The Government’s Medium-Term Strategy for Health and Disability Support Services

Wyatt Creech Health

It is very important that people - both health service providers and the general public - know about this strategy.

This document outlines the Government's medium-term strategic direction for health. It informs the public, the health funding organisations and the health and disability support service providers - including charitable, voluntary and private organisations - of the broad policy settings within which the health sector will be working over the next three to five years.

The Government aims to ensure real gains in the health status of New Zealanders, so all enjoy the benefits of good health and maximise their potential to live a full life. All agencies in the publicly funded health sector need to focus on achieving these aims. This document sets out the Government's twelve medium-term goals which aim to:

  • build certainty and confidence in the security and stability of the New Zealand health and disability system

  • give equity of health status to all New Zealanders

  • maximise the benefits of early intervention, proper integration of services, health promotion, and involvement of communities in developing their own solutions to their health issues.

The goals in this document set a common direction for the Health Funding Authority (HFA), which purchases publicly funded health and disability support services, the Government-owned Hospital and Health Services, and the Crown Company Monitoring and Advisory Unit (CCMAU) which manages the Government's public provider ownership interest.

Working to this common strategy will improve the performance of the health system for all New Zealanders.

Introduction

Since 1992/93 taxpayers, through the Government, have paid for about 77 percent of all health expenditure in New Zealand. General taxation will remain the principal source of revenue for health services. The Government is committed to a three-year funding path that allows realistic rates of growth in public spending on health. This provides certainty for the sector to plan ahead and avoids ad hoc injections of money.

In the future, the health and disability support services will be under pressure from changes in:

  • demography - the size and composition of New Zealand's population, particularly the impact of the ageing population

  • epidemiology - changes in patterns of disease and disability and the emergence of new diseases

  • technology - the emergence of new ways of treating illness and responding to disability

  • expectations - what people require of health and disability support services, and what health professionals expect to be able to offer them, is continually increasing.

Health sector organisations will need to be prepared for these pressures and the implications these may have on the pattern of health care and disability support.

Public organisations in the sector are expected to focus on getting the most benefit for the public from the available resources from Vote: Health and supporting Votes. As the capability at provider and community level develops, the Government wants to see increasing involvement of local communities in providing solutions to local problems. Longer-term contracting arrangements will be developed by the HFA. Administrative costs are to be minimised, while maintaining a reasonable accountability for the spending of public money.

Organisational arrangements in the health sector are now generally working well after significant changes in recent years. It is time to shift the focus to getting better-quality, more effective and more efficient delivery of services. A number of recent health policy initiatives are directed at giving New Zealanders certainty about the security of their publicly funded health and disability support services. The foremost policy is the Hospital Services Plan released in September 1998. This plan holds in place the current configuration of publicly delivered services for three years from that date. The public can have confidence in the security of knowing these services are not going to be suddenly removed.

The Government is committed to acknowledging a special relationship between Maori and the Crown under the Treaty of Waitangi. It is also strongly committed to improving health outcomes for Maori. Considerable progress has been made in this area over recent years. So that Maori may achieve the same health status as other New Zealanders, the Government will continue to work to ensure that publicly funded health and disability support services are responsive to Maori and to enable Maori to play a greater part in the delivery of services.

As part of its programme to reduce health disparities, the Government seeks a significant improvement in the health status for Maori and Pacific people whose health status currently is not the same as other New Zealanders.

Future developments must ensure that services are distributed throughout New Zealand in a way that ensures all New Zealanders, no matter where they are, have access to a reasonable level of services. This would include co-ordinated transport services where needed. The recently released Ministry of Health document Roadside to Bedside advanced this approach. Safety is assured by ensuring services meet appropriate modern quality standards. There will also be a focus on reducing administrative and compliance costs.

In order to ensure stability in the sector and a focus on service improvement, the Government has determined that current public health system structures - the Health Funding Authority and the Hospital and Health Services (public hospitals) - will remain as they are. Structural developments will from hereon be evolutionary as facilities and systems change to meet the needs of modern health service delivery.

Without doubt the current structures and arrangements have the capacity to further improve the delivery of health and disability support services. This stability of structure means that all participants can focus on the future and apply their energy and effort on improving services to achieve better health for individuals and communities.

