Revealed: Better Health Outcomes For All
20 December 2004
Revealed: Better Health Outcomes For All
The roll-out of Primary Health Organisations is contributing to advances in the battle to reduce health inequalities.
This is one of the findings in the Ministry of Health's annual Health and Independence Report 2004which documents the performance of the health sector and the state of public health in New Zealand.
The report, released today by Director General of Health, Dr Karen Poutasi, reveals that more than 3.7 million New Zealanders have enrolled in Primary Health Organisations (PHO) since the first was established in 2002.
Importantly, this includes a significant proportion from the target high needs groups. Nearly 80 percent of people living in high deprivation areas now belong to a PHO and many now receive low cost healthcare.
"These developments indicate that financial barriers to primary health care for disadvantaged populations can be addressed by the roll-out of the Primary Health Care Strategy," says Dr Poutasi. "Cost is a barrier to health for low income people, yet it is often these people who have the greatest health needs.
"PHOs bring public health initiatives alongside traditional general practice to strengthen health promotion and illness prevention efforts."
The Health and Independence Report 2004 focuses on the progress the health and disability system is making towards strategic goals, identifying successes and achievements and discussing critical issues and challenges facing the sector. It is intended to be a resource for a wide range of users, including health planners, health service providers, policy analysts, community groups and those interested in the sector.
"A major part of this year's report explores how we are achieving goals of equity and access, quality, efficiency, effectiveness and intersectoral focus," says Dr Poutasi.
The report reiterates that health inequalities persist, most affecting Maori and Pacific peoples and economically disadvantaged populations. It highlights actions across the sector to address these disparities.
Key findings of the report include:
New Zealanders now have a more positive view of the health system than in 1998 the Government spent on average $1863 per person on health in the 2002/03 year the number of patients waiting longer than six months for their first specialist assessment for elective services has decreased slightly infant mortality has decreased markedly over the last 50 years a substantial increase in numbers of people with diabetes enrolled in Get Checked programmes avoidable mortality has declined by 48 percent since 1980.
Many population-level interventions are now producing positive effects. These include smoking cessation programmes such as Quitline, the Green Prescription programmes aimed at enhancing physical activity and the free fruit in schools programme. The national roll-out of the Meningococcal Vaccine Strategy is expected to have a big impact on controlling the meningococcal B epidemic.
These interventions, along with the reshaping of the primary care sector, are part of the drive to reduce the health burden from chronic diseases such as diabetes and cardiovascular disease, which are the leading cause of morbidity and mortality in New Zealand.
Efforts are also being made to improve cancer control management and services. The New Zealand Cancer Control Strategy and an associated action plan have been formulated to help set the direction for cancer control over the next five years. As well, an independent Cancer Control Council is being set up to provide a sustainable focus on cancer control, and the new position of Principal Advisor, Cancer Control, at the Ministry of Health, will shortly be established.
Work to improve coverage for the country's two national cancer screening programmes continues. A highlight in 2004 was the extension of the age range for women eligible to receive free mammograms through BreastScreen Aotearoa to include women aged 45 to 69 years. This enabled more than 200,000 additional women to access publicly funded breast screening.
There has been concern over waiting times for oncology treatment. Increased numbers of people training to deliver medical radiation therapy are expected to improve waiting times for radiotherapy treatment.
The Health and Independence Report 2004 is available on the Ministry of Health website www.moh.govt.nz
Why is this report being produced?
The Director-General of Health is required to report to Parliament annually on the state of public health within New Zealand. This report brings together a wide range of information from a number of sources, presenting a co-ordinated and cohesive picture of the performance of the health and disability support system. In 2004 the report has a stronger focus on health outcomes than in previous years - in other words, the contribution that publicly-funded services make to improving people's health or their ability to live independently and participate in society.
What does the report contain?
The report looks at the public funds which are allocated to health and disability support services in New Zealand, the workforce underpinning the sector, the services that are delivered and what those services are achieving by way of their contribution to the health and independence of New Zealanders. This year's report explores how we are achieving goals of equity and access, quality, efficiency, effectiveness and intersectoral focus. It also looks at wider societal goals: better health, reduced inequalities, trust and security, and better participation and independence.
What are interim headline indicators?
