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Managed care conferences have recently become a growth industry in New Zealand. The most recent national event, Managed Care - Options For New Zealand, was the second in as many months to focus on this subject.
At the same time, this was the first major initiative to be sponsored by the Ministry of Health (the Ministry) and the four Regional Health Authorities (RHAs), the national funders of emerging forms of managed care.
If attendance was a measure of success, then all those involved with the conference should be highly satisfied. More than 600 people registered, twice as many as were expected, which led to the programme being run in duplicate, a testimony to the fortitude of speakers and organisers alike.
The attendees were divided between two venues, to listen to and debate the presentations of a multitude of speakers, both national and international, representing a wide variety of stakeholders in the process of health care delivery.
The vast majority of attendees were health professionals; medical, paramedical or management. Consumer interests were less well represented, with the exception of those from Maori health initiatives.
Some notable overseas speakers were included in the programme; the five international speakers came from the UK, Canada and the USA (including Hawaii). Howard Luft and Ray Robinson were health policy specialists, David Hadorn a researcher and adviser, David Colin-Thomé a total fund-holding general practitioner, and Ivan Lui-Kwan, the chief executive of a managed care organisation.
The aims of the meeting were:
- to increase awareness of new arrangements, initiatives and plans in New Zealand and overseas;
- to explore what these new arrangements mean for different people and organisations; and
- to identify and discuss key issues.
While loosely structured to include presentations, short papers and small group workshops, a number of significant or recurring themes emerged which underlined the key issues:
- What is managed care in New Zealand? - definitions, models, stakeholders, experience, future directions and developments.
- Political issues - political party positions, acceptability of private investment, profit-making, and enrolment.
- Health service delivery issues - quality, integration, co-ordination, accountability, required skills.
- Ethical issues - the community and the consumer.
- Maori health issues.
- Professional issues - implications for medical and nursing professions.
- Managed care and New Zealand’s accident compensation (ACC) provisions.
The conference was introduced by Karen Poutasi, Director-General of Health, as an opportunity to look at, and identify, the best options for the organisation and delivery of services for the future, a process which would involve everyone participating in the debate to tackle all aspects of managed care, including opportunities, difficulties and risks.
In opening the conference the Minister of Health, Jenny Shipley, noted that managed care had the potential to achieve improved outcomes in the areas targeted for health gain by the Government, and introduced the concept of managed care being a ’wrap-around’ to assist this process.
She sees certain groups, notably Maori initiatives, already moving down this route, while the RHAs are beginning to work with clinicians to interpret what managed care might mean at a local level for communities, the challenge being to manage public expectations to meet health needs with the resources available.
At the same time she delivered a number of statements to the conference:
- That the Government does not intend to impose a definition of managed care for New Zealand on the health sector.
- The conference should define the elements that it feels need to be included in a managed care process.
- The focus should be on patient interests and maximising the use of resources.
- Managing the risk is an issue for further discussion but one that all must share.
- There is a need for greater intersectorial responsibility; using co-operation to make the system work.
For those people looking for solutions or direction, the conference would have been disappointing. This reflects the Government’s decision not to direct the form that managed care should take in New Zealand, and that while many organisations sense the importance of the process, they have yet to come to terms with the issues and implications.
While the diversity of opinion at times meant the core issues were not addressed in any great detail, it was encouraging that so many different groups had a chance to voice their hopes and concerns. Further developments will, as a result, be better matched to the multiple and varied needs which exist.
As the presentations unfurled it became quite clear that managed care in New Zealand will develop its own local identity. Even approaches which have proved successful abroad require modification to suit local health care needs.
While a clear direction for the development of managed care did not result from this conference, this will have to evolve in the near future if this approach is to make any significant progress in New Zealand.
- What managed care models are relevant in this market?
- How can such models be flexible enough to meet the varied needs of individuals and providers?
- How can communities have an input to developments and be assured their interests are protected?
- How can managed care be applied to meet Maori aspirations?
- How can issues of quality, risk and investment be appropriately managed?
- Where does the secondary care system fit in this process?
Progress will be made through further extensive debate which needs to be facilitated, and clarification of both health policy and the health care delivery structure, which it has to be hoped will result from the general election in October this year (1996).