The Government wants to see an increasing emphasis in health service purchasing on outcomes rather than outputs. The services for a person or a community will be looked at as a whole, with the aim of funding and providing the mix of services that gives the best overall result. This more holistic approach is widely supported throughout the health sector, but will require the development of innovative contracts and other appropriate incentives to make it happen effectively.

Sector-led evolution

A key Government goal is to see participants in the health sector take an increasingly prominent role in developing solutions to health issues. Instead of being imposed by the Government, much of the effort in bringing about desired change should be initiated and led by the sector itself, and the communities it serves. Participants in the sector will be expected to work collaboratively to achieve better health outcomes for the public.

The Government will encourage the evolution and use of whatever tools are most effective to achieve the best health and disability sector outcomes. Pilot programmes will be run to test better ways of delivering services. This is happening already with numerous initiatives led by providers and communities throughout the country. The Government will continue with its policy of supporting this style of sector-led evolution: local solutions to local problems.

There is enormous potential to make further progress toward our mission of ensuring that all New Zealanders enjoy improved health status and have the opportunity to live a full life, now and in the future. To capitalise on that potential, the Government wishes to focus the efforts of the funder and providers on better health outcomes. In the next three to five years, the publicly funded health sector must deliver services that ensure real gains in the health status of New Zealanders and contribute to broad social policy goals, in a manner that is responsive to the needs of people and their communities.

Government's medium-term health policy goals

The Government's overarching health and disability policy objective is to ensure real gains in the health status of New Zealanders, so all enjoy the benefits of good health and maximise their potential to live a full life.

To achieve this broad objective, the Government has twelve medium-term goals to focus the efforts of all agencies in the publicly funded health sector. They are designed to:

  • build certainty and confidence amongst all participants in the security and stability of the New Zealand health and disability support system

  • give equity of health status to all New Zealanders

  • maximise the benefits of early intervention, proper integration of services, health promotion, and involvement of communities in developing their own solutions to their health issues.

The twelve medium-term goals, in no particular order, are:

 

  1. Public certainty about access, quality, and security of services

    Give the public confidence that the level, mix, quality and structures of health and disability support services, including rural services, is secure and appropriate to both present and future.

  2. Timely, equitable and nationally consistent access to elective services

    Improve access to a nationally consistent level of publicly funded elective surgery services. This includes more timely access to first assessments and services, and ensuring that elective services are prioritised on a fair, transparent and consistent basis nationwide.

  3. Acknowledging the special relationship between Maori and the Crown

    Acknowledge the special relationship between Maori and the Crown in the health sector to ensure that publicly funded health and disability support services are responsive to Maori and continue to enable greater Maori participation at all levels of the health and disability sector.

  4. Decreased long-standing disparities in health status

    Make marked progress in decreasing the long-standing disparities in health and disability status, in particular for the needs of Maori and the needs of Pacific peoples, so that these groups can enjoy the same level of health as other New Zealanders.

  5. Improved mental health

    Improve services to decrease the prevalence of mental illness and mental health problems, and reduce the impact of mental disorders on consumers, their families, caregivers, and the general community.

  6. Improved child health

    Implement the Government's child health strategy and improve the health status of children at high risk of poor health.

  7. Improved disability support services

    Improve disability support services, with the aim of maximising the ability of people with disabilities and their caregivers to enjoy a full and independent life.

  8. Greater emphasis on population health approaches

    Improve population health policies to improve the overall health outcomes for all New Zealanders, especially those who traditionally have less healthy outcomes. This includes making further progress on immunisation rates, healthier lifestyles, less smoking, better diets, and screening and health promotion programmes.

  9. Well co-ordinated, integrated services that contribute to better health and disability outcomes

    Develop initiatives that integrate the work of providers of primary and secondary health services so as to maximise the overall health outcomes for people and their communities.

  10. Intersectoral collaboration between agencies and providers to achieve social policy objectives

    Promote and support collaborative intersectoral initiatives to improve the delivery of health and other social services that recognise the person as a whole, as part of the Strengthening Families strategy.

  11. Improved capability and adaptability of the health and disability sector

    Improve the long-term performance of the health system by enhancing adaptability and the use of information, and ensuring greater coherence between the health service purchasing and public hospital ownership strategies.

