Have you ever tried to explain to a new graduate, or someone who has immigrated to New Zealand, what all the different health sector organisations do and how they fit together?
It’s not easy, is it?
There are a couple of reasons for that.
First, the reality is that there are multiple organisations and structures, many with similar sounding names, and often with quite a bit of cross-over in what they do.
You’ve got the Health and Disability Commissioner and the Health Quality and Safety Commission. You’ve got the Health Practitioners Competence Assurance (HPCA) Act, the New Zealand Public Health and Disability Act, and the Health and Disability Services (Safety) Act. You’ve got Medsafe,which regulates medicines, and PHARMAC,which decides which medicines to fund.
And just to add to the confusion, the health sector really loves a good acronym: you’ve got the DHBs, the PHOs, the MoH and of course the ACC. And don’t forget about the HPDT – that is, the Health Practitioners Disciplinary Tribunal, which can strike you off the register if you do things that you shouldn’t be doing. It’s enough to make the clearest of minds boggle.
Secondly, New Zealand’s health sector is truly unique. As New Zealanders, we seem to be inherently at risk of overstating our uniqueness and sitting back, smugly, knowing that we really do live in the best country in the world. But when it comes to systems for regulating health professionals and health services, the claim is valid. New Zealand really is unique. And complicated.
So how do we make sense of all of this?
Let’s be realistic here and keep our aspirations modest. To keep it simple, take it back to what you need to tell the new graduate or immigrant. We’d start by telling them four things about the way it works in New Zealand.
- Providing health services
Most of New Zealand’s health system is publicly funded with the Ministry of Health (MoH) allocating more than three-quarters of Government health funding via district health boards (DHBs). DHBs are responsible for providing, or funding, the provision of health services in their district, including public hospital services. DHBs are established by the New Zealand Public Health and Disability Act (2000). DHBs’ objectives include improving, promoting and protecting the health of people and communities and reducing health disparities.
DHBs fund primary health organisations (PHOs) to support the provision of essential primary health services. Many general practices are funded through a PHO. DHBs also fund aged care services contracts plus services provided by non-governmental organisation (NGO) providers including Māori and Pacific health providers and some community mental health and disability service providers.
We also have a well-established network of private health providers. Health services provided by private providers will be paid for in a number of ways – including by health insurers, the patients themselves and, in some cases, by public funders of health services.
- Patients’ rights and health professionals’ responsibilities
Everyone needs to know about the Code of Health and Disability Services Consumers’ Rights (Code of Rights). This sets out the legal rights that health consumers have, and the corresponding duties and responsibilities on individual health professionals and health provider organisations.
The Code of Rights applies to health services provided in both the public and private sectors.
If a patient makes a complaint, it may end up before the Health and Disability Commissioner (HDC). It’s the HDC’s job to receive complaints and, where appropriate, investigate the complaint and form an opinion as to whether any health professional or provider organisation has breached any right in the Code of Rights. In the most serious cases, the HDC can refer the matter on to the Director of Proceedings, who has the power to bring legal proceedings against the health professional or provider organisation.
- Treatment injuries and compensation
This is one of the biggest differences to other countries. In short, patients can’t sue anyone when the treatment goes horribly wrong. There are some exceptions – but let’s not worry about them for now. The basic rule is that you can’t sue for personal injury in New Zealand. Instead, where there has been a treatment injury, the patient has the right to seek cover from the Accident Compensation Corporation (ACC). If ACC grants cover, ACC will then determine what entitlements the affected patient receives. Entitlements might include, for example, rehabilitation costs or compensation for lost income.
- Regulation of health professions
Many – but not all – health professionals in New Zealand are regulated by a single piece of legislation – the Health Practitioners Competence Assurance Act (2003).These health professionals are called health practitioners.
Each regulated health profession has a Responsible Authority appointed to regulate the profession. For example, the Nursing Council regulates nurses; the Medical Council regulates medical practitioners; the Physiotherapy Board regulates physiotherapists, and so on.
Responsible authorities set scopes of practice for the particular profession and for each individual practitioner. The authorities can require a practitioner to undertake certain activities to assure the authority of the practitioner’s competence and safety to practise. The authorities can take action to protect the public if there are concerns about a practitioner.
Formal professional discipline is the responsibility of the Health Practitioners Disciplinary Tribunal (HPDT). This is an independent tribunal that hears charges of professional misconduct and other disciplinary matters. It has the ultimate power to cancel a practitioner’s registration.
So that’s it. A 101 guide to some of the key structures that make up the New Zealand health sector. There is of course much (much) more to it. However, knowing about the four things introduced above will be a good start.
Author: Dr Jonathan Coates, who has a master’s in medical ethics and law and a PhD in health law, is a partner in specialist health sector law firm Claro. Claro recently launched an e-learning platform called Clarify, aimed at health professionals, offering professional development modules on different aspects of health law, including an overview of the New Zealand health sector: www.clarify.co.nz
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