title: An economic analysis of hospital costs in New Zealand

authors: Tatchell, Philip Michael

abstract: The main purpose of this study is to apply economic principles and methods to the analysis of New Zealand’s hospital services in order to ascertain how the costs of providing those services varies among hospitals and over time. Achievement of this objective at the same time enables an assessment to be made of the relevance of the various theoretical models and empirical techniques that have been employed in recent studies of hospital costs in other countries.
Attention in the initial chapters is devoted to identifying and assessing the quantitative importance of the factors responsible for the rapid and accelerating cost increases associated with the provision of hospital services in recent years. Two main groups of factors are identified - demand and supply-related - and their relative cost impacts are tested first by means of a descriptive historical analysis, and then, following the development of a general behavioural model of hospital cost inflation, by means of econometric techniques.

The results of the estimation process indicate that rising hospital costs are largely due to changes on the supply side, particularly to the rising cost, quantity and quality of the labour and non-labour inputs used by hospitals. Demand variables, particularly changing length of stay and the changing diagnostic mix of patients treated in hospital, are also shown to have had an important, though less substantial impact on hospital cost levels. 
The second part of the study is devoted to identifying and examining the factors that give rise to variations in costs among hospitals at a given point in time. Three main groups of factors are identified - patient or output characteristics, institutional characteristics and utilisation levels, and their relative importance in explaining the interhospital cost variations is tested by means of econometric techniques.
The results indicate that variations in the average costs of hospital care are largely explained by the types of patient treated, both by age and diagnosis, by the length of time the patient stayed in hospital, and by the teaching status of the hospital. Considerable attention in this section is also devoted to establishing whether economies of scale exist in New Zealand’s hospital industry and to developing and testing a number of alternative measures of hospital output based on similar measures employed in earlier overseas studies.

A number of implications for policy and for further research arise from the findings. On the cost inflation side apart from suggesting possible ways in which to combat and control the rapid rise in hospital costs, considerable emphasis is placed on the need both for more rigorous evaluation of alternative hospital expenditure programmes and for more and better planning of all hospital and health services. Future research, it is argued, should be directed towards assessing the costs and benefits of particular hospital programmes with a view to ensuring the most efficient and effective utilisation of the scarce resources available for hospital care in New Zealand.
On the cost variation side a revised system of allocating finance to Hospital Boards is advocated which would take into account the various differences among hospitals found to be responsible for the wide variations in their average costs. Introduction of such a population-based allocation system would, it is maintained, ensure that the desired objective of an equitable distribution of resources throughout New Zealand is achieved. Further research is required firstly, to develop a simple yet reliable means of accounting for interboard case-mix differences; secondly, to assess more accurately the nature and extent of the impact of teaching on hospital costs; and finally, to ensure that the economies of scale that appear to exist in New Zealand’s hospital industry are fully exploited.

text: An economic analysis of hospital costs in New Zealand The main purpose of this study is to apply economic principles and methods to the analysis of New Zealand’s hospital services in order to ascertain how the costs of providing those services varies among hospitals and over time. Achievement of this objective at the same time enables an assessment to be made of the relevance of the various theoretical models and empirical techniques that have been employed in recent studies of hospital costs in other countries.
Attention in the initial chapters is devoted to identifying and assessing the quantitative importance of the factors responsible for the rapid and accelerating cost increases associated with the provision of hospital services in recent years. Two main groups of factors are identified - demand and supply-related - and their relative cost impacts are tested first by means of a descriptive historical analysis, and then, following the development of a general behavioural model of hospital cost inflation, by means of econometric techniques.

The results of the estimation process indicate that rising hospital costs are largely due to changes on the supply side, particularly to the rising cost, quantity and quality of the labour and non-labour inputs used by hospitals. Demand variables, particularly changing length of stay and the changing diagnostic mix of patients treated in hospital, are also shown to have had an important, though less substantial impact on hospital cost levels. 
The second part of the study is devoted to identifying and examining the factors that give rise to variations in costs among hospitals at a given point in time. Three main groups of factors are identified - patient or output characteristics, institutional characteristics and utilisation levels, and their relative importance in explaining the interhospital cost variations is tested by means of econometric techniques.
The results indicate that variations in the average costs of hospital care are largely explained by the types of patient treated, both by age and diagnosis, by the length of time the patient stayed in hospital, and by the teaching status of the hospital. Considerable attention in this section is also devoted to establishing whether economies of scale exist in New Zealand’s hospital industry and to developing and testing a number of alternative measures of hospital output based on similar measures employed in earlier overseas studies.

