Hikoi of Hope: Health

Health

A system we can trust

from The Jobs Letter No.85 / 27 August 1998

New Zealand's hospital waiting lists and waiting times are among the longest for developed countries. Latest official figures estimate 2,500 in every 100,000 New Zealanders are on surgical waiting lists - nearly five times the rate of Australia's and about three times the rate of Holland's and Canada's. England also has long waiting lists, though New Zealand's rates per population are about 8% higher. In 1997 there were more than 38,600 people (42% of the official waiting lists) waiting longer than a year, and more than 20,000 (22%) waiting longer than two years. In Holland, a six month wait for an operation is considered unacceptable.

"While total government health funding has increased in real terms in recent years, the extra money is not going to hospital services."
A decade ago the public was represented on elected area health boards. Community Health Committees were established and there was a requirement to involve the public in areas such as mental health and maternity care. Today there is no elected public representation on any health organisation apart from a few individuals nominated by local body councils to sit on CHE boards. In June 1998, the few surviving community health groups had their small state funding allowance abolished.
Rural hospital procedures have been reduced by about a fifth since 1993. In 1992 there were 1,000 surgical discharges from Dargaville Hospital, last year there were 45. Balclutha Hospital's discharge rate fell from 1,716 to 71. Rural general practitioners are leaving their practices because of overwork. Provincial New Zealanders are having to travel to main centres for basic health treatment. International research into safety and cost effectiveness of small hospitals suggests centralisation of services may not achieve the benefits that are often claimed.
Total public hospital discharges per 10,000 population increased by only 1.3% between 1994 and 1997, despite advances in technology which enables patients to recover more rapidly and more surgery to be performed on a day-treatment basis. Between 1990 and 1993, under the previous area health board system, hospital discharges per 10,000 population increased by 19.6%.
In 1991/92 the cost of administering the public health system through the Department of Health totalled $52 million. The administration budget for this financial year is more than $120 million, shared between the Ministry of Health and the Health Funding Authority. (A relatively small portion of this increase would be due to the administration of disability support services which were previously administered by Social Welfare.) Our public hospital companies employ one manager for every five medical staff (compared with one manager for every 14 medical staff under the previous Area Health Board system). Hospital companies are now spending an estimated $330 million on managers and administration, due largely to the work involved in contracting.
While total government health funding has increased in real terms in recent years, the extra money is not going to hospital services. Total government health spending increased by 3.6% between 1988/89 and 1996/97 in real per capital terms, but hospital funding decreased by 6.3% , even when taking into account CHE deficit financing and adjustments for different funding arrangements when area health boards changed to CHEs. CHE/public hospitals are $1.3 billion in debt; they pay about $60 million in interest payments annually.
In 1980 New Zealand government spending on health was 6.2% of gross domestic product (GDP), which placed us 4th among OECD countries. Since then we have been one of only five countries to reduce health spending per GDP. By 1996 New Zealand government spending (including GST and CHE deficit financing) totalled 5.8% of GDP, placing us 14th among OECD counties. Over that same period, private health spending increased from 12.0% to 23.3% of GDP.
About 200,000 New Zealanders had not seen a doctor when they needed to during 1996/97 because of user charges, according to a Statistics New Zealand survey. A survey of GPs published in November 1995 showed 71% of respondents believed their patients were delaying seeing their GP because of the cost.
The Mental Health Commission estimates staff numbers for children's mental health services must increase eight-fold to meet the country's needs, and the number of staff working in adult services needs to double. Despite these signals, Wellington mental health services are facing cuts of up to 20 staff, and the general manager of mental health services at Waitemata Health said severely disturbed mental health patients are dangerously overcrowded and people are being discharged too early because of the demand for beds.
Compared to other OECD countries, New Zealand has high rates of cardiovascular disease, respiratory disease, breast and bowel cancer, motor vehicle injuries and suicide.
Many cases are preventable. In 1960, New Zealand's infant mortality rate ranked 6th out of 21 OECD countries; by 1995 we were in 5th place. Life expectancy has not increased as fast as in many other OECD countries.
Since 1990, Maori life expectancy has not increased. Generally, Maori experience a higher infant death mortality rate (mainly due to sudden infant death syndrome), high death and hospitalisation rates in infant, childhood, youth (predominantly from injuries, asthma and respiratory infections) and higher mortality and hospitalisation rates in adulthood and older age (especially from injuries, cardiovascular and respiratory disease, diabetes and most cancers). Maori are more than twice as likely to be admitted to hospital than non-Maori.
Sources -- Purchasing for Your Health, Ministry of Health, NZ, 1998; Federal Minister of Health, Australia, media release, 17 March 1998, British Medical Journal, 11 January 1997, 21 March 1998; Department of Health, England, media release, 16 June 1998, 30 June 1998; Minister of Health media statement, 28 May 1998; Otaki Community Health Group, media release, 8 June 1998; Opposition spokesperson on Health, media release 15 June 1998, 9 July 1998; Concentration and Choice in the Provision of Hospital Services, NHS Centre for reviews & Dissemination, report 8, 1997; Morning Report, 22 June 1998; Minister of Health, media release (based on data from the New Zealand Information Service), 21 May 1998; New Zealand Health Review, Winter 1998; Department of Health Annual Report, 1991/92; Budget 1998; Health Expenditure Trends in New Zealand, Ministry of Health 1998; Alliance health spokesperson, media release (based on response to a question in Parliament), 10 March 1998; Health Expenditure Trends in New Zealand, Ministry of Health 1998; Statistics New Zealand; Trends in Area Health Board/CHE Performances, Deloitte, Touche Tohmatsu, May 1996; Health Expenditure Trends in New Zealand, Ministry of Health 1998; 1996/97 New Zealand Health Survey, Statistics New Zealand, July 1998; Blueprint for Mental Health Services, Mental Health Commission, 1998; Evening Post, 27 July 1998; NZ Herald, 10 July 1998; The Social, Cultural and Economic Determinants of Health in New Zealand: Action to Improve Health, National Health Committee, 1998; Progress Towards Closing Social and Economic Gaps Between Maori and Non-Maori, Te Puni Kokiri, Ministry of Maori Development, 1998.

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