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- General Policy Direction
- Key New Initiatives
- General
- Changes to Crown Health Enterprise (CHE) Health and Disability (Regional Hospital and Community) Service Providers
- Funding Arrangements
- Increase Health Sector Resources and Remove Financial Barriers to People Needing to Access Health and Disability Services
- Pilot a Community Based Family Health Team Approach for the Delivery of Some Primary Health Care Services by Regional Hospital and Community Services
- Maori Health
- Child Health
- Mental Health
- Legislative Implications of the Policy Agreement
- Fiscal Implications
- Additional Questions
Goals
- The General Policy Direction, as drafted, focusses largely on processes. In order for a system to achieve goals it is important that the objectives are clearly stated, and closely related to the job to be done. The Policy states that the principles of public services will replace commercial profit objectives. What are the ’principles of public service’ and how will these deliver ’health’ to the people of New Zealand?
- In the recent past, the health system has targeted the delivery of ’Health Gain’ as a principle objective; equity, efficiency, effectiveness, access, and appropriateness have similarly been important. What goals or objectives does the Government now wish to target?
- The Government wishes to encourage co-operation and collaboration. What specifically is envisaged and how will this be achieved? Is competition to be removed altogether? If this is the case, how will efficiency and effectiveness be delivered?
- The Policy identifies the establishment of a funding body separate from the Ministry of Health. What will be the remit of the funding body; determination of policy, extent of service responsibility, primary, secondary, tertiary, disability, Accident Rehabilitation and Compensation Insurance Corporation (ACC)? To whom will it report? What will be its relationship with the Ministry?
- At present health services are purchased against policies and priorities issued by the Minister of Health, in general using a process of contestability. It would appear that services are now to be funded through a collaborative process. How will this work in reality? How will it be determined what services are to be made available? How will it be ensured that these are provided? What will be the nature of agreements/arrangements between funder and providers?
- One positive feature of the Regional Health Authorities (RHAs) has been their ability to better address variations in local needs than if centrally located. Is addressing variations in local population needs seen to be important? How will this be addressed by the funding body?
- What structure is planned for the funding body; board, executive, management, regional offices? How will it be established and over what time frame? Will the process include consultation? How will issues such as its location be decided?
- Some important statements are made about public health providers functioning in a businesslike manner, focussing on health outcomes and improving health status, and private sector involvement being subject to criteria yet to be set. Are these requirements specific to public health or do they also apply in the area of personal health services?
- The major short term impact of the proposed Policy falls on the RHAs and their purchasing function. Lack of a well defined change process has the potential to cause major disruption within the health system, in particular to the continued provision of publicly funded services and to individuals working within the system. What is the change process that will be followed and over what timescale?
- Are RHAs to continue to contract on the current basis for 1997/1998? What process will be used for 1998/1999; purchasing or funding?
- There is a significant body of health service expertise within the staff of RHAs. It would be a poor use of an important asset if these people were lost from the health system. How will this be avoided? What will be done to minimise the personal disruption which could eventuate?
General
- Recent comments by the Minister of Health have indicated that not all the Policy initiatives have been fully costed. By when will this have occurred? What policy impact is envisaged?
- How will maximum waiting time be guaranteed?
Changes to Crown Health Enterprise (CHE) Health and Disability (Regional Hospital and Community) Service Providers
- In most western health systems, hospitals are increasingly seen as centres for the provision of ’specialist’ services requiring an institutional setting. Efforts are made to reduce the number of admissions, and length of stay, where appropriate, and increasingly deliver services in an ambulatory/outpatient setting. The objective is to free resources for use in the primary care, prevention, public health setting; being a more efficient and effective way to improve health status.
- New Zealand has struggled to make such changes, as evidenced by CHE deficits and limited changes in the structure of the secondary care service.
- How important are changes in the delivery of secondary care services seen to be for New Zealand? In the absence of a profit motive how will these be delivered?
- What is the Government’s definition of health gain?
- What health outcome goals will be used in contractual funding agreements, and how will these be determined and agreed?
- Use of historical funding information has the potential to tie the system into historical and possibly conservative practice. How will innovation/change be encouraged and rewarded?
- The New Zealand health system still lacks in certain areas of infrastructure, notably information systems, through which care may be better managed. In the profit oriented system the necessary capital was expected to come from private sources or ’savings’. With the removal of the profit motive where does the Government expect capital to originate? Across the whole public system what are the estimated investment (capital) requirements? To what key areas are these to be applied?
Increase Health Sector Resources and Remove Financial Barriers to People Needing to Access Health and Disability Services
- What areas of care are priorities for waiting time action? What form will this action take? How are the additional funds to be used?
- What are the more detailed aspects of the Policy around removal of hospital part charges, free doctor visits and prescription medicines for the under-fives, and asset testing? Are these to be universal entitlements? Will they cover all aspects of care?
Pilot a Community Based Family Health Team Approach for the Delivery of Some Primary Health Care Services by Regional Hospital and Community Services
- Many countries are evolving strategies which aim to move the focus of health care from the secondary to primary sectors, to place emphasis on integration, prevention and community based care centred on the needs of the whole individual and their family.
- The Policy appears to place greater weight on extending secondary based services into the community, than extending primary based services into the secondary area. To what extent is this a specific intent of the Policy? What evidence exists that a secondary based model would be better than a primary based model?
- The term ’family health team’ is introduced, but appears to be based on a secondary care model. Family health teams are generally considered to be primary care based. What is the working definition of a family health team?
- What is to be the role and status of primary care in New Zealand health care? What model(s) of delivery will be encouraged?
- How will the Policy initiatives on Maori health be implemented?
- Will these take place within the other initiatives or follow a policy separate from mainstream services, in particular primary care?
- What will be the framework within which these services are funded and managed?
- What are the more specific details of the child health policy? What are seen as the key priorities and issues?
- What outcomes are expected? What level of funding will be devoted to this area?
- How is it expected that the ’director’ of child health will effect the outcomes required?
- What are the more specific details of the mental health policy? What are seen as the key priorities and issues?
- What outcomes are expected and in what timeframe?
Legislative Implications of the Policy Agreement
- What process will be used to make the legislative changes required? What is the time scale for this process? What will be the approach to consultation?
Fiscal Implications
- In the light of the Minister’s recent comments, which are the areas when further work is required on the fiscal impact?
- When will the fiscal implications be ratified?
Additional Questions
- What will be the extended structure for the funding/delivery of New Zealand health care? Pre-election mention was made of regional offices. Is such an approach still envisaged? What form will it take? How will it ensure integration of all modalities of care?
- Where is the accountability for resources and outcomes to lie in the proposed system? What is the policy on ’managed care’, recognised as one method of achieving this objective?
- What will be the role of the Ministry of Health?
- There is some feeling that the Policy has been developed in a vacuum, not necessarily seeking the wider input of experience and expertise which exists within the health sector. Is this to be a feature of the Government’s policy development?
- How is it proposed that further changes to the health system will be made? Who will lead these? How will the Government avoid losing the good features of the current system in the change process envisaged?
- How will frustration and demotivation within the workforce be avoided?
