ACT New Zealand Policy for Health

Vision

ACT’s vision for health is based on their belief that the health industry no longer recognises the rigid banners between private and not-for-profit health organisations. Losing the distinction between these two tiers is fundamental to achieving the desired goal of ’equal access for all’.

Strategy

In order to achieve the vision requires moving away from ideology and accepting that New Zealand must have the best health system a government can deliver in which the place of delivery is immaterial, ie public or private sector.

The system that ACT hopes to achieve will have similarities with the Dutch and Korean systems but with more checks and balances for expenditure. One in three New Zealanders already have their own private health insurance; ACT believes that government should listen to these people as they are clearly stating their choice. In New Zealand, earners of more than $50K should have the chance to choose their preferred health insurance scheme and ACT would want to put mechanisms in place to allow this. This would extend health insurance to all New Zealanders and allow their entitlement to be taken out of the public system and into a private system for comprehensive cover. They believe this will be an improvement on the current system.

Key Issues

ACT’s argument is based on the fact that previous governments have demonstrated that more dollars are not equal to better health care. This has given a message to all New Zealand that something in the system is not working.

They believe that the current system is not meeting health needs, and has become a two tier system. On the assumption that politicians have argued enough and it is time to allow people to vote and thereby choose the system they want, ACT plans to remove the tiers and allow people to choose health insurance.

Their three key messages are:

• Gradual reform
• More opportunity for deliverable health care and promoting managed care as the future of health care in New Zealand
• Building a comprehensive health insurance/health plan system

The following are specific expectations and issues identified by ACT:

• They do not expect to achieve a perfect health system immediately; if there was such a thing the entire world would adopt it (they comment on the Alliance Party policy as being naive)
• Specific funding for waiting lists would be targeted, as in the UK
• A shift to managed care and emphasis placed on prevention
• Encourage a wide range in delivery to satisfy the variety that New Zealanders want, noting that not all managed care models are appropriate.

Structure

ACT will:

• Remove the monopoly of Regional Health Authority (RHA) providers by providing cover through comprehensive health insurance schemes
• Remove RHA/Crown Health Enterprises (CHEs) as they are replicating bureaucratic structures
• Accountability will lie with the opportunity for clients to move freely between plans and back to the public system if they so choose. Regulation will be introduced for the full cover market to ensure that a minimum level of care is offered.

People

Patients
Credit should go to the National Government for moving in the current direction, but it is not far enough.

Health is becoming more consumer oriented.

Patients are not currently getting the timeliness and quality of service they want. This needs to be improved, but in an affordable manner.

These issues suggest there is a need for sensible change.


Professionals
Currently there are good people working within a system designed to frustrate them. The answer is not to pour money into the system without a concern for outcomes.


Managers
Managers are in a similar situation to the professionals.

There is a large degree of replication of management structures.

Currently competition does not occur in the manner predicted, and therefore the structure and effort is to some extent wasted.

The structure bears no relation to population size as there is continual political interference in health care.

ACT believes that too many political decisions have been taken when there should be clinical decisions, an example of which are the recent changes to purchasing arrangements for maternity. Ideally there should be an Independent Practice Association (IPA) structure for maternity care.


Ministry of Health
ACT identifies with the statement made on this organisation in the Mason report, "there is a lack of vision and guidance." The current government is not good at providing direction, an issue which would be addressed through the Party’s real political vision for health.

Management

The model supported by ACT would have more meeting of minds and sharing of responsibility and skills between management and clinicians.

A purchaser/provider split needs to continue but with many more players in the form of health insurers, health plans and private providers competing with public providers on a level playing-field. Because ACT’s policy has incentives for prevention, it is their belief that an insurer is likely to target high risk groups, thereby increasing the opportunity and likelihood of health gain.

Different industries have different requirements for the ratio between management and service delivery. Health has its own unique issues and it is not possible to compare apples with oranges. It is unclear whether any individual would have true answer to this question and direct comparison would be inappropriate.

Both clinicians and managers need to be upskilled in order to create effective change in the health system.

The current method of contracting has many benefits but few have been realised. There has been insufficient political will to introduce proper competition, ie closing services and introducing more purchaser competition. The continuation of the current direction towards health care plans and more managed care models will be centrally driven.

Funding

ACT seriously questions if more revenue will result from higher taxation policies. Low taxes are currently producing more revenue. For ACT the money to finance their policies will come out of savings and removing inefficiencies in the current system. Increased taxation would make the rest of New Zealand poorer and kill any growth, therefore be counter-productive.

Demography shows an increase in the ageing population which equates to a rise in the servicing of a group which is the most expensive part of the tertiary sector. Over time this will be paid for by long term investment in primary health care and a focus on prevention.

Savings can be made by management structures and best practice being worked through the system, learning from best efforts and community trusts taking over the CHEs.

Change

There is a real opportunity for significant change if clinical staff grasps the nettle within managed care systems. Clinical staff must make the real choices, not the politicians.

Specific Issues

Managed Care
Managed care is derived from bringing incentives in the system back to the wellness of people, in other words ’top of the cliff medicine’.

It is unlikely that the balance will change from hospitals to the primary care system over the next three years, however, by shifting to private health insurance and health plans there is a chance that a significant degree of change will occur.

ACT recognises the need to facilitate change, however, if ideas and results do not convince general practitioners to buy in to the managed care concept, then ACT believes that they are beyond influence. The incentive is health choices for the people and an acknowledgment that patients and their primary practitioner ’know best’.


Maori Health
ACT envisages Maori controlling their own resources in Maori oriented full cover insurance policies. The current system is failing Maori, and prevention is the biggest area of difficulty.


Mental Health
The mental health strategy needs vision and leadership from the top. ACT believes that if the Ministry of Health cannot or will not deliver the vision, there is no reason why any other government institution, eg the Mental Health Commission, should fill this gap.

Mental health has been seen as the poor relation in health, probably because it is not good for scoring political points.

For mental health services there will be ring fenced dollars. Protection of resources through careful planning will focus on keeping the community and patients safe while the individual is rehabilitated.

Mental health is one area where patients do not the have same facility to choose services. ACT would want more family involvement and changes to the pedantic application of the Privacy Act.

Summary

ACT wishes to build on the strengths of the current system and extend those benefits to those who are not able to take advantage of them, eg poorer and less able people/ families. Any answers to the current health debate which make the system harder are not the right way to go.

This is supported by a quote from Abraham Lincoln: "You cannot strengthen the weak by weakening the strong."

ACT’s plans for health include:

• Taking the current reforms further
• Full health insurance cover for all
• Growth in managed care leading to more emphasis on prevention
• Increased choices for all New Zealanders.