forestry
PO Box 2526
Wellington
NEW ZEALAND
Phone: +64 4 894 0675
Fax: +64 4 4 894 0745
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