Editorial - Vol 1, No 3:  Review of the Health Policies of the Main Political Parties of New Zealand: General Election 1996

As we close on the October 12th general election in New Zealand, the first under the new system of mixed member proportional representation (MMP), this edition of Healthcare Review – Online^TM reviews the stated policies of six of the main political parties, based on responses given to a series of circulated questions.

At the time of writing the outcome of the election remains unclear, with marked changes being recorded by the opinion polls in the last 7-10 days. Data from the Department of Political Science and Public Policy at Waikato University suggests the following make-up of the 120 seat parliament:

While National has the largest single block of seats, a government will need to be made up of a coalition of parties. The possibility exists that a National axis could be overtaken by a coalition of Labour, New Zealand First and the Alliance. This has significant implications for future health policy.

It is interesting to compare the key aspects of the six different policies against each other [see Table 1 below].

In this regard there is little difference between the goals and priority areas identified. These tend to focus on improved health and well-being, delivered through increased health promotion and prevention, with a focus on care at the primary level and in the community. Equity of access, addressing health status issues, and achieving improved outcomes are all common themes.

Strategies to address the needs of Maori, child health and mental health are almost universally identified. Some parties have identified the importance of intersectoral links, usually with Education and Social Welfare as having a significant impact on health.

The major differences between parties revolve around the proposed structure in which health will be delivered and the level of funding required.

National’s policy is very much a continuation of the strategies currently being followed, with more detail available, which is understandable given their experience in power. The most similar policies on health come firstly from United, with little conflict, and secondly from ACT, which differs in its focus on the establishment of insurance based health. plans.

Labour, New Zealand First and the Alliance all propose marked changes to the structure, and increased funding requirements. Regional Health Authorities (RHAs) will be removed, being seen to have failed to deliver on community health needs, to be bureaucratic, and constitute an unnecessary overhead.

They will be replaced by some form of organisation representing the local communities responsible for planning and assuring that their health needs are met, loosely based around the current Crown Health Enterprise (CHE) territories, and largely made up of elected members. Day to day operational management rests with a separate organisation. A central government health organisation remains responsible for policy and overall planning.

While these parties are adamant that the purchaser/provider split will be removed, the proposed structures have a clear demarcation between purchasing/planning/commissioning organisations and the organisations which will provide the services required.

The more important difference from current practice is that purchasing will no longer take place in a competitive environment, though exactly how purchasing will be carried out remains unclear. In effect the purchaser/provider split is dead, long live the purchaser/provider split!

The source of funding for services in these new structures is identified to come from a combination of delays in proposed tax cuts, growth in the economy and reduced repayment of foreign debt.

These Labour, New Zealand First and Alliance policies, while similar enough in general approach to form the basis of a coalition, differ in certain details which may prove a stumbling block to a happy partnership, eg Alliance wants a fully funded public health system, New Zealand First rejects a managed care approach.

All three will have to convince the electorate that the traumas of significant structural change can be managed without a detrimental impact to the functioning of the system, and in particular the morale of those employed within it. Also that the result will lead to an improvement in services, which can be sustained by elected boards who may represent communities, but not necessarily understand the complexities of planning and delivering health care.

The polls would suggest that if a coalition can be created, the next government could be formed by these parties, and health care in New Zealand would take a significant turn from its current path.

The alternative would see a government based largely on National, supported by United, with policies similar to those in place today.

The final outcome will be decided by the voting patterns on polling day, and more importantly by deal making which will continue to go on behind the scenes. With no previous experience on which to predict an outcome, and both individuals and parties jostling for power and influence, pragmatism is likely to rule with ’flexibility’ shown over stated policies.

Compromise is likely, with the resulting health policy being a combination of locality focus and community input through members elected to purchasing organisations. The level of funding made available and the priorities to which it is applied will also be revised, while the structure through which care is delivered will remain the biggest point of discussion. We should not expect an early resolution to these issues.

Table 1: Summary and Comparison of Key Policy Areas