Perceptions of funding and commissioning models for alcohol and other drug treatment services in Australia: a qualitative study of service providers and policymakers

Stream: Funding and organising service delivery
Date: Monday, 9 September 2019
Time: 1.30 pm – 3.10 pm

Abstract

Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. While much research has focussed on the amount of funding available, value-for money, or the cost effectiveness of treatment, there has been less attention to different commissioning and payment/funding mechanisms. This study sought to examine the strengths and weaknesses of different funding and commissioning mechanisms as perceived by Australian service providers and purchasers.

Qualitative interviews with service providers and funders were conducted in groups of 3 to 10 people (N=190). Data on commissioning mechanisms were then collated against four thematic headings: competitive tendering, historical arrangements, fee-for-service/accredited providers, and third party outsourcing. Data with reference to payment/funding mechanisms were similarly collated for block grants, activity-based funding, and payment-for-outcomes.

The data shows that there is a:
1) need for a judicious approach in the use of competitive processes to maximise benefits while minimising risks
2) multiple purchasing strategies are used in a system and deliberations regarding which strategy is applied should include consideration of the relative emphasis on aspects such as service reliability versus innovation
3) funders should aim to minimise duplication and administrative burden wherever possible.

In the absence of an evidence-base, purchasers of AOD treatment are left with an apparently arbitrary set of administrative decisions regarding commissioning and payment/funding processes. This article offers guidance to service providers and funders when navigating the funding environment in Australia, and may facilitate more informed and considered AOD treatment purchasing decisions.

Authors

Katinka van de Ven (Presenter), Drug Policy Modelling Program, UNSW Sydney
Dr Katinka van de Ven is a Research Fellow as part of the Drug Policy Modelling Program (DPMP) at the Social Policy Research Centre, UNSW. Her current work is focussed on how funding arrangements, purchasing mechanisms and workforce characteristics of alcohol and other drug (AOD) treatment agencies impacts on client outcomes. Katinka also specialises in the use and supply of performance and image enhancing drugs (PIEDs). Katinka is a Honorary Research Fellow at the Public Health Institute, Liverpool John Moores University. She is an Editor-in-Chief of Performance Enhancement & Health and the Director of the Human Enhancement Drug Network (HEDN).

Alison Ritter, Drug Policy Modelling Program, UNSW Sydney
Professor Alison Ritter is an internationally recognised drug policy scholar and the Director of the Drug Policy Modelling Program (DPMP) at the Social Policy Research Centre, UNSW. She is an NHMRC Senior Research Fellow leading a multi-disciplinary program of research on drug policy. The goal of the work is to advance drug policy through improving the evidence-base, translating research and studying policy processes.

Kari Lancaster, Centre for Social Research in Health, UNSW Sydney
Dr Kari Lancaster is a Senior Research Fellow and Scientia Fellow at the Centre for Social Research in Health, UNSW, and an Honorary Associate Professor at the London School of Hygiene and Tropical Medicine. Kari’s research uses approaches informed by poststructural theory and science and technology studies to contribute to contemporary discussions about issues of policy significance in the fields of drugs and viral hepatitis. Kari’s research has examined how policy problems and knowledges are constituted, and the dynamics of ‘evidence-based’ policy. Kari’s current work extends beyond drug policy and into viral elimination and ‘evidence-making’ practices in health.

Lynda Berends, TRACE Research
The Director at TRACE Research, Dr Lynda Berends, is a health services researcher specializing in the study of alcohol and drug service delivery and system development. Lynda has extensive policy and research experience in the community health sector, having worked in government, clinical and academic research settings.Lynda’s work focuses particularly on implementation effectiveness and integrated models of care across primary and acute areas of health. Her research is grounded in context (policy and settings) and Lynda uses a consultative approach that is based on working with those providing and funding care.

Jenny Chalmers, Drug Policy Modelling Program, UNSW Sydney
Jenny Chalmers is a Senior Research Fellow in the Drug Policy Modelling Program, UNSW. As well as drug policy, particularly the interface between markets and consumer behavior, her research interests include social policy, labor market disadvantage and work-care balance. Jenny has previously worked with the Social Policy Research Centre at UNSW and the Centre for Applied Social Research at RMIT University.