  12. Sustainability of the publicly funded health system

    Fund and develop services on a sustainable basis, lower compliance and administration costs, and continue to improve management of demand-driven expenditure. The remainder of this document looks at these goals in more detail.

  1. Public certainty about access, quality and security of services

 

The Government wants to give the public certainty and confidence that the mix and quality of health and disability support services are appropriate to both present and future needs. As part of this strategy to achieve stability in service coverage, the Government wants the Hospital Services Plan and the subsequent Roadside to Bedside implemented. The rural health policy and improvements to the transparency and consistency of prioritisation and associated decision-making (especially for elective services) also reflect the Government's commitment to this goal. Plans to modernise the hospital sector and develop regional and national centres of excellence aim to prepare the system for New Zealand's future needs, as does work in the area of quality standards. The appropriate take-up of new technology and more flexible use of the workforce will also help make our system more responsive.

Confidence, certainty and stability

To ensure that people, especially those living in rural New Zealand, have certainty of publicly funded health and disability support services the Government approved the Hospital Services Plan in September 1998. This plan assures the health sector and the public that the current arrangements for publicly provided health and disability support services will stay in place for three years from that date. This protects communities from unilateral or arbitrary changes to services. Obviously, changes will occur over the medium term as the health sector adjusts publicly provided health and disability support services to the health needs of people in the new millennium.

The Ministry of Health has produced a plan, called Roadside to Bedside, that includes a long-term framework for acute and emergency services. The aim is for people requiring services to get those services from the right person in the right place at the right time. This depends on decision-making on the right treatment for the patient at the closest point possible to where the need arises, and the immediate transport of that patient to the most appropriate service delivery point.

In order to deliver a consistent level of quality services throughout New Zealand the Roadside to Bedside framework sees our hospital services as working together in five collaborative networks. The concepts behind Roadside to Bedside will be developed over the period ahead. Any decisions will be consistent with the Hospital Services Plan.

The mix of services and coverage

The Government expects the health sector (providers, the HFA and policy agencies) to work together to inform the public of the broad range of publicly funded services that are available. Likewise, information on the policies governing rationing and prioritisation of services needs to be further developed and made public. The aim is for people to be able to see how decisions are made about which services the Government pays for, and where and when they are available.

Approaches to prioritisation need to be developed so that decisions can be made across all the health and disability support services - not just within individual service areas. This will enable resources to be directed to where they will give the most benefit.

A key aspect of assuring the best mix of health services throughout New Zealand is having the Government's ownership and purchase interests properly aligned. Work needs to be done to improve the running of the current system in this respect. Agencies will need to work together and share information to achieve these improvements.

Approaches to greater certainty and transparency

The Government seeks to build certainty and confidence in the security and stability of the New Zealand health and disability support system among all participants. For the public, and specifically for consumers of health services, clear statements of what can be expected from the publicly funded services, and when and where they will be provided, are key to achieving that confidence. There is a need to make sure that people - especially those with poorer health outcomes - are aware of policies that are designed to benefit them. Examples are the free doctor visits for under six-year-olds, and assistance with travel expenses. It is especially important to be able to demonstrate that any changes to service coverage will contribute to gains in health and independence. Prioritisation processes and criteria need to be rational, fair, transparent and nationally consistent. Any changes in service delivery must be consistent with the Hospital Services Plan.

Rural services

The Government has identified services to people in rural New Zealand as an area where it wants people to have greater security and confidence. The Government's policy for rural health and disability support services enables rural people to receive effective appropriate front-line care in their own community, and have timely access to acute emergency services of an agreed standard within acceptable modern standards. Decisions on the allocation of health resources must take into account the ongoing needs of rural communities.

The increasingly specialised nature of clinical services, coupled with higher levels of technology now employed in medicine, means that some services are best delivered through regional or national centres of excellence. Used creatively, new technologies - such as telemedicine, telephone help systems and better transport systems - can enable all New Zealanders to benefit from such services. The Government expects the sector to use technology creatively to facilitate access to health and disability support services for isolated communities.

The Government recognises there is diversity among rural communities and their needs and is keen to create opportunities for them to develop local arrangements that suit their needs. These do not have to be the same everywhere - what is important is that arrangements work well. The Government sees potential for effective alliances and networks to develop between providers at the primary level and between the primary and secondary levels. The Government would like to see providers improve the recruitment and retention of rural health professionals, and develop the professionals with the skills and knowledge that suit the service delivery patterns in rural areas.

