Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; Centre for Health Systems and Technology, University of Otago, New Zealand.
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; Centre for Health Systems and Technology, University of Otago, New Zealand.
Health Policy. 2021 Mar;125(3):406-414. doi: 10.1016/j.healthpol.2020.12.008. Epub 2020 Dec 24.
New Zealand's dual public-private health system allows individuals to purchase health services from the private sector rather than relying solely upon publicly-funded services. However, financial boundaries between the public and private sectors are not well defined and patients receiving privately-funded care may subsequently seek follow-up care within the public health system, in effect shifting costs to the public sector. This study evaluates this phenomenon, examining whether cost-shifting between the private and public hospital systems is a significant issue in New Zealand. We used inpatient discharge data from 2013/14 to identify private events with a subsequent admission to a public hospital within seven days of discharge. We examined the frequency of subsequent public admissions, the demographic and clinical characteristics of the patients and estimated the direct costs of inpatient care incurred by the public health system. Approximately 2% of private inpatient events had a subsequent admission to a public hospital. Overall, the costs to the public system amounted to NZ$11.5 million, with a median cost of NZ$2800. At least a third of subsequent admissions were related to complications of a medical procedure. Although only a small proportion of private events had a subsequent public admission, the public health system incurred significant costs, highlighting the need for greater understanding and discussion around the interface between the public and private health systems.
新西兰的公私混合医疗体系允许个人从私营部门购买医疗服务，而不仅仅依赖公共资金资助的服务。然而，公私部门之间的财务界限并不明确，接受私人资金资助的患者可能随后会在公共卫生系统中寻求后续治疗，实际上将费用转移到公共部门。本研究评估了这种现象，考察了私人和公共医院系统之间的成本转移是否是新西兰的一个重大问题。我们使用 2013/14 年的住院患者数据，确定了在出院后七天内有后续入住公立医院的私人事件。我们检查了随后的公共入院的频率、患者的人口统计学和临床特征，并估算了公共卫生系统承担的住院治疗直接费用。大约 2%的私人住院事件随后入住了公立医院。总体而言，公共系统的费用达到了 1150 万新西兰元，中位数为 2800 新西兰元。至少三分之一的后续入院与医疗程序的并发症有关。尽管只有一小部分私人事件随后有公共入院，但公共卫生系统承担了巨大的费用，这突显了需要加强对公私医疗体系之间接口的理解和讨论。
