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KiwiCare - Alliance Health Services Policy 2002

KiwiCare - Alliance Health Services Policy 2002

Introduction

The most important determinants of health are social, economic and environmental. The Alliance has presented policy that will:

reduce poverty

improve housing

strengthen families

improve workers wages

improve working conditions

pay teachers more and improve schooling

make tertiary education free again

improve the physical environment


These are policies for social justice and a cleaner, safer environment. We will keep NZ nuclear free and keep GE in the lab. Considered as a whole the Alliance policy programme is a blueprint for a healthy society.

Although some of these policies will have an immediate effect, such as improving child nutrition with restoration of the family benefit (reducing iron deficiency anaemia, for example), the impact of most of these polices on health will take time.

There are immediate health needs that must be met now.

It is the Alliance policy to ensure that all New Zealanders have access to health care when it is needed, not according to their ability to pay. The public health system will receive an immediate, large boost in funding of $840M from a 1% dedicated health tax – KiwiCare.

We are pleased with progress that the Labour-Alliance government has made implementing our 1999 Health Policy. We have returned to elected District Health Boards, eliminated unnecessary bureaucracy with the abolition of the HFA and strengthening of the Ministry of Health, and set in place the framework for community controlled Public Health Organisations. Where we would like to achieve a lot more is in improving access to primary care and reducing waiting times for public hospital treatment – predominantly a funding and staffing issue.
Goals

Under Alliance health services policy, our key goals for improvements in health services are:

 Free doctors visits
 Free medical prescriptions
 Improved access to dental and eye care
 Improved access to acute and elective treatment in public hospitals
 Improved mental health services
 Improved maternity care
 Funding long term stay in geriatric hospitals
 Increased pay to help solve the staffing crisis in the public health system
 Full support for the NZ Health Strategy including the Primary Health Care Strategy and the establishment of Primary Health Organisations
 A quality-focussed health system, with explicit incentives and recognition of quality practice

The following policy describes the key components of the Alliances 2002 Health Services Policy

Funding - KiwiCare

At present, 10.22% of individual taxable income is spent on health. We pledge to increase that to 11.25%, through a dedicated health levy of 1%. An extra one per cent may not seem much, but it would add $840 million dollars to the projected health vote for the current year and $1.5 billion to that of last year. The Alliance wants to put adequate health funding above politics. We will approach all parties to seek agreement for KiwiCare: a Dedicated Health Tax, a percentage of individual taxable income that must be spent on health and nothing else.

An extra $840 million would turn the New Zealand health system around. This would be allocated as per the following:

 $350 million extra will go on primary health care. All doctor's consultations will be free.

 Another $115 million to remove all prescription charges. At present, fees as high as $45 and charges of $15 keep many families from getting and following their doctor's advice. Our children suffer from untreated asthma and a variety of third-world diseases like rheumatic fever, TB, and Hepatitis B. Early treatment and preventive care will do away with this scandal and also reduce the costs of treating neglected medical conditions later on.

 $200 million extra will go to District Health Boards and Hospitals. The Alliance applauds DHBs for giving their staff increases above the level of inflation. However, thanks to this, their combined debt is now approaching $200 million and this is the minimum they need to meet their current operating costs. The salary increases are necessary for staff retention given that salary levels offered do not compare well with the incomes that highly regarded NZ graduates (doctors and nurses) can earn overseas.

The debt burden many young health workers now carry as a result of user-pays in education is a further incentive for them to go overseas. Young doctors can have debts in excess of $100,000 before they are even registered. The Alliance addresses this problem in its Tertiary Education Policy: students fees will be abolished; a living allowance paid; the present student debt forgiven after consultation as to the fairest formula.

 $100 million extra will go to cutting the time on waiting lists. The nonsense of waiting lists to get on waiting lists will soon be abolished.

