Editorial - Vol 1, No 5:  Coalition Government Health Policy – Exploring the Implications

The Coalition Government of New Zealand released its Policy for Health in December 1996, which has signalled some significant changes in direction from the health policy of the previous National Government.

Important amongst these are the following:

• Principles of public service replace commercial profit objectives
• Shift from a competitive model to a collaborative model of contracting based on health outcomes
• The move to a central funding authority
• Reorientation of Crown Health Enterprise (CHE) performance from being profit driven to being managed in a businesslike manner
• The Minister of Health is to be responsible for the whole of the publicly funded health sector and the publicly funded health providers
• Piloting the concept of a family health team.

While there are many aspects of the previous reform process which could be changed to advantage, it is important that change is not made which might risk losing developments which have been positive, and takes place against a background of evidence and rationale.

It is useful, therefore, to identify areas where genuine progress has been made, and seek to ensure that the positive aspects are not lost in the change process proposed. Such areas would include:

• Wider consultation around health policy and plans
• Devolved accountability for resources and outcomes
• An emphasis on the importance of primary care, with a change in its structure more appropriate to delivering future needs
• A better definition of the services being purchased, and a clearer responsibility for their delivery
• A greater understanding that health resources are limited and need to be used efficiently and effectively
• Opportunities for a wider range of providers to be involved in the delivery of care, in particular Maori groups and smaller providers.

In an effort to understand these issues in more depth, a series of written questions was posed to the Minister of Health and Associate Minister of Health. Responses were received in writing and are presented verbatim:

• Response from the Minister of Health, the Hon Bill English
• Response from the Associate Minister of Health, Neil Kirton.

While change has been signalled, little supporting detail is provided. The Policy appears to be conceptual in nature, and it would be hard to action without further direction. Many of the issues for which solutions were sought from the previous government remain to be addressed; health gain targets, CHE financing, private investment, management of risk.

Possibly the most concerning aspect is that there remains an absence of vision for publicly funded health services in New Zealand; the Policy focusses on processes rather than goals. Until there is a clear projection of the direction in which health should move, it will remain hard for those working within the sector to align their efforts.

It has to be hoped that such detail will be forthcoming in the near future, or ultimately this will prove a barrier to progress, in particular the achievement of integration, so frequently talked about.

The Minister of Health has agreed to be interviewed to outline how further developments are to be made, which we shall report in our next edition.