01 DECEMBER 2009
Mixed reception to taskforce’s "old-hat" ideas
Virginia McMillan
vmcmillan@clear.net.nz
DAILY NEWS: Economic taskforce’s ideas on health "old-hat" say critics
“Old-hat ideas” and “outdated ideology” are the views of two trenchant critics of the Don Brash-led New Zealand-Australia taskforce’s recommendations on health.
But some in the health sector are cautiously welcoming the Closing the income gap with Australia by 2025 report.
The economic taskforce’s report was released yesterday and suggests, among 35 recommendations, that universal subsidies for doctors’ visits be abolished.
This call accords with the view of the NZMA, where chair Pete Foley says there has long been concern that targeting to low-income people is preferable to subsidising all.
ACC a model health organisation
The taskforce also cites ACC as its model health organisation, because it has separation between funder and provider, and contracts 80 per cent of its work to the private sector.
“In such a world, there is little obvious place for district health boards (DHBs), much less 21 of them,” the report says.
Dr Foley is not sure that a split necessarily gives better health outcomes but says there are too many DHBs and New Zealand has not got the private-public partnership balance correct yet.
Increasing GP fees bad idea
Preventive health researcher Robin Gauld, who calls the report “old hat”, is concerned at the notion of increasing GP fees.
A quarter of people already avoid GP visits because of cost, he says. “That is a real worry.”
Dr Brash’s taskforce says hundreds of millions of dollars a year can be saved by removing the subsidy from the middle class and above.
But Dr Gauld suggests the Government put more money in, so the least well-off have equitable access, and perhaps add a means test “so that millionaires don’t get free care”.
He also says low prescription charges here are the envy of overseas peers. The public might adapt to a rise from a $3 to a $5 fee (the taskforce wants consideration given to $30).
What about quality?
An associate professor in preventive and social medicine in the Dunedin School of Medicine, Dr Gauld says the Brash report has failed to identify the importance of quality improvement. This needs to be a national approach to serve the patients’ best interests, and reduce errors, readmissions, costs and improve safety.
ASMS chief executive Ian Powell says harking back to the Health Funding Authority of the 1990s, as the taskforce does, is just outdated ideology.
The HFA didn’t offer cost-effectiveness but narrowed the focus to contracting, he says. This brings a risk of omitting and fragmenting services just when integration is sought.
The taskforce also appears out of date for its questioning of national employment agreements for doctors, according to Mr Powell. Competition for senior doctors takes place among countries or states with collective contracts, he says.
Effects upstream and downstream
Harry Pert, RNZCGP president, says he’s wary of picking off easy things to change without thought about upstream and downstream effects.
After 15 to 20 years New Zealand still hasn’t had the clinically led reforms of medical care it needs – reforms that would be taken from the patient experience – “what the patient requires rather than what institutions require”. He welcomes the latest contribution to a much-needed debate.
Related links:
Answering the $64,000 Question, Closing the income gap with Australia by 2025 report
Statement from Finance Minister Bill English
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