Chalmers Jenny, Ritter Alison, Berends Lynda, Lancaster Kari
Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales Australia, Sydney, Australia.
Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia.
Drug Alcohol Rev. 2016 May;35(3):255-62. doi: 10.1111/dar.12337. Epub 2015 Sep 30.
The structures of health systems impact on patient outcomes. We present and analyse the first detailed mapping of who funds alcohol and other drug (AOD) treatment and the channels and intermediaries through which funding flows from the funding sources to treatment providers.
The study involved a literature review of AOD treatment financing and existing diagrammatic representations of the structure of the Australian health system. We interviewed 190 key informants to particularise the AOD treatment sector, and undertook two case examples of government funded non-government organisations providing AOD treatment.
Funding sources include the Australian and state and territory governments, philanthropy, fund-raising and clients themselves. While funding sources align with the health sector generally and the broader social services sector, the complexity of flows from source to treatment service and the number of intermediaries are noteworthy. So too are the many sources of funding drawn on by some treatment providers. Diversification is both beneficial and disadvantageous for non-government treatment providers, adding to administrative workloads, but smoothing the risk of funding shortfalls. Government funders benefit from sharing risk.
Circuitous funding flows multiply the funding sources drawn on by services and put distance between the funding source and the service provider. This leads to concerns over lack of transparency about what is being purchased and challenges for the multiply funded service provider in maintaining programs and service models amid multiple and sometimes competing funding and accountability frameworks. [Chalmers J, Ritter A, Berends L, Lancaster K. Following the money: Mapping the sources and funding flows of alcohol and other drug treatment in Australia. Drug Alcohol Rev 2016;35:255-262].
卫生系统的结构会对患者治疗结果产生影响。我们展示并分析了首份关于酒精及其他药物（AOD）治疗资金来源的详细图谱，以及资金从资助方流向治疗提供者的渠道和中间环节。
该研究包括对AOD治疗资金筹措情况以及澳大利亚卫生系统结构的现有图表说明进行文献综述。我们采访了190位关键信息提供者，以细化AOD治疗领域，并选取了两个由政府资助的非政府组织提供AOD治疗的案例。
资金来源包括澳大利亚联邦政府、州和领地政府、慈善机构、筹款活动以及患者自身。虽然资金来源总体上与卫生部门以及更广泛的社会服务部门相符，但从资金来源到治疗服务的资金流动复杂性以及中间环节数量值得关注。一些治疗提供者所利用的资金来源众多也是如此。多元化对非政府治疗提供者而言既有好处也有坏处，增加了行政工作量，但降低了资金短缺风险。政府资助方则受益于风险分担。
迂回的资金流动增加了服务所利用的资金来源数量，并使资金来源与服务提供者之间产生距离。这引发了对所购买内容缺乏透明度的担忧，以及对于接受多重资助的服务提供者在多个有时相互竞争的资金和问责框架下维持项目和服务模式所面临的挑战。[查尔默斯J、里特A、贝伦兹L、兰卡斯特K。追踪资金流向：绘制澳大利亚酒精及其他药物治疗的资金来源和资金流动图谱。《药物与酒精评论》2016年；35：255 - 262]
