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Health Stats Show Need For Realigned Spending

“Our Health, Our Future” – the Ministry of Health’s detailed analysis of the state of the nation’s health released yesterday – “demonstrates clearly and unequivocally the need for a realignment in health spending,” says the Royal New Zealand College of General Practitioners.

“Diseases and causes of death which are receptive to a preventative or early intervention approach are on the increase,” noted College Chairperson Dr Ralph Wiles. “Things like asthma and diabetes have increased in prevalence and diabetes is predicted to continue to rise. Smoking is declining among male, but not among females. Diet remains a problem, with the prevalence of obesity rising rapidly in the past ten to twenty years. And suicide now outrates road accidents as a cause of death.

“All these things could be dealt with at a primary care level with significantly more success than at present. But funding levels simply do not allow it. People see their GP when they are sick, and want a cure for that specific malady. Most doctors would also take the opportunity of an appointment to discuss risk factors such as obesity or smoking, but must face the fact that they may be doing so in the face of patient resistance and thus might require a longer-than-usual consultation, or several consultations, to ‘get the message across’.”

The College recently published a strategy document on primary care, which has been sent to key decision-makers in the health sector and in government. “One of the recommendations in that document is that government shift resources from secondary to primary care, and concentrate much more on prevention. Better to pay a GP and a Practice Nurse to spend time helping a patient with diet, smoking and exercise requirements than to fund heart surgery later on. Better for the economy, better for the patient, and better for society,” Dr Wiles says.

“When a report such as this concludes that ‘universal adoption of a diet in accordance with New Zealand food and nutrition guidelines would probably have an impact equivalent to the total elimination of smoking’ (i.e. 4302 deaths in 1996) then it’s time the government and the HFA looked carefully at where the health dollar is going. While nicotine addiction can be hard to break, and even getting a sedentary person to exercise can be difficult, a healthy diet is relatively easy to adopt.

“If GPs and Practice Nurses were properly funded for preventative work rather than expected to undertake this a no charge to the system as while at the same time diagnosing and treating a specific illness, then the health of New Zealanders would show a marked increase – and that, after all, is what health spending is all about,” Dr Wiles said.

“While primary care teams do an immense amount of preventative work now, it’s not always feasible to undertake it when it’s needed. If a patient presents complaining of shortness of breath and chest pains and is obese, then they’re going to be receptive to dietary advice and counselling on smoking cessation as part of the consultation. But what if the same patient, with the same obvious risk factors, presents complaining of having a cold? A perfunctory ‘you really should try and lose some weight, you know’ is not going to have much of an impact.

“The government funds ‘Well Child’ checks – consultations aimed not at tacking a specific illness but at monitoring and, if need be, addressing concerns about, the health of the child,” Dr Wiles pointed out. “Perhaps we need ‘Well Person’ checks too, where people can turn up at their GP every so often, and simply discuss their overall health in an unhurried atmosphere. A lot of follow-up could then be undertaken at less cost through Practice and Public Health Nurses.”

Dr Wiles said he was optimistic the new Minister and her officials would be supportive of some shift in funding from secondary to primary care. “Ms King appears open to new approaches and eager to really make a difference to health outcomes. While we can understand the urgency she feels, GPs hope that the new structure will also mean a new paradigm in care delivery. It’s not an insurmountable task, by any means. When 57 percent of New Zealanders are at risk from inadequate fruit and vegetable consumption, 42 percent from physical inactivity, and 24 percent each from smoking and high cholesterol, the answers are fairly obvious. Every dollar spent addressing those simple problems save several dollars in secondary care further down the road.”


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