2013/14
SERVICE COVERAGE SCHEDULE
This document is incorporated as part of the Crown Funding Agreement under section 10 of the
New Zealand Public Health and Disability (NZPHD) Act 2000
Version / 1.3Last modified / 25July 2013
Citation: Ministry of Health. 2013/ 2014 Service Coverage Schedule
Wellington: Ministry of Health
First Published in November 2012 by the Ministry of Health
PO Box 5013, Wellington, New Zealand
SCS 2013-141
Table of Contents
1Purpose and principles of service coverage information
1.1Definitions of terms used
1.2Responsibility for ensuring delivery of service coverage expectations
1.3Service coverage information
2Key principles underlying the funding of services
2.1Eligibility criteria applying to publicly funded services
2.2Availability of publicly funded health and disability support services
2.3Funding
2.4Quality and standards
2.5Prioritising the funding of services and managing service risk
2.6The Government’s health priorities for Māori
2.7Services to meet Pacific peoples needs
2.8 Health Emergency Coverage
3Specific services with transitional issues in 2013/14 and out years
Public Health
3.1Antenatal screening for Down syndrome and other conditions
3.2Public Health services
3.3Tobacco control
Child and Youth
3.4Gateway (Health and Education) Assessments
3.5Youth health services
3.6School Immunisation Programme
Other
3.7Physiotherapy services to ACC clients
3.8Maternity Services
3.9Diagnostics
3.10Positron Emission Tomography (PET) Scanning
3.11Oral Health Service Coverage
3.12Organ Transplantations
3.13Pharmaceutical Service Coverage
3.14Behaviour Support Services
3.15Disability Support Services New Model Programmes
4Individual Service Cover Schedules
4.1Blood Services
4.2Dental Health Services
4.3Diagnostic Therapeutic and Support Services- Personal Health
4.4Disability Support Services
4.5Emergency Ambulance Services
4.6Health and Support Services for Older People
4.7Immunisation Services
4.8Long-term Support Services for People with Chronic Health Conditions
4.9Maternity Services
4.10Mental Health and Addiction Services Continuum
4.11Palliative Care
4.12Pharmaceutical Services
4.13Primary Health Care Services
4.14Provision of Equipment, Modifications and other Supplies and Services
4.15Public Health Services and Prevention Services
4.16Specialist Medical and Surgical Services
4.17Travel and Accommodation Services
Appendix One: Special High Cost Treatment
Appendix Two: Requirements in relation to accident claimants
Appendix Three: Gateway Assessments
Appendix Four: Change Summary- 2013/14 Service Coverage Schedule
2013/14 SERVICE COVERAGE SCHEDULE
1Purpose and principles of service coverage information
The purpose of including service coverage information within, but not limited to, the Crown Funding Agreement (CFA), is to allow the Minister of Health (the Minister) to explicitly agree to the level of service coverage for which the Ministry and District Health Boards (DHB) are held accountable.
The Minister is ultimately accountable to Parliament and to the taxpayer for the use of public health funds to fund the service cover for the people of New Zealand.The Minister has the final decision rights over service coverage.
This Service Coverage Schedule (SCS) is released subject to endorsement by the Minister in accordance with the CFA requirement.The SCS is updated annually.
1.1Definitions of terms used
Throughout the Service Coverage Schedule, reference is given to:
‘responsible funder’ is the party/parties that determine the service mix
‘funding’ refers to the exchange of dollars for delivery of health and disability services
‘service mix’ is the specific quantity and type of services that are used to meet the service coverage
‘Ministry funded’ refers to services funded by the National Health Board Business Unit.
1.2Responsibility for ensuring delivery of service coverage expectations
Responsibility for service coverage is spread across DHBs and the Ministry and lies with the party responsible for determining service mix.
DHBs are responsible for taking appropriate action to ensure that service coverage is delivered for their population, including populations (that may have high or different needs) such as Māori, Pacific and high needs groups.This applies whether services are funded directly by the DHBs or by the Ministry.
Where devolution of funding responsibility of services to DHBs has not occurred, the Ministry is accountable for service mix decisions, and for ensuring delivery of service coverage, in collaboration with DHBs.
Gaps in service coverage can either be related to issues of funding or service delivery or both.The Ministry and DHBs should work together to ensure resolution of service coverage gaps.
It is the responsibility of funders to decide if additional levels or standards are or can be funded or provided from the available funding.
1.3Service coverage information
Service coverage information describes how government policy is to be translated into the required minimum level and standard of services to be made available to the public.
1.3.1Information should include the:
range of health and disability support services
coverage and/or terms of access to those services
user charges (if any)
standards for safety and quality
particular process requirements indicated by The Minister (such as implementation of booking systems and Second National Mental Health Strategy and Blueprint).
In most instances, the description used will be of the range of services to be funded, but not the way they should be funded.