In terms of hospital services, the Government's rural health policy proposes that people living at a distance from a hospital retain access to a full range of safe, high-quality services. Although people will continue to have to travel for some services, access to public hospitals will be determined on the basis of reasonable need and ability to benefit, not by where a person lives.

Proposals for new or changed services in rural areas, including those that service particular or at-risk groups, must be carefully assessed before they are launched and communities need to be properly informed. Where that base work is done, the Government will encourage initiatives that address particular needs, for example, a particular disease like diabetes, or a particular type of service like dental care. The list of proposals would be as short or as long as the community determines.

Modernisation: investment in state-of-the-art facilities

The Government has already announced its determination to modernise public hospitals to provide better-quality and more modern services. Considerable investment (around $920 million) has been made in the past five years, and in the next three years another $1 billion will be invested.

Major initiatives are under way throughout New Zealand. Decisions are due on the Auckland Hospital Services Development Plan (HSDP). In Wellington, immediate major developments include a new Emergency Department and the development of proposals for a new regional hospital. Many new local health clinics offering various levels of ambulatory care are also being developed and implemented.

Ensuring high-quality services

The Government wants services to be safe and of satisfactory quality. The Government will continue its work to create a regulatory framework that encourages flexibility and innovation in health and disability support services while ensuring safety. Legislative changes will be advanced to ensure that the proposed new regulatory environment supports modern service standards throughout the health and disability sector. These are designed to make sure people know that if they require services, those provided in New Zealand match international standards. This new system for safety and quality standards for hospital, residential care and other health and disability support services will replace the current licensing arrangements, which are out of date and inflexible. This development will have significant implications for providers and third- party purchasers over the next few years.

A new regulatory framework for public health to replace the existing Health Act will be introduced. This will improve our ability to prevent and mitigate threats to public health and safety.

  1. Timely, equitable and nationally consistent access to elective services

 

The Government seeks to provide certainty around publicly funded elective services. Over the next few years it will expect to see continued implementation of booking systems that use nationally consistent clinical priority assessment criteria for hospital-based services. This will allow people to have confidence that if they need treatment they will get it within a fixed period of time, and that they will be treated fairly.

Progress will include improving access time for first assessments and services, and ensuring that elective services are prioritised on a fair, transparent and consistent basis. This will require greater transparency in the prioritisation of elective services. New Zealanders, wherever they live, are entitled to expect to receive the same level of service to address the same level of need and ability to benefit.

  1. Acknowledging the special relationship between Maori and the Crown

 

The Government acknowledges the special relationship between Maori and the Crown under the Treaty of Waitangi. It will give recognition to this by working to ensure public health and disability support services are responsive to Mäori and by continuing to enable greater Maori participation in the purchase and delivery of health and social services, as signalled in Whäia Te Ora Mø Te Iwi.

The Government has made significant advances for Maori provider development during the 1990s, as evidenced by the substantial number of Maori providers now participating in the delivery of services to Maori. The Government will continue to support development of the capability of Maori to participate in the delivery of services where this ensures services are responsive to Maori needs. The Maori Provider Development Scheme will continue to provide extensive support to the growth of Maori providers of quality health and disability support services.

  1. Decreased long-standing disparities in health status

 

Although the Government seeks to ensure that New Zealanders in general enjoy improved health status, particular emphasis will be placed on decreasing the disparities of health status experienced by Maori and Pacific peoples when compared to the health status of other New Zealanders. The Government seeks a significant improvement in health status for these communities. The disparity in health status is linked to service access and socioeconomic status. The Government expects innovative contracting practices and services focused on improving health outcomes, including better health promotion and early intervention programmes.

Maori health

The Government seeks a significant improvement in Maori health and disability status. The Government is committed to Maori health and to enabling greater participation by Maori at all levels in health services, including purchase and delivery. The Government expects action in better targeting and provision of services that improve health outcomes for Maori. It will also seek further progress on making mainstream services more responsive to Maori communities. The health of Maori is influenced not only by the appropriateness of health care services, but also by cultural and social factors. The Government expects to see services responsive to Maori whanau, family, hapu and iwi and the continued development of initiatives focusing on improved outcomes for Maori people. In particular, the areas for focus will be child and youth health, mental health, primary care, workforce development, preventative health and diabetes. Pacific peoples' health

The Government wishes to see improvement in the health status of Pacific communities in New Zealand so that they have the opportunity to enjoy the same health status as other communities. The health of Pacific peoples is influenced not only by the appropriateness of health care services, but also by cultural and social factors. The Government expects to see services responsive to Pacific communities and the continued development of initiatives focusing on improved outcomes for Pacific people.

