The National Party Policy for Health

Vision

The National Party is committed to ensuring that New Zealanders are able to take advantage of a modern health system and benefit from the advances of medical technology to the extent that the country can afford.

These will have a measurable impact, both in the short and long term, on the general health of New Zealanders, to be demonstrated through increased life expectancy and improved health status. The key areas for focus will include:

• Health prevention and promotion through immunisation programmes for children and older people, breast screening, cervical cancer screening, smoke-free programmes, sexual and reproductive health strategy
• Improved mental health services as outlined in the Mental Health Strategy
• Improved primary health care services, particularly for children.

The policy has three key goals:

• To improve the health of people in New Zealand
• To put people at the centre of service delivery
• To get the greatest amount of health and disability support services for the dollars available.

The new health system has removed many of the barriers to change that existed under the old regime. Within the next five years there will be more opportunities to develop new and improved ways of delivering health services to New Zealanders.

A strong economy is seen as essential to providing the resources to deliver the objectives. Advances in medical technology and pharmaceuticals will provide new ways of treating people who are sick or have a disability. These advances will also present new challenges on how they can be provided in the current economic environment.

Strategy

The National Party is committed to continuing to provide the economic framework that will enable a modern health system to be maintained, and encourage the health and disability sector to take a positive approach to the opportunities that exist to bring about improvements in health services.

Innovations that bring health services to consumers in an appropriate manner will be supported, in particular initiatives by Maori and Pacific Islands people.

National will continue to monitor the Regional Health Authorities (RHAs) through the Ministry of Health, with the key areas being:

• Health prevention, promotion and environmental safety
• Delivery of high standard health and disability services
• Improved equity of access to services.

During the next five years strategies will target the following:

• Increase public funding for health and disability support services every year to maintain an acceptable level of services in the face of rising demand
• Continue to implement programmes that keep people well, and provide care and support for people who become sick or disabled
• Encourage more diverse purchasing arrangements that allow decisions on service delivery to be made closer to communities
• Continue to develop fairer and more open mechanisms on how decisions on access to services are made
• Continue to work towards an equitable health service so that people with the same needs get the same level of service wherever they live
• Encourage Maori to have a greater involvement in developing services for Maori
• Increase the use of evidence based guidelines and other quality assurance tools by health professionals to improve effectiveness of services
• Increase the focus on service delivery in the community as opposed to institutions with a greater role for primary, community and ambulatory services
• Achieve greater equity of access, improved quality of service, and better value for money by the development of common base definitions and information standards.

Key Issues

National has identified a number of key health issues as needing special attention because of the wide impact they have on families and communities:

• To improve child health services, including those for young people
• To implement the Mental Health Strategy
• To improve the health status of Maori
• Improve services for the elderly
• To continue to promote prevention programmes such as smoke-free and immunisation programmes
• To reduce waiting times for hospital treatment.

Child Health
Investing in child health is seen to lead to significant health gain by reducing mortality and morbidity, increasing length and quality of life, and strengthening families. There is a need to improve services to those with higher risk of adverse health outcomes. The key issues are:
- Improve coverage and co-ordination of well child/tamariki ora services
- Promote positive parenting
- Strengthen families
- Promote healthy and safe behaviours such as a smoke-free start to life, road safety and good nutrition
- Promote immunisation of babies and children
- Promote improved co-ordination, integration and access to services.


Maori Health
For Maori health the focus must be on achieving health gain for Maori by addressing the disparities between Maori and non-Maori. The key issues are:
- Purchase effective service delivery systems and decision making systems that are responsive to Maori needs
- Encourage the development of Maori providers, especially in primary health care
- Encourage systems and services that empower Maori individuals, whanau (family) and care givers
- Focus on the health of whanau, particularly tamariki (children), rangatahi (young adults) and wahine (women).


Mental Health
For mental health the goal is to decrease the prevalence of mental illness and reduce the impact of mental disorders on consumers, their families, care givers, and the community. Some of the key issues are:
- Implement the Mental Health Strategy
- Improve promotion of mental health and reduce stigma towards mental illness
- Improve access to mental health services for children and their families
- Manage the process of deinstitutionalisation
- Improve the range of mental health services for Maori.


Planning for an Ageing Population
New Zealand, like many other western style countries, has an ageing population. It is projected that by the year 2011 there will be 543,000 people aged 65 and over. By the year 2031 this figure will have reached 940,000 and will comprise 21% of the population. Today 40% of the health dollars are spent on this age group, a figure projected to rise in the years ahead to meet the demands of the population.

Key issues are:
- Meeting this demand through a growing economy, good planning and discipline over the fair distribution of care to ensure even the current range and quality of services remain available to this group of New Zealanders
- Planning for the health and disability support needs of older people - to continue through the Taskforce on Positive Ageing and include the development of recommendations on appropriate strategies, policies and service initiatives to promote positive ageing covering health, housing, transportation and any other relevant issue.


Physical Environmental Health
The goal is to promote an environment which improves and protects the public health.