1.3.2Circumstances where more service coverage information detail is required
More detail of the range of services, including their terms of access, quality and safety standards and/or method of funding, is required in the following circumstances:
when close government interest exists and action is being taken, for example, because of:
-significant reprioritisation, transition or policy development
-funder or system performance shortfall
-requirements to undertake the provision of a service in a particular manner
-DHBs asking to have the service specified in more detail
There are other requirements such as:
changes in legislation
specific safety requirements to protect the health of the public or consumers
user charges or levels of subsidy for services.
2Key principles underlying the funding of services
2.1Eligibility criteria applying to publicly funded services
The Ministry and the DHBs will fund services for eligible people according to the obligations set out in this document.A full description of the eligibility criteria applying to funded health and disability services is set out in the Eligibility Direction[1] issued by the Minister. The Direction is available publicly on the Ministry website[2] along with a range of other supporting material and tools, including an electronic guide to eligibility.
All sections of the SCS, unless specified otherwise, apply to eligible people only.
Additional purchasing criteria (such as those applying to acute treatment for ineligible people) may be found in individual CFAs.
2.2Availability of publicly funded health and disability support services
The obligations of responsible funders to people outlined in this document represent population level expectations, and generally do not confer individual entitlements to services. Levels of access to services are determined clinically, and are based on principles of levels of need and ability to benefit.
The availability of publicly funded health and disability support services and level of services to be funded (service mix) will be determined in line with the requirements outlined below. These requirements ensure that rationing decisions are made to enable the maximum benefit from the funding available:
- access to services will be determined on a fair and reasonable basis, and subject to generally accepted clinical protocols
- priority for access will be granted on the basis of need, ability to benefit and/or an improved opportunity for independence for those with a disability. The responsible funder will, where appropriate, target delivery of services to those groups with poor health status and those likely to benefit
- the responsible funder will ensure people have reasonable access to services as close as possible to where they live, taking into account the geographic location of where they live and the nature of the service to which access is required
- when determining the availability of funded services, the responsible funder will consider and accommodate the needs of people in remote areas in the most practical, efficient and clinically safe way.
- if a patient chooses to supplement the volumes of consumables prescribed and funded by the DHB it is up to the patients to purchase the additional consumables that they wish to have. There is no provision for part funding by the patients for their preferred consumable product.
2.3Funding
Funding for services will not duplicate the services that are already funded by the District Health Boards (DHBs), the Ministry, the Accident Compensation Corporation (ACC), other accident insurers or other government agencies.
Publicly funded inpatient services, as well as day patient, outpatient services and any community referred services provided in the hospital setting, are provided to eligible people free of charge. This includes all the services and supplies associated with the hospital treatment.
Services for which co-payments have been agreed are Dental, Orthotic and Pharmaceutical services (refer to the individual schedules for the details).
No co-payment will be sought from Service Users for supplies and equipment unless permitted under current Crown Funding Agreement and Service Coverage Schedule for the Provision of Equipment and Modifications and other Services and Supplies (T1 Community Health, Transitional and Support Services).
2.4Quality and standards
The service agreements that responsible funders have with service providers contain service specifications that are considered appropriate for those services. These service agreement service specifications set out a description of the range of services to be funded.
2.4.1Service specifications
All nationwide service specifications (except for Disability Support Services) are published on the Nationwide Service Framework (NSF) library website[3].
Disability Support Services service specifications are published on
For new services, a service specification will need to be developed to recognise the service coverage components to be provided, as follows:
- service definitions, objectives, service users and access criteria, service component description, quality requirements, purchase unit(s), data collections, information requirements and reporting and appropriate standards for safety and quality
- the particular characteristics, special needs, and cultural values of communities (in particular Māori, Pacific peoples, and people with disabilities) shall also be taken into account
- funders will fund or provide consumers’ complaints services (consistent with the Code of Health and Disability Services Consumers’ Rights[4] that enable people to make complaints about services, providers and funders; and have such complaints heard.
2.5Prioritising the funding of services and managing service risk
2.5.1Deciding priority for publicly funded services
The Ministry and DHBs have a set budget provided by the government from which they fund the services that are deemed to meet the minimum needs of New Zealanders.
There is a system for deciding priority for publicly funded services that endeavours to balance values and principles, equity, effectiveness, value for money, and whānau ora, against the pressure of infinite demand for more and better services. Funders should be guided by the principles outlined in ‘The Best Use of Available Resources[5]and the related information in the Operational Policy Framework (OPF).
The Ministry and DHBs will comply with their funding obligations as described in this document by prioritising within and between services, and within and between population groups within the constraints of statutory requirements such as the Mental Health Commission Act[6].
2.5.2Requests for specific variation to the national minimum service coverage requirements
If theobligations are unsustainable, the responsible funder will identify the areas where re-prioritisation is necessary.
A DHB or the Ministry can request a specific variation to the national minimum service coverage requirements. Such a request will be considered as part of the Annual Plan (AP) and/or CFA process. Variations or exemptions shall be recorded in the accountability documentation with a clear reasoning for their existence and a time-bound review, resolution or improvement path and must be publicly transparent.
