Election Selection - Picking over policies
Virginia McMillanvmcmillan@clear.net.nz
Feature
Virginia McMillan picks through the policies
on offer from political parties in search of some healthy
content
General practice funding woes may yet get traction in the run-up
to the election on the 26th of this month. Access and affordability
for patients, alongside after hours and capitation, are where some
of those seeking the vote are arguing change is needed.
There are also calls for new approaches to the business model, and
to recruitment and retention.
New Zealand Doctor invited political parties to comment
on issues of interest in primary care circles (see table).
On after-hours care, National has announced plans to roll out free
after-hours care for under sixes nationwide next year. It also
plans nationwide doctor and nurse-run telephone triaging.
The Greens do not have a policy on after hours but say a review is
needed to underpin a new approach, perhaps enforcing PHOs'
contractual obligations. From Labour also comes a promise to
provide free care for under sixes, 24 hours a day, seven days a
week. Newcomer Mana takes it further, arguing after hours should be
free for under-16s and seniors.
After-hours care for all communities is a policy plank for United
Future, although detail is lacking in its main document.
ACT, where the health spokesperson is former health and disability
commissioner Robyn Stent, wants targeted primary care subsidies
rather than ones that also cover the rich.
United Future sees the administrative and policy compliance burden
as taking up too many resources.
Labour and the Greens want general practice funding mechanisms
changed, the Greens pointing to outreach and integrated care, in
particular, as needing to be funded. Labour names rural and
vulnerable populations as key areas missing out.
Both put affordability as the goal. The two parties suggest the
business model needs work - likely to mean more emphasis on
salaried GPs.
Labour is battling after three years out of power, with former
health minister Annette King as deputy leader but the busy
Wellington Central MP Grant Robertson talking hard as health
spokesperson.
United Future is hottest on the issue of recruiting and retaining
New Zealand trained professionals in a competitive global market.
Sabbaticals and working holidays are among the Peter-Dunne-led
small party's solutions. Mr Dunne has had an associate health
minister role, as has Tariana Turia (Maori Party) in the National
line-up.
Labour, the Greens and United Future are united in seeing the
nursing profession as able to deliver more, given the right
structures.
A public health view also appears as a major theme among
opposition parties. The idea that government incentives toward
healthy environments and healthy choices can save and improve
lives, and prevent illness, seems writ large this time
around.
The Maori Party, as a coalition partner this term, had already
made a major public-health inroad. After it took the lead on
tobacco, National responded, saying in March it supported the goal
of a smokefree New Zealand by 2025.
Doctors and many other health professionals have in the past three
years been vocal about the harms of alcohol, warning it is too easy
to obtain. Now Mana (headed by former Maori Party MP Hone Harawira)
is targeting alcohol companies and wants to see alcohol advertising
banned.
The Green Party, with experienced health leader Kevin Hague in the
spokesperson job, advocates banning broadcast advertising of
alcohol and mandates warnings on alcohol products.
The party delves deep into day-to-day allowable activities in
schools (teach cooking, provide free fruit, allow only healthy
foods, and check on corporate food promotions).
It also wants the medical curriculum to take account of nutrition
and complementary therapies.
Overarching a large swathe of detailed Green policy is one stating
health of the population should be "a key goal across all
government activities".
By contrast, ACT says: "In a sense, the most important healthcare
policy is economic growth." Only with serious economic growth
policies will the country afford a world-class system, warns the
minor party that has had cabinet responsibilities this term and is
now led by the former National leader Don Brash.
National's responses show confidence that its fixes will keep
delivering in the areas it has deemed crucial, such as workforce
planning, downsizing bureaucracy,
increasing collaboration and elective surgery. For National, it
seems, public health is largely a matter of screening and
prevention strategies for a range of specific diseases.
National has had a high profile in health, thanks to the
high-energy, always-on-message minister Tony Ryall who has met
everybody who is anybody in the sector.
A confidence and supply arrangement with the Green Party saw
National adopt a home insulation subsidy programme with its origins
in public health research. The Greens say they would gradually
raise spending on prevention to 10 per cent of the health budget
over time.
Labour says it prioritises preventive health and primary care, and
presents numerous ideas for planning and implementing that. United
Future also takes a wide-reaching view and includes, for example,
action on air and waterway pollution.
The call from the NZMA and others for policies that reduce
inequities was broader still, pitching progressive taxation as one
way to improve health via tax and social policies.
Labour has been campaigning on a capital gains tax, while Mana
proposes a financial transactions tax.
Under Mana policy, fast foods would be taxed and GST wiped; Labour
would take GST off fresh fruit and vegetables.
ACT is sticking with its traditional lower-taxes philosophy.
Download
Health policy tables