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Vision
The United Party’s vision for health is to achieve a top quality health care system, with a focus on health promotion and primary care. Equity of access is seen to be vital.
There are resource issues, but the Party believes that health promotion has been demonstrated to be effective, particularly in comparison with other health care treatments.
The focus of activity will lie in the following:
- Public health
- Research
- New initiatives
- Healthy children.
Strategy
The principles of managed care are embraced as the basis for an implementation strategy though the detail of how this would be managed have yet to be identified.
The reasons for following this approach are because it will enable the following key principles to be embraced:
- Focus on a healthy population
- Reaching out to the community
- Family focus
- Co-ordination of health promotion
- Involves schools and public health nurses
- Can encompass a range of services including secondary care.
Some related issues are identified:
- Has the potential for medium term savings, but these are unproven
- Real accountability within a managed care system remains difficult, but good accountability is required to ensure good outcomes
- There needs to be some incentive for carrying responsibility.
Key Issues
The major issue identified is the emergence of a two tier system. Equity issues must be tackled through ensuring that the delivery model can address these.
Managed care appears a good model within which the objectives this party espouses can be delivered. The specifics of the model(s) to be used appear to need more definition, with identification of their strengths and weaknesses.
The role of health professionals within the system is important, and concern is expressed over lack of co-ordination of service delivery, partly due to breakdowns in communication between individuals and partly due to inadequate planning.
Waste of resources is seen as the last of the key issues. One way to tackle this would be to minimise duplication of services, often occurring when different sectors make similar purchasing decisions, eg Accident Rehabilitation and Compensation Insurance Corporation (ACC) and Ministry of Health.
Structure
No wholesale restructuring of the system is envisaged. It is believed that there have been enough changes for the present, and the system should be allowed a period of stability.
Professional management is seen as important to the efficient and effective running of the health care system. This is seen to be particularly important in hospitals.
While central planning for policy development would remain, this would continue to be a separate function from purchasing, and there are no plans to centralise funding.
Improving health is seen to be a complex issue with many aspects of the social structure having a direct impact. In the present structure there are significant gaps and overlaps in the provision of services to individuals.
To address this it is envisaged that the Regional Health Authorities (RHAs) should explore a wider role than health alone, to create improved linkages with other sectors, in particular education and social welfare. Examples of areas to be addressed could include:
- Parenting
- Healthy homes
- Whanau support.
People
There is a need to involve a wider range of individuals in the planning process, particularly a wider range of health professionals.
The need for brainstorming to identify the widest range of solutions, before narrowing the options, is seen to be important.
Management
The general standards of management of health have improved in recent years, an impetus which needs to be maintained.
Funding
United is committed to continuing the principle of the majority of health funding requirements coming from public funds. Currently this is 76% of the total funding requirements, and would be raised to 80%. Private insurance would be expected to contribute the remaining 20%.
The gap between the current and proposed levels of funding, being 4% of $5 billion, would be funded from the expanding economy and not from increased taxation.
Detailed budget requirements for the next five years have not been identified.
The issue of private investment in public sector health is recognised to be a reality, and not seen to be a fundamental problem. The key requirement, however, is to ensure that the money is put to good use, aligned with the goals and principles of the system to ensure quality standards are maintained, and that any margins made must be justified against the results delivered.
Change
The priority for change is to ensure a shift in focus from secondary to primary/community care. To effect this requires the movement of resources, which it is acknowledged has proved difficult.
The United Party has no easy solutions, however they believe that the change process requires increased dialogue between a wider range of those involved in the delivery of health care, to identify goals and processes, rather than having solutions imposed.
Specific Issues
Maori Health
Maori health issues are identified as a priority, and amongst these, Maori health status must be addressed. In this regard health promotion is seen as important, along with much improved links between health, housing, welfare etc so that the socio-economic impact on health is also tackled.
A specific Maori health system is not seen as the solution, however, the model required should be based on needs, which suggests some arguments for equity based funding.
Managed care is seen as one specific model through which Maori aspirations to deliver focussed care can be achieved, and is an approach United would encourage.
Mental Health
Mental health is also identified as a priority. United was instrumental in instigating the Mason report and wishes to see it implemented in full. At the same time they believe this can only occur if it is done with a high degree of independence.
Managed Care
While managed care as a principle for health delivery is supported, the specific manner in which the model should work remains open for further discussion.
The features seen to be of advantage include an ability to focus on developing a healthy population through a family focus, the co-ordination of health and promotion activities, the potential to integrate secondary care, and some potential for savings in the medium term.
Accountability for achieving good outcomes is important within this model, but in reality is hard to achieve. Incentives are likely to be required to encourage greater responsibility.
Summary
The United Party wishes to create a top quality health care system focussed on health promotion and primary care. Within this system public health, healthy children, research, and new initiatives are the priorities. Particular issues to be addressed include equity, Maori health and mental health.
Resourcing issues need to be addressed, to ensure equity as a route to tackling health status issues, particularly amongst Maori. Funding would continue to be split between public and private, the level of public funding to be increased to around 80% of the total requirement.
There are no plans for a wholesale restructuring of the current system; a period of stability is seen to be required. Nonetheless a need for greater focus on the community and wider links with other agencies, particularly education and social welfare, will be encouraged.
The importance of greater input to policy and planning by health professionals is identified as lacking at present and would be addressed.
To achieve the Party’s goals, there is a need to move resources towards primary care. Managed care is seen as a model through which this can be achieved and would be encouraged, although the details of how this would work have yet to be refined. In this system outcomes must be improved, which will require a greater level of accountability and responsibility than at present.
Partnerships being contemplated include a preference for a coalition with National or central parties. Working with Labour has not been ruled out, but may require some significant changes to present policies.