A number of implications for policy and for further research arise from the findings. On the cost inflation side apart from suggesting possible ways in which to combat and control the rapid rise in hospital costs, considerable emphasis is placed on the need both for more rigorous evaluation of alternative hospital expenditure programmes and for more and better planning of all hospital and health services. Future research, it is argued, should be directed towards assessing the costs and benefits of particular hospital programmes with a view to ensuring the most efficient and effective utilisation of the scarce resources available for hospital care in New Zealand.
On the cost variation side a revised system of allocating finance to Hospital Boards is advocated which would take into account the various differences among hospitals found to be responsible for the wide variations in their average costs. Introduction of such a population-based allocation system would, it is maintained, ensure that the desired objective of an equitable distribution of resources throughout New Zealand is achieved. Further research is required firstly, to develop a simple yet reliable means of accounting for interboard case-mix differences; secondly, to assess more accurately the nature and extent of the impact of teaching on hospital costs; and finally, to ensure that the economies of scale that appear to exist in New Zealand’s hospital industry are fully exploited.

year: 1977

title: A quantitative investigation into the effectiveness of a 2x2, crossover, randomized control trial, for individuals suffering from non-specific chronic lower back pain, using a physical exercise-focused clinical intervention on the transverse abdominus/ multifidus (stability) and rectus abdominals/ erector spinae (dynamic) muscles.

authors: Callaghan, Adam James

subjects: lower back pain

abstract: A plethora of research has been conducted on interventions to reduce non-specific
lower back pain and improve the quality of life of sufferers. However, there is a lack of
distinction on the complementary nature of these interventions. Our primary research goal
was to assess the effectiveness of stability- and dynamic-style clinical interventions, focusing
on exercises to strengthen specific trunk muscles, including the transverse
abdominis/multifidus (stability-AB), and rectus abdominis/ erector spinae (dynamic). We
aimed to determine the effectiveness of these interventions in reducing non-specific chronic
lower back pain. Our research questions focused on whether a two-part clinical intervention
targeting specific core muscle groups (dynamic or stability) improves pain outcomes, whether
exercises targeting specific core muscle groups improve disability index physical impairment
and overall low back pain rating scale scores, and if there is a difference between intervention
groups and the sequential order of intervention for these outcomes. Additionally, we wanted
to investigate the correlation between these outcome measures and trunk endurance strength
scores. Seven participants were randomly assigned to either the stability (N =4) or dynamic
(N = 3) exercise group. Outcome measures included back and leg pain, lower back pain
visual analogue scale scores, disability index, physical impairment, and total Low Back Pain
Rating Scale (LBPRS) scores. Four measures of trunk endurance strength were taken using
Mcgill's Torso Endurance Test Battery (MTETB), which involves trunk extension, trunk
flexor, and trunk lateral tests on both the left and right sides. Assessments were performed
before the first clinical intervention, after the first intervention, and after the completion of
the final intervention. Each intervention phase lasted 4 weeks for each participant before they
switched to the opposing exercise group. The scores of back and leg pain, lower back pain,
disability index, and physical impairment all improved significantly after both interventions.
We found no difference between the groups during these intervention phases, or any potential
crossover/sequential effect, except for the dynamic group showing a significant improvement
in physical impairment scores after the first intervention, which remained consistent between
interventions one and two. In conclusion, both exercise approaches were similar across all
our outcome measures and may serve as complementary interventions for individuals
suffering from non-specific chronic low back pain.

