Gareth Morgan and Geoff Simmons, Authors of Health Cheque

Prescription One: Managing Demand – reducing the demand for healthcare services by improving prevention, catching problems early and improving the information on the downsides of treatment.

• Investing in prevention is a massive challenge, as shown on the recent Inside New Zealand documentary on child poverty. New Zealand is one of the worst performing on many children’s health indicators, despite having one of the lowest rates of poverty among the elderly. If poor parents can’t afford to invest in their kids health then society needs to with better healthcare in the early stages of life. But it is more than just healthcare, we also need to make sure they get fed decent food and have decent housing.
• Labour and particularly the Greens have a more comprehensive approach on prevention, including tackling some of the broader public health issues that lead to poor health, and actions to reduce obesity and improve oral and mental health (both of which tend to go hand in hand with other health problems). The Greens have even pledged to put 10% of the health budget into prevention. The question as always is whether all of their investments would deliver the best bang for the buck.
• All parties are working on free after hours healthcare for under sixes.
• National are promising more of the same; a tightly targeted focus on proven preventative measures. In primary care, their emphasis is likely to remain on more procedures, with GPs continuing to take over some responsibilities normally reserved for secondary care. Without extra money to fund this change, it seems to be coming at the expense of doing preventative work in high risk communities.
• No party is talking about raising awareness of the downsides of medical treatment, particularly in end of life situations.

Prescription Two: Rationing Treatments – set up an independent body to oversee new healthcare spending, similar to how Pharmac operates for drug treatments.

• No party has really grasped the nettle on rationing treatment. No politician wants to burst the public’s bubble on our ‘all you can eat’ healthcare system.
• After two years of prevaricating, National has finally reformed the National Health Committee to oversee value for money in the health sector. It is too soon to really say how much teeth this Committee will have and how public its work will be, as it is reporting directly to the Minister. In our view it should be independent and be able to make decisions about where new healthcare spending should go.
• Labour has called for “an honest conversation with New Zealanders about the future of healthcare in New Zealand”, but there is no policy behind this to speak of as yet. Instead it is calling for more funding to make up for the ‘shortfall’ that occurred under National. The Greens are also calling for more funding of elective surgery. So there is no realistic end in sight for our burgeoning healthcare budget, despite these belt-tightening times.

Prescription Three: Service Delivery – empower health professionals to find the most efficient and effective way of delivering healthcare services in the future.

• This is the issue where National have been strongest in the previous three years, with the National Health Board (NHB) and Quality and Safety Commission so we can probably expect more of the same. Will they reform things more radically? This isn’t clear. Last election they promised no reform to DHBs and the Ministerial Reform Group worked to improve things within the existing structures. This election they have kept pretty quiet on this, which might leave them with more room to manoeuvre.
• Labour are pushing a greater move to team based primary healthcare in the community, by reviewing the funding formula and greater use of salaried GPs. They seem set to continue National’s drive for efficiency and innovation.
• No party seems to be offering medical staff the incentives and freedom to improve health service delivery. National’s call for improved clinical governance was the closest to this, but there has been little in the way of tangible follow up.
• No party is seriously looking at what services are best delivered where. Labour and the Greens are promising to increase rural funding, and National’s NHB is taking an incremental approach to reform.

So really most parties are still playing to type. National is focussed on short term efficiency, whereas Labour and Greens are more focussed on prevention. If only we could pick the best policies of all parties: get efficiency savings from secondary care and plough them back into increased prevention!

About the Author

Gareth Morgan

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Gareth Morgan is a New Zealand economist and commentator on public policy who in previous lives has been in business as an economic consultant, funds manager, and professional company director. He is also a motorcycle adventurer and philanthropist. Gareth and his wife Joanne have a charitable foundation, the Morgan Foundation, which has three main stands of philanthropic endeavour – public interest research, conservation and social investment.