In particular, the areas for focus will be child and youth health, mental health, women's health, sexual and reproductive health, and primary care.

The continued development and strengthening of Pacific community providers will also be an area of emphasis. This includes the development of co-ordinated and integrated approaches within Pacific communities with mainstream and Maori organisations. The Government expects to see action from mainstream providers in considering the impact of services that will significantly improve Pacific health outcomes, especially in areas with large Pacific populations.

  1. Improved mental health

 

The Government is committed to having mental health services that work well. We have a national mental health strategy Looking Forward, which was developed further in Moving Forward. The strategy has the goals of reducing the prevalence of mental illness and mental health problems and reducing the impact of mental disorders on consumers, their families, caregivers and the general community. To improve services and in response to the Mason Inquiry report, the Government allocated specific funds for mental health services, and set up the Mental Health Commission to monitor progress and work with the sector to get more and better services, to reduce discrimination and to strengthen the workforce. Progress has been made in these areas.

The Government seeks continued progress in access, effectiveness and quality of care, particularly through promoting closer co-operation among providers, encouraging community based planning, and development and delivery of mental health services. Implementation of the National Drug Policy and the New Zealand Youth Suicide Prevention Strategy are particular areas where the Government seeks progress.

Other key areas for progress are Mäori mental health, Pacific peoples' mental health and child and youth services. The health sector also needs to lead progress in strengthening the mental health workforce by promoting training, and effective recruitment and retention practices.

  1. Improved child health

 

The Government wants the health sector to place continued emphasis on improving the health status of children at high risk of poor health. Improvements in life-time health outcomes are sensitive to interventions early in life. The Government is supporting universal provision of preventive services and early intervention through immunisation, €œWell Child€ checks and publicly funded free GP visits for children under six.

The Government's Child Health Strategy, developed following extensive consultation, seeks better forms of contracting and other relationships to improve, protect and promote the health of children. Providers of services for children need to work together in a co-ordinated fashion with funders and the Government to improve child health outcomes. The Strengthening Families initiative brings together the work of social service agencies at a community level.

Strengthening Families will continue to improve the broad social services sector's capability to address the needs of children experiencing multiple social and economic disadvantage and children with high health and disability support needs, especially tamariki Maori and Pacific children.

  1. Improved disability support services

 

For some years there has been a real effort to improve disability support services. To achieve the desired outcomes, people with disabilities and their support networks need to be empowered. Where it is appropriate, the Government seeks greater emphasis on family involvement in determining the nature and content of the services provided.

The Government is exploring increasing flexibility in funding arrangements for disability support, such as individualised funding for people with disabilities. Giving the individuals concerned control of their support services budget is one way of increasing their independence and empowering them to make their own choices about services.

  1. Greater emphasis on population health approaches

 

Over the next three to five years greater emphasis needs to be placed on population health approaches. This should assist in improving the overall health outcomes for all New Zealanders, especially those groups with generally poorer health outcomes. The Government wants to see increased emphasis on primary care, prevention and health promotion to minimise acute episodes of ill-health and the potential for injury. This includes improving immunisation rates, healthier lifestyles and better diets, less smoking, and enabling New Zealanders to make individual and collective choices that improve their health.

In line with the Strategic Direction for Public Health, greater focus should be placed on strengthening the public health infrastructure and support of public health action. A focus on the determinants of health, and building and supporting strategic alliances, should assist in shifting the focus onto the fundamental causes of poor health rather than on dealing with the consequences.

Effective public health action will require collaboration among agencies. For example, the HFA will be working with the Ministry of Health on strategies that address illnesses, including diabetes, that cause major health problems for significant numbers of New Zealanders.

