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King: 2.5m New Zealanders now covered by PHOs

King: 2.5m New Zealanders now covered by PHOs

Health Minister Annette King says primary health organisations (PHOs) are going from strength to strength, with about 2.5 million New Zealanders now covered nationwide.

Six new PHOs looking after the primary health needs of about 257,000 people began operating this month, bringing the national total to 59. Ms King said she was very pleased to see that four of the six new PHOs are in the South Island, with two in Nelson-Marlborough, and one each in South Canterbury and Canterbury.

?In just 18 months, 59 PHOs have been established. I think that is an incredible success story. It takes us well down the road to providing fair, accessible and affordable public health services for all New Zealanders,?? she said. ?I am delighted with the way the PHO movement has developed around the country.

?PHOs have the very real potential to improve the overall health of all New Zealanders, giving us one of the best chances we've had in years of truly making a difference to the quality of life in this country.??

Ms King said figures from the October 2003 quarter show that more than half of all Maori (56.4 percent) and almost all Pacific peoples (92 percent) in the country are now enrolled in a PHO. ?The Government is committed to improving the health of high needs groups such as Maori, Pacific and people on low incomes.

?PHOs are not just about making primary health care more affordable. They have a public health focus, are intended to involve a whole team of health professionals offering a variety of services, and are charged with providing continuity of care for their enrolled populations.?

?Community participation in the governing process of PHOs is also important, because a strong primary health care system must give local people a voice in the planning and delivery of services in local communities,?? she said.

The new 1 January 2004 PHOs are (name of PHO, name of DHB, type of funding, estimated enrolled population): • Wairarapa Community PHO, Wairarapa, Interim, 37,000. • Hurunui Kaikoura PHO, Canterbury, Interim, 12,000. • Aoraki PHO, South Canterbury, Interim, 43,000. • Nelson Tasman Bay PHO, Nelson-Marlborough, Interim, 83,000. • Marlborough PHO, Nelson-Marlborough, Interim 32,000. • ProCare Network North PHO, Waitemata, Interim, 50,000.

Questions and Answers

What is primary health care? Primary health care covers a broad range of out-of-hospital services, although not all of them are Government funded. It aims to improve the health of the people in communities by working with them through health improvement and preventative services, such as health education and counselling, disease prevention and screening. Primary health care includes first level services such as general practice services, mobile nursing services and community health services targeted especially for certain conditions, for example maternity, family planning and sexual health services, mental health services and dentistry, or those using particular therapies such as physiotherapy, chiropractic and osteopathy services. Chronic diseases, such as diabetes, are best managed by primary health care services so complications can be prevented or mitigated.

What is the Primary Health Care Strategy? Launched in February 2001 by Health Minister Annette King, the strategy builds on the population health focus and the objectives of the New Zealand Health Strategy and the New Zealand Disability Strategy. It outlines how a different approach to primary health care will improve the health of all New Zealanders through: a greater emphasis on population health, health promotion and preventative care; community involvement; involving a range of professionals and encouraging multidisciplinary approaches to decision-making; improving accessibility, affordability and appropriateness of services; improving co-ordination and continuity of care; providing and funding services according to the population?s needs as opposed to fee for services when people are unwell.

What is a Primary Health Organisation (PHO)? PHOs are local provider organisations through which District Health Boards (DHBs) will implement the Primary Health Care Strategy. The essential features of PHOs are set out in the Minimum Requirements released by the Health Minister in November 2001: • PHOs will aim to improve and maintain the health of their populations and restore people's health when they are unwell. They will provide at least a minimum set of essential population-based and personal first-line general practice services • PHOs will be required to work with those groups in their populations (for example, Maori, Pacific and lower income groups) that have poor health or are missing out on services to address their needs • PHOs must demonstrate that they are working with other providers within their regions to ensure that services are co-ordinated around the needs of their enrolled populations • PHOs will receive most of their funding through a population needs-based formula (capitation) • PHOs will enrol people through primary providers using consistent standards and rules • PHOs must demonstrate that their communities, iwi and consumers are involved in their governing processes and that the PHO is responsive to its community • PHOs must demonstrate how all their providers and practitioners can influence the organisation's decision-making • PHOs are to be not-for-profit bodies with full and open accountability for the use of public funds and the quality and effectiveness of services.

What is the Government's high-level direction for the Primary Health Care Strategy? The agreed high-level direction is as follows: • Subject to the availability of funding, the public share of primary health care funding will be substantially increased over the next 8-10 years • Over time, as PHOs are formed, they will be funded according to the needs of their enrolled populations to provide more effective and affordable care with a population health focus • As this happens, reliance on the Community Services Card (CSC) will be progressively reduced • As the CSC will still be needed for a number of years, measures will be implemented to improve its take-up in the meantime.

When did the first PHOs begin operating? TaPasefika Health Trust and Te Kupenga O Hoturoa, in the Counties Manukau District Health Board (DHB) region, were established in July 2002.

How many PHOs are there now? There are 59, covering about 2.5 million New Zealanders.

What are the formulae that have been developed to fund PHOs? There are two: Access and Interim.

How does the Access formula work? It allows all those enrolled with an Access PHO to be charged low patient fees, or access free care, and there will be no need to use CSCs. In the first instance, the Access formula will be available only for PHOs (or practices/clinics within PHOs) serving populations with high concentrations of NZ Deprivation Decile 9/10 and populations with high health needs.

What about the Interim formula? Until there is enough funding for all PHOs to be on the Access formula, an Interim formula will apply to other PHOs/practices. The Interim formula will continue to use CSC status both for determining funding and setting patient fees. It includes additional funding for a range of new functions such as health promotion and extra services to improve access for high-need groups. Over time, as funding allows, the per capita amounts in the Interim formula will be increased towards the levels in the Access formula. This started on 1 October 2003 with increases for children and young people. All New Zealanders enrolled in PHOs aged 65 years and over will be eligible for low-cost primary health care from 1 July 2004.

How are the existing PHOs funded? >From 1 January 2004 there will be 33 PHOs that are Access-funded, 13 are interim PHOs and 13 are mixed (Interim PHOs with some practices in the area that qualify for Access funding).

Is it important that people enrol with a single practice in a PHO? Yes. Enrolment with one practice offers huge potential benefits to people who use their services, but it also requires a two-way commitment. It means the team of health professionals will work to maintain and improve the health of those people enrolled with them. The PHO will work with other health services in the area to make sure patients get the most benefit from good quality health care.

What benefits will people get if they keep visiting the same PHO practitioners they?re enrolled with? The potential benefits for New Zealanders who enrol with and stay with their regular primary health care provider are huge. International evidence backs up the importance of this sort of continuity of care where the PHO team gets to know their regulars and better understands and caters for their health needs, and people enrolled with PHOs can tell them about the services they want.

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