Speech to Confederation of Medical Associations

[Appropriate Mihi]

It was with great pleasure that I accepted the opportunity to speak to such a distinguished and varied gathering as this.

May I welcome all the delegates from abroad and from New Zealand, I trust your conference is going well.

You certainly picked a challenging topic to address on "The Ethics of Managed Care".

As an Associate Health Minister in a country which has been making significant changes to its health system, let me assure you the Government is well aware of the competing demands of providing excellent health care to an ageing population in a time when all Government budgets are being critically examined.

I've been involved in the health portfolio as a Minister for the past two years and I'm convinced we have made real progress in how to best provide quality healthcare without wasting taxpayer dollars.

Two examples are the surgical booking system and our streamlined system for seeing what gets spent and where.

The booking system is intended to provide fair and timely access to specialist services (these include surgical, medical and diagnostic services).

The booking system provides the Government with better information about future funding requirements for specialist services.

The booking system provides an honest and clear picture for patients. This is an important point.

The old waiting list system was basically a fraud perpetrated on patients.

They often languished for months or even years under waiting lists with very little information.

They did not know if or when they would receive treatment, and many complained of having insufficient information to be able to make informed choices about other options available.

In some cases, patients were placed on waiting lists for procedures that were not available under the public system.

The anxiety associated with being on a waiting list was significant for many people. Some postponed holidays for years due to fears of missing out on "their turn" if they happened to be unavailable when the hospital called.

Now, the booking system ensures equal access for equal need.

Developments in health will always exceed our ability to pay. The booking system helps to define how the available funds will be spent.

The number of patients waiting more than the six month standard for treatment has decreased over the last six months.

The number of patients waiting more than six months in the front five specialties (Cardiology, Cardiac Surgery, Ophthalmology, ENT, Gynaecology) while still high, have decreased over the last six months.

In order to run effective booking systems it is necessary to ensure that only patients who meet the criteria are provided with undertakings of publicly funded treatment.

It was acknowledged that full implementation of booking systems was therefore particularly challenging in services which had large existing waiting lists.

In response, the Government set up a $285 million Waiting Times Fund to help clear existing waiting lists. The Waiting Times Fund is now in its last year and residual waiting lists have decreased from 90,000 in 1996 to less than 50,000.

It is expected that full implementation, including elimination of residual waiting lists, will be completed by 30 June 2000.

I am also pleased that we are making progress with our monitoring processes. Where before we had 23 hospitals and 4 regional health authorities - all with differing methods of measuring progress - we now have the one funding agency and a much clearer picture of where the six or seven billion dollars we spend a year on health is actually going.

There is one other area where I am not so proud. As we all know, Maori figure prominently in the health statistics - and not because we are all shining examples of excellent health.

So logic would suggest health spending on Maori should be higher than our numbers in the population would warrant because our health needs are greater.

But it's not so.

The Health Funding Authority reports that in the 1998/99 year, it spent $636 million on Maori health.

That was 11.9% of the HFA's budget, even though the HFA estimates Maori to be 14.5% of the total population of New Zealand. (I would quibble with that, as I believe Maori are closer to 16% of the population, but that's an argument for elsewhere).

In 1999/2000, the HFA plans to spend $665 million on Maori health, which is 12.07% of the HFA's budget and an increase of $29 million on the previous year.

So even by the HFA's own population figures, it can be seen that spending on Maori health is significantly below our ratio of the population, notwithstanding that our health needs are greater.

This is brought out even more starkly when you realise that the planned expenditure for the 1999/2000 year equates to $1271 per capita for Maori, compared to $1337 for non-Maori. Maori are being shortchanged by at least $40 million.

This is not to say that the HFA is deliberately under-spending on Maori health, indeed it is actively trying to correct the imbalance.

But the figures are unambiguous. The group that has the greater health need in our community is not getting even the proportional funding it needs, let alone any special advantage.

There is clearly still work to be done in delivering ethically and financially responsible healthcare to all the people of all our countries.

Thank you for your attention, I wish you well in your deliberations.