A possible change to funding medicines in the community is among several major issues Otago District Health Board will have to grapple with early this year.
The board has received 22 submissions to the Otago and Southland Community Pharmaceuticals Initiative which explores new ways of funding community medicines as a way of reducing the increasing costs of prescribed drugs.
A report on the feedback is expected to go before the Otago and Southland boards' community and public health advisory committee in February, with the boards expected to consider the matter in March.
The Otago board is also expected to take a hard look at its bleak financial situation early in the year.
Senior management staff are working out how the board can break even over three years and board chairman Richard Thomson has signalled there will need to be a debate with the community about which services it can continue to provide.
The board faces an expected deficit of more than $13 million this year and does not expect to get enough money to fund this, plus cover long overdue capital expenditure.
Also on the agenda will be deciding how plans for regional clinical services should proceed.
The outcome of the regional hospital capacity review, looking at what will be required in the next 20 years in both provinces, is expected mid year.
At its first meeting in February the board is expected to consider how its plans to save an estimated $1 million by charging for laboratory tests could work.
Any implementation of this, however, may be affected by Health Minister Tony Ryall's moratorium on the issue.
He wants the impact of a similar existing scheme operating in Hutt Valley and Capital and Coast district health boards reviewed, but no date for the outcome of that has been announced.
The community pharmaceuticals initiative might save up to $9 million over three years in Otago, if pharmacies were bulk-funded, although there are several factors which could affect this calculation, including how many pharmacies might participate.
Last financial year the board spent $46.4 million on community medicines.
The original initiative report recommended bulk-funding of community pharmacies (which would be optional), but following legal advice and comments from the Commerce Commission some board members suggested funding through primary health organisations (PHOs) would be preferable.
This option, while in the report, had initially been ruled out because of concern about possible anti-competitive behaviour and price-fixing issues.
Mr Thomson regarded this as the best option and expressed concern that ill will generated from bulk funding community pharmacies could harm the pharmacy sector.
The Pharmacy Guild was worried pharmacy bulk-funding could pit GPs and pharmacies against each other, while some doctors have taken issue with any suggestion they are overprescribing or prescribing unnecessarily.
Under either of the funding options, incentive payments would be used to encourage pharmacies and PHOs and general practices to work together to make the most of community medicine expenditures, cutting down on any wasteful practices and ineffective treatments.
Under the PHO model, participating PHOs would hold the money for pharmacy professional services and contract pharmacies to provide dispensing services.
Savings made would then be distributed by the PHOs to participating general practices and pharmacies.
The way patients paid fees or got prescriptions would not change.
At present, community pharmacies receive a fee for every medication on prescription they dispense to a patient, which was described by the pharmaceuticals initiative project team as creating a perverse incentive for community pharmacies to focus on increasing the number of prescriptions to ensure business viability.