Significant health gains can be made from investing in programmes that reduce mortality, disease, injury and disability, and increase length and quality of life. Some of the key issues are:
- Improve co-ordination of public health services and intersectoral co-operation
- Improve the safety of drinking water supplies
- Reduce the risks of food-borne illness and promote healthy nutrition
- Improve the safety of domestic, learning and local physical environments.


Waiting Times
Hospital services are always available for people who have acute health needs. Where the need is not so urgent people may have to wait for treatment.

To reduce the time people have to wait for hospital $130 million has been put aside to introduce a booking system which will eliminate the waiting list over the next two years.


Information
The availability of good information is vital to the decision making process on which health services should be provided and where. The privacy of health information is paramount. This will be preserved by in-built safeguards using modern computer technology.

To address this need National would continue to support the vision proposed for information management encapsulated within the Health Information Strategy for the Year 2000:

"Timely, accurate and robust information is available to all agencies involved in the provision of health and disability support services and to consumers, with the knowledge, agreement and confidence of everyone, which will facilitate the ongoing, continuous improvement in the health and disability status of all New Zealand people."

Structure

There will be no change to the current policy of separating the purchaser and the provider of public health services. This approach has enabled the government to know exactly how much is being spent on various health services and procedures and to measure the outcomes.

As more information becomes available RHAs will be better able to manage the resources they have and to direct funding into the areas that most need attention and better reflect the services that are needed at a regional level. For this reason there is no intention at the present time to move to central contracting.

The role of the Ministry of Health to provide policy advice to the Minister of Health and monitor the RHAs will remain unchanged.

The present structure of RHAs and Crown Health Enterprises (CHEs) will remain but there is nothing magical about the number of these agencies and they could change in the future.

National will continue to encourage development of primary care services that are appropriate to the people who use them.

Disability support services will continue to be purchased by RHAs. National will work to ensure that people with disabilities are involved in the planning and development of services to meet their needs. These services will continue to be based on comprehensive needs assessment so that individual needs can be better met.

People

National believes it is important that the health system employs the best people available to manage the resources. Whether they come from inside or outside the health sector is secondary to their ability to meet the requirements of the job. Good management skills are vital to ensure a modern and progressive health system.

Considerable satisfaction can be gained by health professionals from having the opportunity to manage resources devolved to them. This requires upskilling of their management abilities.

Consumers/Patients
Consumers and patients need the assurance that health services will be available when they need them. Key issues to deliver this assurance include:
- Funding - in the current year $5.4 billion will be spent in the public health system to provide health and disability support services for New Zealanders
- Mental health - a 10 year Mental Health Strategy and the establishment of the Mental Health Commission, whose principle role is to ensure that the strategy is implemented, and to hold the Ministry of Health, RHAs, mental health providers, and health professionals to account for improving mental health
- Health and disability - the office of the Health and Disability Commissioner has been established, whose role it is to protect and promote the rights of health and disability service consumers and to facilitate fair and efficient resolution of complaints relating to the infringement of those rights.


Professionals
For professionals the key issues are:
- Managing risk in an environment where consumer expectations are rising - people are better informed of their rights through the development of the Code of Rights, and also want more information and involvement in decisions about their treatment
- Increasing use of evidence based practice will reduce or eliminate ineffective practices and improve health
- Technological change creates challenges for health professionals that impact on patterns of general and specialist skills and on the delivery of health care
- Upskilling of health professionals is required to keep pace with this.


Managers of CHEs / RHAs
Key issues include:
- Managing financial, health and ethical risk
- Increasing focus on improving the health status of Maori in keeping with government priorities
- Changes to service contracting strategies, particularly in the development of strategic alliances such as with Maori.


Planners / Ministry of Health
Identified issues are:
- The availability of information which is both accurate and relevant to support the sector in its efforts to meet the needs of consumers
- Ensuring greater transparency and accountability in decision making
- Changes to the range and prevalence of disease and how these can be managed.

Management

National will not introduce any new major changes to the management of the health system. The best managers should be employed to do the job and should be encouraged to be innovative and flexible in their approach.

In the 1995/1996 year the operating expenditure of the four RHAs and the combined salaries of the chief executive officers of the 23 CHEs amounted to 1.33% of the government’s commitment to the public health system of just over $5 billion. This is not seen to be in any way excessive.

Funding

Funding for health is expected to increase each year over the next five years. The largest proportion of this, at least 77%, will come from the State with the remainder coming from the private sector. National is committed to a publicly funded health system as the best means of ensuring that people can access modern, well equipped health services when they need them.

There will always be a need for ongoing investment, to ensure that the health system is able to keep up to date with modern technology and to meet the expectations of consumers.

The underlying premise of the present system of health care delivery is not to save money but rather to make better use of the dollars available. This means that gains made through improved efficiency can be ploughed back into the system to provide other health services.

Overall funding will come from a combination of the government paying the overwhelming costs of running the public health system, with people paying for some of their health care, either directly or through insurance.

