Life support

Life Support: Will government health reforms help the current state of the system?

Experts have “considerable hope” that health reforms will be more than a band-aid for a system that is caving under pressure, but fear it may struggle to function and change could take years.

July 1 marked the most sweeping change to the nation’s healthcare system in more than two decades. The 20 District Health Boards have been abolished and New Zealand Health and the Maori Health Authority forged in their place.

The move came amid one of the worst winters Aotearoa has seen in years, and amid mounting pressure on GPs, primary care, hospitals and planned care – highlighted this week in the Stuff’s Life Support health status survey.

A University of Otago panel on Wednesday night called for a “significant” overhaul of how health care is funded in New Zealand, and said reforms would fail if workforce issues n were not resolved.

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Public Health Professor Peter Crampton led a discussion on health reforms, as one of four in the the university’s annual winter symposium series.

Crampton was joined by Professor Robin Gauld, pro-vice chancellor of Otago Business School and co-director of the Center for Health Systems and Technology; GP and Professor Tim Stokes; and public health physician and dean of the Dunedin School of Medicine, Professor Joanne Baxter.

A panel of health experts remains hopeful for health reforms, but says more emphasis is needed on primary care, on how we finance health and on tackling health problems. workforce.

Kathryn George / Stuff

A panel of health experts remains hopeful for health reforms, but says more emphasis is needed on primary care, on how we finance health and on tackling health problems. workforce.

Labor causes a “crisis”

New Zealand health workers have become a critical point of contact.

Stokes said the reforms offer the opportunity to achieve more equitable patient outcomes, allowing more people to receive high-quality, accessible and timely care.

However, he said we cannot implement changes in the healthcare system without a strong workforce.

Healthcare workers have “high intrinsic motivation” to care for their patients. However, we have moved from intrinsic motivation to “moral distress”, where clinicians cannot always provide timely care to patients as they wish, given external pressures: “this needs to be fixed”.

Gauld said we were ‘very, very behind where we need to be’ in health staffing, and it was time the issue was brought ‘to the forefront’ – particularly by increasing Maori health staff and the Pacific.

However, this would take “many years” to resolve, and there was no easy answer.

Baxter said that due to the previous DHB setup, there is “patchy” information about health workforce gaps and regional differences.

It was difficult, because “it’s a crisis right now”, but being able to step back and think about it at the national level would be really important, and she thought the reforms would offer a “better position” to do so. to face.

“You have to be patient”

The time it takes to incorporate such changes has also been raised as an issue, with experts saying New Zealanders need to be patient as many – including on the frontline – won’t see any differences for some time.

“It will take time, and people need to understand that,” Stokes said.

Stokes said he believed the reforms were a “road paved with good intentions”.

“This road could, I hope, lead us to a ‘New Jerusalem’ – be transformative and enable equity.

“But it could lead us down a road to a darker place, where reforms essentially become structural reorganization, where we then allow the current pressures on New Zealand’s health system to go unaddressed.”

Dr Robin Gauld suggested that Aotearoa open the debate on a “social insurance” health care financing model, to allow for greater equity.

Provided

Dr Robin Gauld suggested that Aotearoa open the debate on a “social insurance” health care financing model, to allow for greater equity.

“Rethink” funding needed

Gauld believed the reforms would struggle without a “fundamental overhaul” of the way we finance health.

Currently, funding is split between primary care and the public hospital sector. The private and public hospital sectors operate in parallel, but the private benefits “significantly” from public backing and support.

“The objectives of coordination and equity [in the reforms] are inherently undermined by these underlying institutional arrangements.

Gauld also said we needed a “serious debate” on a social insurance model for health care – a scheme similar to the ACC, funded by a combination of employee and employer contributions, as well as funding governmental.

He noted that while there is no perfect model, social insurance is based on equity and opens the resources available in the system to everyone, whether public or private.

Stokes also noted that Aotearoa is not spending enough on health, to be able to correct historical underfunding of primary and community care.

Hope for collaboration, community voices will be heard

The role and scope of the new Maori Health Authority was also widely discussed.

The “persistent and pervasive” health inequalities facing Maori were “unacceptable” and clearly visible in morbidity and mortality data, Baxter said.

Professor Joanne Baxter said Maori had been poorly served by the health sector in the past and hoped that the establishment of the Maori Health Authority would enable Maori to be present and engaged in the system, in a way that works for them.

Provided

Professor Joanne Baxter said Maori had been poorly served by the health sector in the past and hoped that the establishment of the Maori Health Authority would enable Maori to be present and engaged in the system, in a way that works for them.

The Māori Health Authority was an important platform to enable increased Maori presence, engagement and representation in the health system, including through the voice of the iwi partnership councils.

Baxter was “optimistic” this would result in services actually meeting the needs of Maori.

But again, it wouldn’t happen overnight, and its existence was already in question.

“We know that for such significant changes to make a difference, we need to give it time, resources and support.”

Baxter “very much hopes that we will have the opportunity and the time to help the [Māori Health Authority] realize their aspirations. »

If the reforms work, the health system would have both local insight into community needs and national oversight of emerging inequalities – balancing these and ensuring equity would be one of the big challenges ahead.


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