A feature of the report is its reporting of progress against health and independence indicators, which link back to the goals and objectives of key sector strategies including the New Zealand Health Strategy, the New Zealand Disability Strategy, He Korowai Oranga (the Maori Health Strategy) and the Primary Health Care Strategy. They also reflect the Ministry's policy priorities for 2004/05. The interim headline indicators have been identified as having potential to shed light on wider aspects of system performance. As they are only interim, they will be reviewed in 2005 as part of the Ministry's wider examination of system performance indicators.
Who is the audience for the report?
The Ministry hopes that the report will be widely read, to increase the community's understanding of the health sector, the resources devoted to it, how they are spent and what that expenditure achieves. It is intended to act as an information resource for a wide range of users including health and disability support service providers, those responsible for health policy and planning, community groups and professional bodies
How do New Zealanders view the health system?
New Zealanders now have a more positive view of the health system than in 1998. The 2004 Commonwealth Fund Survey found that only 19 percent of New Zealanders felt the health system should be rebuilt, down from 32 percent in 1998. As well, 60 percent of New Zealanders said they had received same day access to medical care when they were last ill - the highest percentage of the five countries surveyed (New Zealand, Australia, Canada, the United Kingdom and the United States) (pg 56) In the quarter to June 2004, 90 percent of patients surveyed on their satisfaction with treatment received in public hospitals indicated they had received either good or very good service from their District Health Boards (page 55).
What are the key findings of the report?
The report details a range of indicators showing progress towards health and disability support sector goals. These include:
In 2004/05 the total Vote Health spend was $9.92 billion, or 20 percent of the total government expenditure budgeted for the year (pg 19). In real dollar terms, the Government spent on average $1863 per person on health in the 2002/03 year, compared with $1401 ten years earlier (pg 21).
Infant mortality has decreased markedly over the last 50 years, from 31.1 deaths per 1000 live births in the 1950s to 6.1 deaths per 1000 live births in 2000/02 (pg 34).
Avoidable mortality has declined by 48 percent since 1980. There are however higher levels of avoidable mortality among Maori and Pacific peoples, and in higher deprivation groups (pg 155).
Diabetes management is improving, with the number of people with diabetes enrolled in the Get Checked programme up from 35 percent in 2001 to 59 percent in 2003. Improving coverage is also evident for Maori and Pacific peoples (pg 163).
The suicide rate was slightly higher in 2001 than in 2000, however the rate for males was the lowest it had been since 1986 and the Maori male youth suicide rate was the lowest since 1996 (pg 190).
Cigarette consumption declined by 27 percent over the five years to December 2003 (pg 168).
The 2002/03 New Zealand Health Survey recorded 35 percent of adults as overweight and 21 percent of adults as obese. The prevalence of obesity in the total population is increasing (pg 178).
While cancer mortality has declined since 1990, the incidence of cancer is increasing. About 16,000 people develop cancer each year and forecasts suggest this could rise to 22,000 by 2011 (pg 119).
The number of patients waiting longer than six months for their first specialist assessment for elective services has decreased slightly, from 27,897 at the end of 2002/03 to 25,425 on 30 June 2004, indicating that DHBs are improving their systems in matching commitments to provide assessments with their capacity to deliver (pg 80). An orthopaedic initiative which began on 1 July will double by 2008 the number of major joint replacement operations currently performed in public hospitals (pg 84).
Fifteen percent of adults with disabilities received a needs assessment at some time. Lack of awareness about Needs Assessment and Service Co-ordination agencies is higher among Maori (41 percent) and Pacific (50 percent) people with disabilities than other ethnic groups (33 percent) (pg 91).
The average length of stay in hospital has fallen by 50 percent since 1988/89, from 6.6 days to 3.2 days in 2003/04. This is largely due to advances in medical technology, such as new surgical techniques, more effective drugs and improved community and follow-up care, as well as more effective hospital administration (pg 139).
The total net result of all DHBs has improved substantially from 2001/02 to 2003/04, with the net total deficit falling from $286.7 million to $48.6 million. This is largely due to increased Government funding, but it also reflects the significant efforts of boards to operate within their funding (pg 144).
The proportion of people treated on a day case basis increased by 14.4 percent each year from 1988/9 to 1995/96 and a further 3.3 percent each year to 2003/04 (pg 141).