In 1995 the government paid for 77% of all health care, the health insurance industry funded just over 6% and individual New Zealanders paid directly for 17% of their own health care. Of all surgical and medical treatments in hospitals 83.4% was publicly funded, while health insurance paid for only 9.3% of these treatments. The balance was paid for by individuals.

In the area of general practice the government pays 56.8% of doctors’ visits and health insurance covers 11.1%. For prescription drugs the government pays for over 70% of these compared to just 4% by health insurance and the balance by individuals.

For those New Zealanders who want the ability to select the time and place for non-urgent surgery, given that the public sector will always provide urgent and semi-urgent treatment, there will always be a role for the public and the private sectors in delivering health care.

Change

There will be no major change to the present health system. As the new system becomes more established there may be a need for modification in certain areas.

RHAs have the flexibility to be innovative in their purchasing of health services. As they become more informed about the needs of the people in their regions it is to be expected that some changes may occur.

Frustration and demotivation come about when people feel they have no opportunity for input or control over what is happening in their environment. As the management of resources is devolved to community and practitioner level, people working in these areas will have a greater involvement and gain more satisfaction from what they are doing.

Advances in medical technology are likely to enable more procedures to be done at the primary health care level in facilities attached to general practice. A number of procedures can now be done using day surgery which only a few years ago would have necessitated a hospital stay of several days.

In the next three years there will continue to be changes in the way services are delivered at a local level as more general practices become involved with budget-holding and managed care. While the focus of health care may change to preventive and primary health care, hospitals will continue to have an important role in the delivery of secondary and tertiary health care services.

Specific Issues

Managed Care
Managed care has an exciting future in New Zealand. Where it is used well there can be greater co-ordination of services and more efficient use of the available health dollar. It must provide a system whereby providers take responsibility for a person’s health needs and manage them through all contacts with the health system, and has enormous potential to help achieve better outcomes in health gain priority areas such as child health, mental health and Maori health.

The concept of managed care is presented as one of managing patients’ interests with the use of available resources to deliver equity and fairness. One of the most important aspects of managed care is the devolvement of responsibility to groups that are closer to the communities they serve. In this way responsiveness to local need can be enhanced. However, success will require all sectors to work together.

Recently there has been enormous interest shown in the concept of managed care as an alternative option for providing health services in New Zealand. As it becomes more widely used and the benefits start to come through, GPs with a desire to have a greater say in how services are delivered for their patients will want to become involved.


Maori Health
In the last six years there has been an increasing focus on Maori health. The present government made Maori health a health gain priority area to ensure that services are developed that will assist Maori to reach the same health status as that of non-Maori. This focus will continue, particularly in the area of child health and mental health.

A number of new initiatives have been developed to enable Maori to become providers of health services. Examples of this include midwifery, well child services, mental health services and drug and alcohol programmes. It is expected that RHAs will continue to encourage Maori to become providers of health services.


Mental Health
Mental health is one of National’s priority areas. The Mental Health Commission has been established and given a specific range of tasks to complete. Together with the advisory board which has been established to assist them, they have the range of expertise and skills to move forward so that New Zealanders with mental health problems can receive quality services that meet their needs.

Legislation to ensure the independence of the Commission is before parliament. This will now fall to the new government to consider.

The Mental Health Strategy requires that key mental health stakeholders and professionals be involved in the planning of mental health services. National expects, therefore, that health professionals will have significant input as we work towards improved provision and integration of services for people with mental illness.

Summary

The National Party is committed to ensuring that New Zealanders are able to take advantage of a modern health system and benefit from the advances of medical technology to the extent that the country can afford.

These will have a measurable impact on the general health of New Zealanders, to be demonstrated through increased life expectancy and improved health status. The key areas for focus will include:

• Health prevention and promotion through immunisation programmes for children and older people, breast screening, cervical cancer screening, smoke-free programmes, sexual and reproductive health strategy
• Improved mental health services as outlined in the Mental Health Strategy
• Improved primary health care services, particularly for children
• To improve the health status of Maori
• Improve services for the elderly
• To reduce waiting times for hospital treatment.

The policy has three key goals:

• To improve the health of people in New Zealand
• To put people at the centre of service delivery
• To get the greatest amount of health and disability support services for the dollars available.

National, through its health policies, wants to obtain the best possible range and quality of health and disability services for New Zealanders. This will be achieved through an increase of the money put into health each year and the use of current structures to make the most efficient use of the resources available.

Funding will continue to be largely from public sources, to the level of at least 77%, with the remainder from private sources and insurance. The premise of National’s approach revolves around efficiency, not cost saving. Gains made should be reapplied to the purchase of additional services.

National believes it is important that the health system employs the best people available to manage the resources, who may come from inside or outside the health sector.

While no specific structural changes are envisaged, the policy does encourage greater delivery of care at the primary level. Changes in technology will allow this to occur, while managed care provides a framework within which the required services can be managed.