  1. Well co-ordinated, integrated services that contribute to better health and disability outcomes

 

The Government wants providers and communities to co-operate and collaborate for better care and better service in an integrated, responsive way. This includes better working relationships within the primary sector and between the primary and secondary sectors. The aim is for services to contribute to better health and disability outcomes in the most efficient manner by:

  • organising services around the needs, preferences and overall health status of patients and groups in the community

  • encouraging early intervention and effective health promotion programmes to prevent disease and disability, and to protect and promote health and independence

  • encouraging local solutions to local problems

  • making decisions about resource use as close as possible to the point of service delivery. With the objective of improving health outcomes in mind, the Government expects to see, and will facilitate, the development of a broad range of integrated care initiatives.

This will provide a good basis for evaluating the longer-term benefits of various approaches, and will help inform the future direction for integrated care. The Government will expect safeguards to be in place to ensure continuity of services to New Zealanders. The intention is that service providers be encouraged to use their resources on services that result in the best health outcomes for patients and their communities. This is likely to focus on early intervention, prevention and health promotion, and improving co-ordination and collaboration.

By promoting a number of different initiatives, various arrangements can be evaluated and best-practice results disseminated around the country so that all areas can take advantage of ideas and systems that give better health outcomes. Where possible, the Government is willing to see change resulting from simple, cost-effective, high impact initiatives. Suitable approaches include:

  • developing collaboration among providers working in a locality. This would aim to focus services on the overall welfare of the patient and their community, make services and access more user-friendly, and reduce the costs, delays and errors that can occur when patients move between providers.

  • new provider organisations offering comprehensive care for a specific condition, by adopting treatment protocols, sharing knowledge and resources, developing prevention programmes and developing individual care management approaches.'

Such organisations will be able to improve the quality and effectiveness of services for people with chronic condition - diabetes and asthma are two cases in point. To give effect to this, the HFA will work with the Ministry of Health to further develop and implement strategies that address illnesses that cause major health problems for significant groups of New Zealanders. An example is the publication Strategies for the Control of Diabetes in New Zealand, released by the Minister of Health in October 1997.

  • joint initiatives between providers so that decisions about services can be better informed of, and therefore reflect, local needs and preferences and practices. Such schemes have already pushed ahead in Mäori and rural communities and could extend more widely.

  • systems to deliver integrated service purchasing to allow the delivery of broader health outcomes across a wide range of publicly funded health and disability support services for defined populations.

Most of the successful initiatives to date have been led by local providers motivated by a commitment to improve outcomes for population groups or patients with specific diseases. Many of their achievements are due to better co-ordination and collaboration, for example, in developing better protocols for referral.

The emergence of integrated care and other innovative funding and contracting arrangements may require the Government to re-examine the 'ring-fencing' of funding - although changes will only be considered if it is clear they will enhance the effectiveness and efficiency of those essential services.

  1. Intersectoral collaboration between agencies and providers to achieve social policy objectives (Strengthening Families)

 

Poor health status for some groups is bound up in a complex web of social and economic issues. These issues can best be addressed by taking a holistic approach. If the Government is to deliver on its social policy objectives, and make progress in the identified health gain priority areas, health services need to work constructively with other social services for those at risk. Intersectoral co-ordination is key to this. For community groups and others on the ground delivering services, lack of co-ordination among sectors, public agencies and providers has been a source of endless frustration.

Strengthening Families is the Government initiative that pulls various social agencies together to address problems collectively. Already programmes launched under the Strengthening Families umbrella are demonstrating that different agencies can work together to achieve health and social goals. Family Start is a good example: the provision of very early intervention services to families in difficult circumstances is making an important contribution to breaking intergenerational cycles of disadvantage.

The Government will continue to place emphasis on improving the co-ordination of social services for families. Intersectoral initiatives between agencies and providers to improve health outcomes for New Zealanders will be strongly encouraged. This will include continuing support for community-based early intervention programmes like Family Start and similar initiatives.

  1. Improved capability and adaptability of the health system

 

The publicly funded health system must be sustainable, able to adapt to change, cope with new pressures, and able to capitalise on new opportunities offered by technology and information. The Government has a stewardship role in making sure the system works as a whole so that all New Zealanders can benefit from what the health and disability sector has to offer them, while being cognisant of the need for service stability.

Each agency, in carrying out its specific role, needs to be mindful of the Government's collective interest and the medium-term objectives for health, social and economic policy. To ensure that the collective interest is best served, the Government will work to foster greater collaboration among providers and between the providers and funders.