 $20 million dollars extra will be used to meet the rural medical crisis. This is in addition to the $32 million of new funding announced by the government in March, making a total of $52 million. Some of this would go on the training of rural doctors, upgrading medical technology, and provision of clinics. But much of it would raise the incomes of doctors, nurses, and pharmacists to a level where their numbers in scarce areas (including urban ones) would increase and alleviate the intolerable work loads that exist at present.


 Another $55 million will be spent on mental health and public health initiatives, including sexual and reproductive health. Urgent needs to be addressed in mental health are covered in a separate policy.

Item Additional expenditure
Free doctor visits $350M
Free prescriptions $115M
DHB deficits $200M
Reduce waiting times $100M
Rural medical crisis $20M
Mental Health & Public Health $55M
Total $840M

Free Primary Health Care

With the exception of the US, New Zealand is unique amongst comparable countries in having significant financial barriers to primary health care. In some places adults can pay $45 (or more) for a routine medical consultation, and face prescription charges of $15 per item.

The Labour-Alliance government has signalled an increase in funding for primary health care over three years that will result in an extra $165M annually in the third year. While we welcome this, it is not enough. The Alliance will fully fund all doctor’s consultations. This will require an extra $350M, in addition to the budgeted increases.

 Subsidy of $42 per visit for everyone

The Labour-Alliance government will use $40M of the $165 already allocated to reward high quality practice, for example paying more for increased immunisation rates, and to fund PHOs for the extra administration required to operate a population-based primary care strategy. This leaves $125 extra available for doctors visits. Current expenditure is $180M. The Alliance will add a further $350M to these amounts making a total of $655M. The 3.8 million New Zealanders make 4.1 visits per annum, making an average subsidy of $42 per visit.

This will more than meet current GP fees, as a proportion of fees are already reduced or waived. Most importantly, in poorer areas, where charges are low already, it will result in a significant boost in resources available to practices for extra services, eg extra doctors, nurses or community workers.
 Remove prescription charges

We will also remove prescription charges so that a family can always get an appropriate medicine for free. This is a major problem for many families, and seriously affects the ability of poorer people to follow their doctor’s advice. The inability to afford prescriptions is almost certainly a factor in poorly controlled asthma for many families.

Early treatment for acute illness and removal of financial barriers to screening and preventive care will improve the health of many populations, particularly the most disadvantaged, and will also reduce secondary costs in the future. For example, in south Auckland epidemic rates of cellulitis could be reduced by early treatment with antibiotics. Although most GPs do not charge for children’s visits, the prescriptions still cost money, and are often not picked up. For children with asthma a single steroid inhaler (“preventer”) costs $15. Regular use of a preventer can prevent attendances at Emergency Department with acute asthma.

 Dental and optometry services
The Alliance will explore the best way to provide free dental and optometry services. These services would be the next major extension of primary care services when further funding from growth is available.

Public hospitals

 Fund deficits

There is no doubt that our hospitals are underfunded. The combined annual debt of DHBs is now approaching $200M. In the absence of further efficiency gains this is the extra amount required to meet current operating costs. Some of these costs are from age increases. The Alliance wants a boost in hospital wages, particularly for nurses who remain relatively underpaid in New Zealand.

 Standards for access

The Alliance hospital plan will ensure that 90% of New Zealanders are within a sixty minute road trip of a public hospital providing general services twenty four hours a day. Where small clinical volumes means that a doctor can not maintain their experience with a wide enough range of conditions (for example, rural surgeons), we will help those facilities with the provision of telemedicine services, and mobile surgical clinics. The Labour-Alliance government has already commenced a trial of mobile surgical services. We will not close remaining rural hospitals.

 $100M for reducing waiting times

Specialist services will again become available to everyone. The Alliance will also substantially boost funding to reduce surgical waiting times. We have budgeted an extra $100M specifically for reducing waiting times. However, a significant factor affecting waiting times is the lack of workforce (see later). Removing student fees, paying living allowances and stopping all interest payments on existing loans will reduce financial incentives for young doctors and nurses to leave New Zealand.

