A better balance of resources towards primary prevention of illnesses is one of the key focuses of a wide-ranging Review of the health system announced today by the Minister of Health David Clark.

The over-arching Review – which encompasses Labour’s election promise of  a review of primary health care funding – is to look at how the country structures, resources and delivers the $18.2 billion national health system for ‘decades to come’.

This is likely to include a shake-up of the 75 per cent ($13.2 billion) of health funding that is currently distributed via the 20 district health boards to not only provide secondary and tertiary services but also most aged care, mental health and primary care services.

“New Zealanders are generally well served by our health services, particularly when they are seriously unwell or injured. Overall we are living longer and healthier lives – but we also face major challenges,” said David Clark when announcing the Review to be carried out by an expert review panel with a final report due by January 2020.

Clark said the Review had to face up to the fact that the health system did not deliver “equally well for all” – particularly Māori and Pacific peoples – and also to “get real” about the impact of the growing and ageing population and the increase in chronic diseases like diabetes.

“Those issues in turn create pressure on services and the health workforce that need to be addressed for the long term sustainability of our public health service.”

The Review terms of reference (ToR) says the increasing pressures on the health system – particularly from the ageing population and growing prevalence of chronic diseases – needed to be addressed by a “greater focus towards primary and community-based care while also maintaining our world-class tertiary care services”.

As at present the country was “seeing demand, and resources directed to secondary services grow faster than primary services,” said the ToR. “Current incentives within the health system are causing many people, particularly those on low incomes, to wait until they are sick, instead of accessing the care they need to stay well.” 

It also noted that the current “devolved health system has a complex mix of governance, ownership, business and accountability models and arrangements”. “This complexity can get in the way of ensuring public money is spent to invest in, and provide healthcare to the public in a coherent and smart way,” says the ToR

The Review is expected to culminate in a report with a number of recommendations (see focus of recommendations below) and for those recommendations to also consider: demographic impacts, the international landscape, distribution of healthcare resources, changes to health funding systems, infrastructure investment, supporting primary care and prevention, as well as the opportunities and risks provided by technology.

“In considering the matters above, the Review should consider the overall structure, governance of the health system and distribution of resources to ensure it is fair, better balanced towards primary prevention, equitable and effective, as well as simple for people to access and navigate,” says the ToR.

The Review is also expected to give due regard to the already underway Mental Health and Addictions Inquiry and the Waitangi Tribunal’s WAI 2575 Health Services and Outcomes Kaupapa Inquiry, as well as the Ministerial Advisory Group on Health.

The Review is to present an interim report to Government by July 2019 and a final report by January 2020, including recommendations on:

  • How the health system can improve accessibility and outcomes for all populations
  • Whether the health system promotes the right balance between availability of services, (particularly tertiary services) population density and proximity
  • Whether the current system is well-placed to deal with environmental challenges such as climate change, antibiotic resistance and technological advances
  • Whether there are changes that can be made to the health system that would make it fairer, more equitable and effective
  • How the technological and global healthcare context is evolving, what opportunities and risks this rapidly-evolving context presents, and whether there are changes that would support the health system to adapt effectively given the rapid changes underway.

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