Government's stewardship role involves:

  • considering the sector as a whole and promoting intersectoral linkages

  • taking a medium/long-term view of issues and opportunities

  • facilitating information sharing among providers, and between providers and funders, while protecting privacy and information security

  • monitoring and evaluation

  • being principled but pragmatic and flexible in relationships

  • encouraging evolutionary rather than revolutionary change in roles and structures

  • engendering greater trust and co-operation

  • promoting certainty in the supply of health services

  • developing 'intelligent' purchasing that focuses on cost-effectiveness in contracting and services.

The Government, through its accountability arrangements, will make it a requirement that the funder and providers work together to meet these expectations. The way in which responsibility for funding of services and provision of services is assigned will not need to change. The current institutional structure provides the necessary clarity of roles and freedoms to manage effectively. But to support a well-functioning system the Government will:

  • develop policies that remove barriers to innovation and improve incentives for better services

  • create a regulatory and funding framework that is flexible, allows innovation, and ensures safety in health and disability support services

  • provide stewardship to make sure that the system works as a whole and that all New Zealanders are able to benefit from what it has to offer.

Over the coming years there will be a continued shift in emphasis to models of care, delivery and health promotion built around local communities. This will involve the adoption of more flexible work practices crossing over historical professional, organisational, and geographic boundaries. The health workforce needs to be able to adapt, and information will need to be accessible across traditional boundaries. Similarly, information flows between the funder and providers need to be continually improved to enhance the capacity of the health system to address complex issues and effectively deliver services.

Information initiatives will be important to improve the exchange, custody and management of data in the sector. Information, information technology and telecommunications will be key in allowing different practices to evolve that provide the appropriate care in the appropriate place. Such developments will also permit consistent and coherent information for planning, monitoring, and evaluating health services. Privacy and information security issues will continue to require careful attention. Part of establishing a learning health and disability support system is the need to develop and maintain an adaptable workforce with an adequate supply of the skills required at each point in time. Health professionals need to focus on ways they can be more responsive to patients' needs through:

  • employers, such as hospitals, taking a more active role in shaping their own skilled workforce

  • increasing the 'openness' of professional registration and disciplinary processes

  • making it easier to utilise new types of practitioner who can meet patients' needs more conveniently or efficiently.

Legislation will be introduced to allow more responsive approaches to service delivery. Nurse prescribing is an example of how patient access to services can be enhanced by making better use of the talents of our workforce.

  1. Sustainability of the publicly funded health system

 

Sustainable funding

The Government wants to ensure public expenditure on health and disability is set at levels that mean the delivery of services to New Zealanders is sustainable in the longer term. About 77 percent of all health expenditure in New Zealand is taxpayer funded. General taxation will remain the principal source of revenue for health services, recognising that charitable, voluntary and private sector providers (which deliver more than 50 percent of health services by value) and private financing (which accounts for 23 percent of expenditure on health) will continue to play a role in our health services. The Government is committed to a three-year funding path that allows realistic rates of growth in public spending on health. The objective is to provide certainty for the sector to plan ahead and thereby avoids ad hoc injections of money.

Improving incentives

There is room to improve the incentives for funders, providers and consumers in the allocation and use of scarce resources, particularly demand-driven expenditure. This could include improving the design of user part-charges to ensure it is consistent and effective with respect to the health policy objectives. Reducing administrative costs

The Government wishes to see administration and compliance costs minimised and will seek increased efficiencies from the HFA in the contracting process. This includes the more timely conclusion of contract negotiations and development of a longer-term contracting environment.

Long-term financing pressures

New Zealand needs to be well-prepared for the effects of change in demand associated with continuing technological, demographic, and epidemiological change and changing expectations. In particular, the long-term effect of the baby boom will be a large increase in the elderly as a proportion of the population from 2020 to 2040. People use much more health care per-capita in their last years of life. The demographic changes require Government and the health sector to be in a position to manage the pressure on their ability to finance. Changing assumptions about the health status, longevity, or time in the workforce of the elderly, or the costs of health care, have some effect, but the demographic facts dominate.

A key question is how much as a society we should expect people to plan ahead for health needs, including how better choices about lifestyles can impact on the cost of health to individuals and society.