DHB Showcase

One of the best parts about my time in New Zealand is that I have had the opportunity to learn about the healthcare system here, and efforts in Canterbury to deliver good-quality, affordable, integrated healthcare.  The DHB (District Health Board) is working with different primary care groups in the region to establish "Integrated Family Health Centers" (much like our Patient-centered Medical Home in the U.S.).

Here in Canterbury region (including Christchurch); most GPs own their own practice- either solo or a small group of GPs (maybe up to 6-10 doctors).  Other healthcare services also act independently- for example, privately-owned pharmacy practices, physical therapy (physiotherapy), etc.

The reimbursement model is mixed- capitation makes up about 50% of the GPs revenue, and ACC (accident coverage from the government), AD (acute demand- coverage from the government for more serious work-ups and treatment) and co-pays make up the other 50%.

For example, for capitation, the GP may receive $108 per year for one person enrolled in his or her panel (actual amount varies based on age and gender), and the average panel size is 1200-1500.  Co-pays to see a GP are about $40-50.

The Canterbury region has about 450 GPs and 600 Practice Nurses.

GPs here work hard- seeing patients about every 10-15 minutes usually.  They do not have much time built in for preventive care or outreach.

Most practices seem to have EHRs (MedTech).

Challenges: an aging workforce (average age of a GP here is 52)
  work-life balance
  worrying about passing on the practice when ready to retire (having a good replacement).

I was invited to tour the "DHB Showcase"- a warehouse that displays some of the challenges in providing healthcare in the Canterbury region, and some mock-ups in planning a new regional hospital.

These pictures may look familiar to some of you- very similar to our cardboard mock-ups in the warehouse in Burien when Group Health was working on designing new primary care clinics!

It was disappointing, though, that primary care groups have not been able to go through this process yet for the new clinics they are designing.

Wall outlining the demographics of Canterbury.
On the opposite wall there were iPads that connected to screens above- we did an aging activity, where you snap a picture of yourself, and a new picture is projected, making you look about 50 years older!  Not flattering for anyone...

This was an activity where we designed the different tiers of healthcare and brainstormed which services (radiology, home care, physiotherapy, pharmacy, GP, etc) needed to be close by in communities, and which ones could be shared by a larger region.

Post-its looking very "LEAN".

Mock-up of a hospital room.

Mock-up of a floor plan.