文稿:傲雪
翻译:Darren
编辑:申睿霖
健康指标将跟踪所有的NZers的更好护理，8月6日政府对卫生系统的改革向前迈出了一大步，将公布这一制度，以追究其责任，并确保它为所有新西兰人提供更公平的医疗保健。
卫生部长安德鲁·利特尔已经宣布，20个区卫生委员会将解散，代之以更加注重初级卫生保健的新国家体系，结束卫生服务的邮政编码彩票系统，并削减官僚机构，使卫生保健工作者能够关注病人。
今天，安德鲁·利特尔启动了卫生系统指标框架，以补充改革。这些指标是一种新的思维方式。他们不是用资金激励，也不是在目标没有达到时指手画脚——他们既不是胡萝卜也不是棍子。
安德鲁·利特尔说:”它们衡量了我们的卫生系统在全国的运作情况，并有机会创造地方解决方案，以满足当地卫生需求。这一框架将帮助该部门专注于最需要改进的领域，特别是毛利人和太平洋人民。这些指标基于政府的六项卫生优先事项 — — 改善儿童福祉、改善心理健康、通过预防措施改善福祉、建立一个强大和公平的公共卫生系统、更好的初级保健和财政上可持续的卫生系统。
已经制定了12项指标，每三个月将公开报告一次实现这些指标的进展情况。当指标显示存在问题时，卫生服务部门将与当地社区合作，想出解决它的有效方法。这些指标取代了过时和无效的国家保健目标制度”。
安德鲁·利特尔说：”这些目标自2007年以来一直有效，而且有大量证据表明，新西兰和其他国家的目标不起作用。
卫生系统指标框架内的指标是什么？
政府优先事项指示器
描述，改善儿童福祉
24个月儿童免疫率
在两岁之前接种所有适龄疫苗的儿童百分比。
儿童门诊敏感住院（年龄范围0-4)五岁以下儿童因社区可能预防或更好地管理的疾病而住院率。改善心理健康
25岁以下的人可以在转诊后三周内获得专门的心理健康服务，转诊后三周内获得精神卫生服务的儿童和青年百分比，获得初级心理健康和成瘾服务，正在制定的测量标准，通过预防改善福祉，成人门诊敏感住院（年龄范围45-64岁），45岁人群的住院率=201264年，该病在社区中可能得到预防或更好地管理。
强大和公平的公共卫生系统，急性病床日率。在医院接受计划外护理（包括紧急情况）的天数，获得计划护理的机会。提前计划进行手术或护理的人，占商定人数的百分比交付计划中的事件，更好的初级卫生保健。
人们报告说，当他们需要时，他们可以得到初级保健，说他们在需要时接受全科医生或护士护理的人百分比。
人们报告说参与有关他们的护理和治疗的决定。说他们觉得自己与全科医生或护士一起参与自己护理和治疗的人百分比。
财政上可持续的卫生系统，财政年度末年度盈余/赤字，净盈余/赤字占总收入的百分比
。计划预算与年终实际情况之间的差异预算与实际差异占预算的百分比。
卫生系统指标框架如何运作？
卫生系统指标框架是衡量卫生系统对新西兰人民工作情况以及确定我们需要在哪些方面做得更好以满足毛利人和太平洋人民需要的一种新方法。
新框架包括12项高级别指标，这些指标经过精心挑选，以确保卫生系统侧重于为所有新西兰人实现Pae Ora（健康的未来）的正确领域。新框架认识到，地方问题需要本地解决方案。这意味着，为提高每个高级别指标的业绩而制定的行动将在全国各地有所不同，以反映每个社区的独特挑战和需求，以及阻碍公平获得服务的任何障碍。重点是在地方一级不断改进，而不是把注意力集中在实现国家设定的业绩目标上。
国家保健目标发生了什么？
虽然国家保健目标的结果将不再作为一套指标公布，但卫生局将继续向卫生部报告其目标的业绩，作为其定期季度报告程序的一部分。
2021/22年如何进一步发展该框架？
该部和总部将在2021/22年期间与过渡股和部门利益攸关方合作，进一步发展该框架，并确保该框架补充今后保健和残疾系统的总体监测和问责安排。
这将包括最后确定其余两项初步指标的衡量标准，并可能包括制定进一步指标，例如与心理健康、青年健康、获得保健服务的机会、机会/结果的公平性和婴儿健康有关的指标。必须确保任何额外的指标与部门参与者的作用和问责制保持一致。
何时采取当地行动？
2021/22年期间，将支持DHB和当地提供者与其利益攸关方合作，包括毛利人/Iwi伙伴关系委员会和临床医生，为每个高级别指标制定一套地方行动，为国家改善作出贡献。预计到2022年7月1日，所有地方行动都将到位。
新框架将如何改善毛利人和太平洋人民的平等？
所有高级别指标（财务业绩除外）的数据将按民族提供，包括全国和（在适当时候）地方一级。这将有助于我们确定我们需要做得更好的地方，特别是对毛利人和太平洋人民而言。
将与当地社区和利益攸关方合作，制定改善国家业绩的地方行动，以确保这些行动符合目的，并将以对毛利人和太平洋社区有效的方式进行。
Health Indicators will track better care for all NZers
The Government’s reform of the health system took a big step forward today with the unveiling of the system that will be used to hold it accountable and ensure it delivers more equitable healthcare for all New Zealanders.