 No subsidies for private health

Medical and surgical specialists who run private practices will be encouraged to commit themselves to the needs of the public health system. Maintaining rural hospitals also offers the possibility of providing integrated community-level health care. In some areas, the small rural hospital can be the focus of community health services.

The full costs of all emergency and other services (such as intensive care, blood bank services, ambulances, MRI scans) which are provided for every patient transferred to a public hospital from a private hospital in an emergency will be recoverable, and private hospital systems will be required to make provision for that liability. There will be no hidden subsidies for the private hospital sector.

 The right to care and treatment

The Alliance supports the position of Health and Disability Services Commissioner but believes it needs to be adequately resourced to accomplish prompt investigation and reporting of complaints. The Commissioner administers a Code of Health and Disability Rights. This Code does not currently include access to services or timely treatment as a right. Timely treatment was accepted by the Cartwright Enquiry as axiomatic to ensuring good quality care, since delay frequently jeopardises outcome. Under our administration the right of access to services and timely treatment will be included in the Code of Health and Disability Consumer Rights. This commitment will make treatment within a minimum time the legal right of every New Zealander. The time for assessment and diagnosis for cases considered urgent by the referring GP will be six weeks. There will be no hidden waiting list. The maximum time for urgent treatment will be six weeks. The maximum time for ‘elective surgery’ will be six months.

Workforce development

There is a major issue with staff retention in the health system – the salary levels offered in New Zealand do not compare well with the incomes that highly regarded NZ graduates (doctors and nurses) can earn overseas. The debt burden many young health workers now carry as a result of user-pays in education is a further incentive for health workers to go overseas. Young doctors can have debts in excess of $100,000 before they are even registered.

Safe staffing must be implemented across both the public and private sectors. Negotiated safe staffing levels for nurses and other health workers will deliver the appropriate skill mix and manageable workloads in the health sector. To solve the staffing crisis in hospitals the Alliance has budgeted for CPI adjusted wage increases for all state sector workers, a major improvement in the coordination of medical workforce planning, and fully funded education. The Alliance will undertake a national tripartite review of nurses wages and working conditions to address recruitment and retention problems.

The Alliance will ensure that key public health functions remain funded and organised centrally, through the Ministry of Health, when this is the most effective way of delivering the services.

We will also give attention to workforce issues for critical support workers in the health sector. In particular we will address homecare workers payment rates and their limited access to training and career development through the provision of improved funding and minimum worker requirements in Government contracts and accreditation of recognised qualifications.

A strategy for pharmaceuticals and laboratory testing

 Using appropriate medicines

There will be a complete package to control the rising cost of pharmaceuticals, and to encourage the increased use of proven effective medication, such as “statins” for preventing heart disease or reducing the renal complications of diabetes. Current spending will be controlled so that those who need essential drugs can get them readily. Recognising quality practice will be a major feature of the strategy.

 Reducing variation

One of the keys to this policy is understanding, and if desirable, reducing, medical variation. The Alliance will fund research in this area. Strong financial incentives will be provided for high quality practice, by both hospital specialists and general practitioners.

 Natural and Traditional medicine

We will ensure that appropriate alternative treatments are available through the public health system when these are clinically prescribed. The extent of the provision of such treatments will be a decision to be made by District Health Boards, working within their nationally approved annual plans. The delivery of information and research on these treatments will be the responsibility of the Ministry of Health. Procedures for the recognition of alternative treatments will be transparent and independent.

The health care of children and young persons

 Child health DHB priority

An Alliance government will support facilities to establish the physical and mental well-being of children, the treatment of their illnesses, their rehabilitation where necessary and the re-establishment of normal growth and development. We will incorporate this emphasis in DHB annual plans.

