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HEALTH
INTRODUCTION
Health is a critical investment in New Zealand's human resource - not a balance sheet item. New Zealand First wants a properly funded and resourced public health service. As a starting point we must move toward health expenditure of 10% of GDP. This is achievable if we also have an economic plan to improve our national income.
We must accept that health outcomes are a defining feature of our first world status, and their continued decline affects our quality of life. Where once New Zealand was in the first five countries in the OECD for life expectancy and infant mortality, we are now in a much inferior position.
Concrete steps must be taken to reverse this decline. Health is a broad and disparate issue, and must be treated as such. There are no simple solutions to the many and varied difficulties confronting the health sector. We must face the realities that New Zealand (like most Western nations) has an ageing population and greater life expectancy and therefore, with our seniors greatly more likely to need health services, this places unique demands on both the funding and provision of health services.
When last in government New Zealand First undertook to remove the profit focus from the health system. We promised to introduce new initiatives in the area of child health, and to reduce hospital waiting lists. We delivered on these promises and provided $1.5 billion additional funding for public health. Major challenges remain.
Getting the greatest amount of health and disability support from our health spending is critical as not all problems can be solved by increased spending. It is certainly true that New Zealand's public health service was allowed to be run down as a result of a mean-minded approach and a penchant for structural change.
We find it most disturbing that Treasury reports are now showing that despite increased spending in the health sector, health productivity (the number of operations etc) is declining.
We also understand that the health sector has been through 'structural fatigue', with successive governments undertaking major reforms. While aware of this, New Zealand First believes that the sector does not need wholesale changes, there are refinements that would improve health outcomes.
Our ultimate aim must be to provide our citizens with certainty about their healthcare and ensure timely access to quality services.
PLANS
New Zealand First will:
- commit to incrementally raising spending on health to reach our target goal of 10 percent of GDP;
- explore options associated with boosting uptake of private health insurance, including the provision of tax rebates for those with private health insurance;
- establish a Commission of Inquiry into the public health system with the aim of establishing precisely what the public expects of the health system and what the system can deliver. Our ultimate aim is to establish a public health compact with the public stipulating the guaranteed minimum services the public can expect from the public health sector. It will also consider the overlap with the private sector;
- review the number of District Health Boards (DHBs), to ensure they are appropriate for the demographic demands of health and efficiency of delivery of services;
- redress the balance between health administration and health practitioners within DHBs, ensuring that extra money going into health is ring fenced for the delivery of health services rather than growing the health bureaucracy;
- reduce the burgeoning health bureaucracy at all levels within the Ministry, DHBs and Primary Health Organisations (PHOs), with the intention of creating greater efficiencies and more value for money from the health dollar and to ensure that there is a return to ministerial accountability for health outcomes;
- reduce the proportion of places at medical training institutions which can be taken by foreign students while increasing the number of places available in areas of need (such as radiologists) for New Zealand students;
- review the costs of gaining initial medical qualifications, including exploring the option of a 'bonding' system for medical students who are willing to trade-off student loan abatements for staying in New Zealand;
- immediately review funding of PHOs that fail to maintain adequate emergency services and establish a process whereby funding for emergency services must be ring-fenced by DHBs when distributing funding;
- extend New Zealand First's initiative (of 1997) of free doctors visits and prescriptions to include all primary school-aged children;
- establish and implement a national strategy for addressing cancer treatment, diabetes, arthritis, asthma, obesity and other diseases and health concerns where a national strategy is clearly needed;
- provide nationwide screening for Hepatitis B (completing the 1997 New Zealand First initiative), asthma and diabetes, improve access to breast cancer and cervical screening services, and resource the development of suitable screening and health education programmes for men's health issues including prostate cancer;
- support the introduction of a nationally co-ordinated immunisation register as part of a strategy to stamp out third world illnesses;
- continue to focus upon family health, and particularly early intervention, by expanding such programmes as "Family Start" and home based support;
- expand the services and family support of the 0800 advice line, including over the Christmas period;
- restore emphasis on preventative measures and health education and ensure the nationwide health screening of all children under one year;
- ensure that all New Zealand pre-school and school children receive adequate dental care. (In particular, a national strategy that includes a shake-up of the state funding of teenagers' dental treatment is necessary to avoid a future toothless society);
- fund additional mobile dental care services and improve access to high quality oral healthcare services;
- provide additional resourcing for child and youth mental health services, and the necessary resources and funding to address the continuing appalling state of mental health services by completing the full implementation of the recommendations of the Mason report;
- redress the inadequate treatment and professional support provided to mentally ill patients and their families. The lack of discharge planning coupled with refusal of medical responsibility for crisis intervention in some areas remains a great concern;
- give the Mental Health Commission greater independence to provide national leadership in the mental health sector;
- increase the number of acute and non-acute beds and accommodation units for the mentally ill and modify the process of judicial review of decisions to release mentally ill patients into the community;
- improve residential services for people who have severe illnesses or disabilities and/or substance abuse problems;
- facilitate the improved co-ordination and integration through PHOs and other organisations of community health, dental health, disability support, family health, Maori health, maternity, mental health, and public health services and overcome the debilitating effects of a health system that lacks cohesion and common standards of delivery;
- use a range of measures to ensure the adequate recruitment and retention of health professionals in rural areas including, consideration of student loan abatements, fees reductions, scholarships and bonding schemes, amending the definition of "rural" in relation to the rural GP premiums and lifting the levels of primary healthcare premiums, the development of a robust peer support programme for rural practitioners, an alternative route for the registration of family doctors, the supply of locums to enable ongoing training, support and a sustainable quality lifestyle, and resources for visiting specialists;
- maintain rural health services and ensure good access to basic healthcare equitably throughout the country including the immediate development of a rural and provincial health services plan with a view to early injections of health funding to ensure the continuity of essential services;
- increase the use of technology to reduce isolation (e.g. mobile services, helplines, telemedicine, teleradiology) and consider the appropriate expansion of the health-centre model;
- ensure a high quality 'rural service' specialisation is available in our medical schools;
- seek consistency in the provision of ambulance and helicopter services;
- further develop a strategy for meeting the health needs of an ageing population and review specific disability provisions and resthome care;
- review the funding of resthome care contracts, particularly in relation to costs imposed by legislative changes which impact on the cost of care;
- assure equity of access to health and disability services across generations by removing income and asset testing for older people needing long stay geriatric hospital care services and asset testing for long stay geriatric private hospital care;
- implement national standards for geriatric home care that are appropriately monitored and enforced;
- ensure that safety considerations are paramount in funding decisions relating to maternity care services and require improved provision of ante-natal classes, maternity services for rural, Maori and Pacific Island women, and the improved monitoring of maternity services;
- conduct a review of the efficiency and efficacy of Pharmac's operations;
- adequately resource elective surgery and increase waiting times funding so as to firmly establish guaranteed maximum waiting times for a range of surgical and specialist treatment. Very few services are meeting the stated objective of seeing 90% of new referrals within two months;
- protect the funding for health research, research institutes, and for training that have a long term benefit;
- legislate for clear labelling of all genetically modified food (GMF) products and ban all imports that do not meet these requirements;
- ensure that the application of the Privacy Act does not impinge upon public health and safety, particularly in relation to national databases where appropriate; and,
- review issues relating to the treatment of overseas patients within our public health system.
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