It is time to take a look at what outcomes population-based funding is delivering across the country, one of the University of Otago's medical professors, Prof John Highton, says.
During question time at a lecture in Dunedin earlier this week, Prof Highton, a rheumatologist, said addressing the issues of the population-based funding (PBF) system would be a "reasonable starting point" for quality improvement in health.
There was a need to "see if it's delivering outcomes across the country which are in any way comparable".
"I think it is not," he said.
It could not be a coincidence that nearly all the current district health board deficits were in the South Island.
His comments came after a lecture by Associate Prof Robin Gauld, of the University of Otago's Centre for Health Systems, on engaging senior management and the board in clinical quality improvement.
In response, Prof Gauld said PBF was a mystery and it seemed "almost impossible to open it up" with Ministry of Health tactics to keep "key data" close to its chest.
The research being done in the centre on this suggested the ministry could not necessarily "cross the T's and dot I's when it comes to how PBF is constructed", he said.
Also in question time, Southern District Health Board orthopaedic specialist David Gwynne-Jones said a limiting factor in quality improvement was the requirement to develop a business case for any initiative suggested.
Much time would be spent on preparing such cases which would then be declined and not funded.
"That's what's really slowing us up" in terms of quality improvement, he said.
He said he had stopped writing the business case proposals because "they are all declined".
Mr Gwynne-Jones has been outspoken this year about the need for Dunedin Hospital to carry out extra acute surgery.
Extra hours have been approved, but do not appear likely to be introduced before November.
Another questioner, Emeritus Prof Gil Barbezat, who heads the new Gastrointestinal Disease Centre establishment board, a joint venture between the university and the district health board, asked why there was a block between the clinical and management approaches.
They seemed like "oil and water" rather than an effective emulsion, he said.
He said he had been dealing with an instance where recommendations from 1995 were repeated in March this year with nothing achieved in the interim and clinicians having to deal daily with the outcomes of that.
Prof Gauld said part of the problem at Southern DHB had been funding which meant the board was not doing anything other than "coal-face business".
Allan Cumming, who has been employed by the DHB as facilitator of the "Putting the Patient First" project designed to improve patient flow throughout Dunedin Hospital, said if organisations did not have any money, they had to improve processes and focus on reducing waste, which could account for 30% of the budget.