 A national immunisation register

We will publicly fund the current immunisation programme and expand it. There will be major investment in raising immunisation rates to 95% through providing a range of providers with access to a national immunisation register, linking to birth data and with increasing funding available to immunise children that have not completed all immunisations by age 2.
 Plunket

The 6% government funding increase to Plunket over the last five years has been inadequate to ensure Plunket can fully deliver the essential services mandated in the national Tamariki Ora/Well Child Schedule. The Alliance will ensure Government funding meets the real costs required to provide a health service that invests in our children and families’ well health. We will also ensure Plunket is funded to adequately implement its Maori Strategic plan.

Mäori Health

The Treaty of Waitangi is the basis of Alliance policies directed towards improving the health of Mäori. The health of Mäori is well known to be generally poorer than that of Pakeha, even when allowance is made for the effects of low income. Mainstream health services have failed, by and large, to address Mäori health issues adequately. It is only with the recent development of health services controlled by and providing for Mäori that significant progress has been made in improving access and appropriateness. However there are still huge gaps, particularly in primary health care and mental health services.

We recognise rangatiratanga in the area of health and the status of health as a taonga. It is Alliance policy to improve Mäori health through a reduction in socio-economic disparities, ensuring that culturally and spiritually appropriate health services are available, and resourcing Mäori health initiatives.

Under our plan the government will take responsibility to guarantee equal access for Mäori to all health services, equity of outcome in the enjoyment of good health and the right to develop Mäori controlled health services.

We will ensure all health services are able to work effectively with Mäori clients and that culturally appropriate health services are available. This includes recognition of Mäori concepts of health and traditional healing methods, the involvement of Mäori in health policy and planning, the employment of appropriate Mäori staff at all levels of the public health system and the development of Mäori controlled services.

The health of the elderly

The elderly have special health needs and higher costs including more regular visits to the doctor, medical prescriptions and hospital services, including long-stay geriatric care. We do not see why people should be financially or otherwise disadvantaged for being old. We are please that we have achieved our 1999 policy of removing asset testing for long term residential care. General and base hospitals will include assessment and rehabilitation services. District hospitals will provide continuing care.

The Alliance will improve funding for aged care residential beds. This funding will be tagged to the improvement of wages, training and workloads for staff – not to increase the profit of private providers.

We will maintain, and where appropriate improve, current levels of rest home subsidy. In addition a variety of housing options will be developed offering different degrees of support as alternatives to leaving personal residency for full rest home care including a variety of home help.

Women's Health

It is a part of our plan that all women’s health care needs, including visits to the doctor, pharmaceuticals, screening programmes and maternity care should be met within the comprehensive public system we envisage. Free primary care is the key to implementing these policies. This will include in particular:

 Cervical and Breast screening

Our plan will meet the costs of an effective national cervical screening programme that is accessible, free from user charges and culturally sensitive. The same will apply to breast screening, which will be extended to when benefits are demonstrated. We will also pay for the introduction of other national screening programmes where they are shown to be effective. Adequate follow-up services will also be given priority.

 Maternity Care

The Alliance will support policies aimed at promoting and ensuring a choice of qualified birth attendants for women. We will pay for more adequate provision for post-natal care. Rural maternity services will be retained. The development of birthing centres for low-risk deliveries will be encouraged.

Sexual and Reproductive Health

New Zealand has high levels of sexually transmitted diseases and unintended pregnancies. We will enhance access to and information about sexual health and contraception; in particular this will include positive information for younger women on sexual health and fertility and provision of free condoms in schools.

The Alliance will provide free contraception and fully fund the Family Planning Association and Te Puawai Tapu.

An Alliance government will adopt the Abortion Supervisory Committee's recommendation that all medical practitioners may become certifying consultants for termination purposes. Services and research will be targeted to meet the needs of groups such as teenagers, Mäori and Pacific Island women, migrant women and women with disabilities.