2.5.3Service coverage gaps must be reflected in DHB APs
All service coverage gaps affecting the DHB’s population should be acknowledged in the DHBs APs. Supporting material for each service coverage gap should include either a workout plan for managing resolution of the gap identified within the period of the AP, or background material supporting an exception to service coverage for the period of the AP.
Where the gap is to be managed within the period of the AP, DHBs will be required to report on progress towards resolution through the service coverage measure in the DHBs performance measures.
New policy expectations, agreed during the course of the year that impact on service coverage, will be implemented via a variation to the CFA.
2.5.4The Ministry and DHBs have the responsibility to manage service risks
Strategies used to manage service delivery risks include:
- working with clinicians and consumers (specifically Māori and Pacific peoples and users of mental health services) to develop best practice guidelines
- developing criteria governing the use of extremely high cost treatments
- working with other government agencies to ensure coordination of services to identify and address policy and service risks
- collaborating with other DHBs and the Ministry nationally and, where appropriate, regionally, to ensure coordinated planning, funding and delivery of Public Health Services and to collectively manage risks to Public Health
- collaborating with other DHBs to ensure the coordinated planning, funding and delivery of mental health services and services for Māori.
2.6The Government’s health priorities for Māori
The overall aim of He Korowai Oranga, the Māori Health Strategy[7], is Whānau Ora. Guided by He Korowai Oranga, the Ministry and the DHBs aim to improve outcomes and reduce inequalities for Māori within the context of the New Zealand Public Health and Disability Act (NZPHD).
The Ministry and DHBs are committed to working with Māori to build capacity to actively participate in the health sector at all levels, and to provide high quality information and effective service delivery, which considers the impact on Māori, their whānau, and their health needs.
The Ministry and the DHBs will meet Crown objectives for Māori health by working to ensure that all health and disability services are provided in a timely manner, are of high quality, and are effective in order to improve the health of Māori and their whānau, and reduce health inequalities for Māori.
The DHBs will allocate resources to improve health outcomes and reduce inequalities for Māori. The Ministry and the DHBs will ensure that mainstream services are effective for Māori and work to improve access for Māori, particularly for primary care services. Building Māori health providers’ capacity and capability are also important strategies in improving Māori health status. The Ministry and the DHBs will continue to support accelerated development of the Māori health workforce at all levels of the health sector.
The Ministry and the DHBs will progress towards addressing the broad determinants of health through inter-sectoral collaboration, and the coordination of health services to Māori and their whānau.
Each DHB will continue to identify and account for Māori health funding. This will involve identifying the expenditure targeted at improving outcomes for Māori, which includes: Māori Providers, Māori workforce and provider development, Māori targeted services across mainstream services, and resource allocation for inter-sectoral initiatives to improve Māori health.
2.7Services to meet Pacific peoples needs
'Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010-2014 sets out the Ministry’s priority outcomes and actions that will contribute towards achieving better health outcomes for Pacific people, families and communities.
To ensure systems and services are effective for Pacific peoples, DHBs with significant Pacific populations will engage Pacific communities in DHB development and planning processes in order to allocate resources to reduce inequalities and improve health outcomes for Pacific peoples.
The Ministry and the DHBs will ensure that all services are effective for Pacific peoples, taking account of the health status, linguistic, cultural and social characteristics of Pacific communities, and will work to improve Pacific peoples’ access to all services, particularly primary care services.
Funders will develop the capacity of Pacific peoples to participate and be involved in the health sector through increased numbers of Pacific providers and co-designing responsive initiatives with Pacific expertise.
Funders will support Health Workforce NZ Strategy to respond to the changing needs of the health system and contribute to the development of the Pacific health workforce at all levels of the health sector.
2.8 Health Emergency Coverage
DHBs are responsible for being prepared to respond to health emergencies within their region, and in supporting other DHBs when there is a local emergency.
DHBs must ensure that essential health services such as, ambulance, primary health care, hospital services, mental health, disability support, aged residential care and public health services will continue to be delivered during health emergencies, civil defence emergencies, large casualty-causing incidents, major weather events, infrastructure failures, or natural disasters.
DHBs are required to maintain adequate stocks of reserve supplies of antibiotics as agreed with the Ministry of Health.
3Specific services with transitional issues in 2013/14 and out years
Public Health
3.1Antenatal screening for Down syndrome and other conditions
Since 2009, the Ministry has been implementing quality improvements to antenatal screening for Down syndrome and other conditions. The aim of these quality improvements is to enable New Zealand women, who choose to have screening, to access safe screening options consistent with international practice. Laboratory services for first trimester combined screening and second trimester maternal serum screening will be nationally purchased, and changes in practice for maternity care providers promoted through the development of best practice guidelines and education initiatives.
3.2Public Health services
Core public health services are defined in an overarching tier one service specification (issued in August 2010).The tier one specification is supported by 13 tier two service specifications.These service specifications were finalised and published on the NSF Library website for use in 2010/11.