Health Minister Andrew Little has already announced the 20 district health boards will be disestablished and replaced with a new national system with a a greater focus on primary healthcare, bring an end to the postcode lottery system of health services, and cutting bureaucracy so healthcare workers can focus on patients.
Today, Andrew Little launched the Health System Indicators framework that complement the reforms.
“The indicators are a new way of thinking. They are not about incentivising with funding or pointing the finger if targets are not met – they are neither a carrot nor a stick,” Andrew Little said.
“They are a measure of how well our health system is functioning across the country, and an opportunity to then create local solutions to address local health needs.
“This framework will help the sector focus on the areas that most need to improve – especially for Māori and Pacific peoples.
“The indicators are based on the Government’s six priorities for health – improving child wellbeing, improving mental wellbeing, improving wellbeing through preventative measures, creating a strong and equitable public health system, better primary healthcare and a financially sustainable health system.
“Twelve indicators have been developed and progress in meeting them will be publicly reported on every three months.
“When the indicators show there is a problem, health services will work with local communities to come up with effective ways to fix it.”
The indicators replace the outdated and ineffective National Health Targets regime.
“The targets have been in place since 2007 and there’s plenty of evidence – from New Zealand and other countries – that they don’t work,” Andrew Little said.
“They are arbitrary and don’t reflect the real priorities of the health system.
“Even worse, they led to what can only be described as perverse outcomes, with district health boards seeking to meet, such as doing lots of small procedures instead fewer major ones so they could claim more people were being treated.”
What are the indicators within the Health System Indicators framework?
Government priority
Indicator Description
Improving child wellbeing Immunisation rates for children at 24 months Percentage of children who have all their age-appropriate scheduled vaccinations by the time they are two years old
Ambulatory sensitive hospitalisations for children (age range 0‑4)
Rate of hospital admissions for children under five for an illness that might have been prevented or better managed in the community
Improving mental wellbeing
Under 25s able to access specialist mental health services within three weeks of referral
Percentage of child and youth accessing mental health services within three weeks of referral
Access to primary mental health and addiction services
Measurement criteria under development
Improving wellbeing through prevention
Ambulatory sensitive hospitalisations for adults (age range 45‑64)
Rate of hospital admissions for people aged 45‒64 for an illness that might have been prevented or better managed in the community
Strong and equitable public health system
Acute hospital bed day rate
Number of days spent in hospital for unplanned care including emergencies
Access to planned care
People who had surgery or care that was planned in advance, as a percentage of the agreed number of events in the delivery plan Better primary health care
People report they can get primary care when they need it
Percentage of people who say they receive care from a GP or nurse when they need it People report being involved in the decisions about their care and treatment Percentage of people who say they feel involved in their own care and treatment with their GP or nurse Financially sustainable health system Annual surplus/deficit at financial year end
Net surplus/deficit as a percentage of total revenue
Variance between planned budget and year end actuals
Budget vs actuals variance as a percentage of budget
How does the Health System Indicators framework work?
The Health System Indicators framework is a new way of measuring how well the health system is working for people in New Zealand and identifying where we need to do better to meet the needs of Māori and Pacific peoples.
The new framework includes 12 high-level indicators that have been carefully selected to ensure the health system focuses on the right areas to achieve Pae Ora – healthy futures – for all New Zealanders.
The new framework recognises that local problems require local solutions. This means the actions developed to improve performance on each of the high-level indicators will vary across the country to reflect the unique challenges and needs of each community and any barriers preventing equitable access to services. The emphasis is on continuous improvement at a local level rather than focusing attention on achieving nationally set performance targets.
What is happening to the national health targets?
While results for the national health targets will no longer be published as a set of metrics, DHBs will continue to report to the Ministry on their performance for the targets, as part of their regular quarterly reporting processes.
How will the framework be further developed in 2021/22?
The Ministry and HQSC will work with the Transition Unit and sector stakeholders during 2021/22 to further develop the framework and ensure it complements overarching monitoring and accountability arrangements for the health and disability system going forward.
This will include finalising the measurement criteria for the two remaining initial indicators and could potentially also include developing further indicators, for example in relation to mental health, youth health, access to health services, equity of access/outcomes and infant health. It will be important to ensure any additional indicators are aligned with the roles and accountabilities of sector participants.
When will the local actions be put in place?
DHBs and local providers will be supported during 2021/22 to partner with their stakeholders including Māori/Iwi partnership boards and clinicians to develop a set of local actions for each high-level indicator that will contribute to national improvement. It is anticipated that all local actions will be in place by 1 July 2022.
How will the new framework improve equity for Māori and Pacific peoples?
Data for all the high-level indicators (except financial performance) will be available by ethnicity, both nationally and (in due course) at a local level. This will help us identify where we need to do better, especially for Māori and Pacific peoples.
The local actions to improve national performance will be developed in partnership with local communities and stakeholders to ensure they are fit for purpose and will be delivered in a way that works for Māori and Pacific communities.
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