In addition the Alliance will ensure:
 an increased focus on the health determinants, analysis and strategies to improve the health of Maori women,
 more effective strategies to protect women from violence,
 counselling and recovery programmes for victims of sexual, physical, mental and emotional abuse
 comprehensive and appropriate policies to support and address mental health issues that particularly affect women eg post-natal depression, anorexia nervosa, attempted suicide.


Public and Preventative Health

The Alliance will strengthen the position of public health services. We will ringfence public health funding and increase it. The Ministry of Health public health directorate will be responsible for providing accurate information on the health costs of social circumstances (e.g. employment, income, housing and various substance uses such as tobacco and alcohol). The Hazards Control Commission (Environmental Protection Agency - EPA) and the Environment Risk Management Authority (ERMA) will be required to report to and liase with the Ministry of Health. The Resource Management Act and the Hazardous Substances and New Organisms Act will be revised to ensure that the Hazards Control Commission and the ERMA will more effectively address and manage risks which impact on health.

The efficiency of public health protection measures will be improved through co-ordination with Regional Councils, which have responsibility for water, sewage, public transport, air and noise pollution and planning for the physical and social environment. We will also take significant preventive health initiatives.

 Alcohol

We will abolish tax deductibility for alcohol advertising. Some of the increased revenues this will entail will be directed towards funding treatment for alcoholism and services to victims of alcohol related violence. Funding will be increased so that sporting, recreational and artistic activities will be able to replace their alcohol sponsorship with health sponsorship. We will also increase funding for treatment of alcohol dependence and abuse and direct funding towards maximum cost-effectiveness. Alcohol containers will be required to carry general health warnings.

 Tobacco

We will take further steps to see that the major role that tobacco products have in creating ill-health and burdening the public health system is reduced by targeting the encouragement of reduced cigarette and tobacco use by young people. It is better for health promotion efforts to go into targeting young people before they start smoking than to penalise adults who are already smoking. Manufacturers will be required to provide adequate product information about the dangers of smoking including passive smoking during pregnancy. There will be no loosening of current restrictions on tobacco advertising.

Because of the huge burden of illness and premature death placed on the Mäori community by tobacco, we will give high priority to Mäori health initiatives aimed at reducing smoking. Priority will also be given to reducing exposure to smoke during pregnancy and early childhood.

 Environmental health

Legislation will be passed to ensure the more effective removal of harmful and damaging contaminants from air, water and food. The Alliance will insist upon much more detailed product information labels on food and beverages, including identification of any components that have been genetically engineered. The administration of hormonal growth promotors to farm livestock will be banned.

The personal health risks as well as the environmental effects of potential hazards such as pesticides are inadequately known. It is our policy to extend funding for this research to more adequate levels, and on the basis of this research we will take further environmental protection and preventative health measures. Improved information and better understanding of the impact of natural environment contamination and poor social conditions will lead to improvements in the health status of communities and individuals.


No more reorganisations

The continual re-organisation of the health sector in the last 15 years has left the sector very fragile. Critical processes are not working as they should as institutional memory has been destroyed. As administrative structures have changed accountabilities have become blurred and quality has not been maintained.

The Alliance will not change the overall structure of the existing health system. It needs time to become functional. The Alliance will support current initiatives towards safety and quality in our hospitals, and towards paying primary care providers based on the quality of the service they delivery.

Conclusion

It is really remarkable that we do not have an adequate health service. People who visit NZ, or to come to live here, get a nasty surprise when they have a health problem. In Australia, or the UK (and Canada, and most of Europe) you do not pay for most health services. They are funded from general taxation and special levies (MediCare or National Insurance). Doctors from Australia who come to work here are stunned that a GP can not order an ultrasound scan for a patient – the patient has to buy it. If they can’t afford it, they don’t get it – or they turn up at ED, and get ten times as much spent on them as necessary.

Survey upon survey has shown that people would be prepared to pay more tax if they knew it would buy health services. It is both socially just and economically sensible to implement KiwiCare the Alliances health services policy. By strengthening primary care and putting the hospitals on a sound financial footing we can have a much better health service.

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