text: A quantitative investigation into the effectiveness of a 2x2, crossover, randomized control trial, for individuals suffering from non-specific chronic lower back pain, using a physical exercise-focused clinical intervention on the transverse abdominus/ multifidus (stability) and rectus abdominals/ erector spinae (dynamic) muscles. A plethora of research has been conducted on interventions to reduce non-specific
lower back pain and improve the quality of life of sufferers. However, there is a lack of
distinction on the complementary nature of these interventions. Our primary research goal
was to assess the effectiveness of stability- and dynamic-style clinical interventions, focusing
on exercises to strengthen specific trunk muscles, including the transverse
abdominis/multifidus (stability-AB), and rectus abdominis/ erector spinae (dynamic). We
aimed to determine the effectiveness of these interventions in reducing non-specific chronic
lower back pain. Our research questions focused on whether a two-part clinical intervention
targeting specific core muscle groups (dynamic or stability) improves pain outcomes, whether
exercises targeting specific core muscle groups improve disability index physical impairment
and overall low back pain rating scale scores, and if there is a difference between intervention
groups and the sequential order of intervention for these outcomes. Additionally, we wanted
to investigate the correlation between these outcome measures and trunk endurance strength
scores. Seven participants were randomly assigned to either the stability (N =4) or dynamic
(N = 3) exercise group. Outcome measures included back and leg pain, lower back pain
visual analogue scale scores, disability index, physical impairment, and total Low Back Pain
Rating Scale (LBPRS) scores. Four measures of trunk endurance strength were taken using
Mcgill's Torso Endurance Test Battery (MTETB), which involves trunk extension, trunk
flexor, and trunk lateral tests on both the left and right sides. Assessments were performed
before the first clinical intervention, after the first intervention, and after the completion of
the final intervention. Each intervention phase lasted 4 weeks for each participant before they
switched to the opposing exercise group. The scores of back and leg pain, lower back pain,
disability index, and physical impairment all improved significantly after both interventions.
We found no difference between the groups during these intervention phases, or any potential
crossover/sequential effect, except for the dynamic group showing a significant improvement
in physical impairment scores after the first intervention, which remained consistent between
interventions one and two. In conclusion, both exercise approaches were similar across all
our outcome measures and may serve as complementary interventions for individuals
suffering from non-specific chronic low back pain.

year: 2024

title: Creating an environment to inform, build, and sustain a Māori health research workforce

authors: Barrett, Nikki Maree

subjects: Kaupapa Māori

abstract: Ensuring the growth and development of the Māori health research workforce is key to achieving health equity for Māori and enabling positive change for all New Zealanders. The purpose of this study was to identify enablers and barriers to research for Māori staff in a large health organisation, and to understand how research is developed and undertaken. A Kaupapa Māori mixed-methods study was undertaken, using an electronic survey comprised of quantitative data and open-ended responses delivered to all Māori staff at the Waikato District Health Board. Following the survey were 10 one on one interviews. Survey data were analysed using descriptive statistics and open-ended responses summarised. A descriptive thematic analysis was undertaken of the interview data. Each of the interview responses was coded and five themes emerged. Frontline Māori staff affirmed their desire to conduct, design, and undertake health research. Challenges to staff included a lack of information on research opportunities, unclear processes for initiating research, and lack of support and resource. The evidence from participants provides insights into Māori health research priorities, considerations for those wanting to undertake research, and solutions for informing, building, and sustaining the Māori health research workforce.

text: Creating an environment to inform, build, and sustain a Māori health research workforce Ensuring the growth and development of the Māori health research workforce is key to achieving health equity for Māori and enabling positive change for all New Zealanders. The purpose of this study was to identify enablers and barriers to research for Māori staff in a large health organisation, and to understand how research is developed and undertaken. A Kaupapa Māori mixed-methods study was undertaken, using an electronic survey comprised of quantitative data and open-ended responses delivered to all Māori staff at the Waikato District Health Board. Following the survey were 10 one on one interviews. Survey data were analysed using descriptive statistics and open-ended responses summarised. A descriptive thematic analysis was undertaken of the interview data. Each of the interview responses was coded and five themes emerged. Frontline Māori staff affirmed their desire to conduct, design, and undertake health research. Challenges to staff included a lack of information on research opportunities, unclear processes for initiating research, and lack of support and resource. The evidence from participants provides insights into Māori health research priorities, considerations for those wanting to undertake research, and solutions for informing, building, and sustaining the Māori health research workforce.

year: 2023