New Zealand health targets

At the commencement of the 2007/2008 financial year the New Zealand Government, in conjunction with District Health Boards, introduced health targets. The objective being to improve universal access to health services throughout the country, to all sectors of the population.

Health targets focus upon 10 areas, these being:

1. Improving immunisation coverage
2. Improving oral health Improving elective surgery
3. Reducing cancer waiting times
4. Reducing ambulatory sensitive (avoidable) hospital admissions
5. Improving diabetes services
6. Improving mental health services
7. Improving nutrition, increasing physical activity and reducing obesity
8. Reducing the harm caused by tobacco
9. Reducing the percentage of the health budget spent on the Ministry of Health

District Health Boards and the Ministry of Health are jointly responsible for working together to achieve target outcomes. Targets are negotiated for each District Health Board (DHB) area.

First quarter results were published in November 2007. Second quarter results are due around April 2008. These showed progress being made. In short, off the ten health targets set, eight were on track and two showed progress, however in these two instances, issues of data collection or implementation created difficulties in meeting targets.

It is noticeable these target areas appear not to include any direct focus upon the impact of excessive alcohol and drug use! Target areas 1, 2, 5, 8 and 9 have a primary care focus, where the aim is to help consumers take increased responsibility for their own health and consequently reduce the level hospital admissions. Achievement of these targets has a double benefit. The overall health of the population improves and the cost of providing public health services is reduced. There is a flip side to a healthy population. Healthy people live longer, thus increasing the cost of aged care.

The two areas where progress was made, but targets not achieved, were (3) improving elective surgery and (6) improving diabetes services. The measurement tool for improving elective surgery is the Elective Surgery Performance Indicator (ESPI). This measures the flow of patients through the hospital system. This target area is of particular interest to consumers as it measures the time those in need of surgery spend on the waiting list. ESPI’s go to the heart of productivity processes within a hospital.

There are three target areas within the health target for improving diabetes services. These include, free annual diabetes checks, good diabetes management and retinal screening.

One quarter of reporting does not an improvement maketh. In other words it is early days. Clearly some District Health Boards are experiencing difficulties establishing a quarterly reporting process. Given the Governments advance notice of health targets and the consultation process prior to their establishment, there is no excuse for quarterly reporting processes not being in place. Not having achieved this is a failure of management. Those District Health Boards experiencing such issues include two of the largest in the country, Auckland and Canterbury. The fact that significantly smaller DHB’s with lesser resources are able to achieve such processes doesn’t bode well for the larger ones.

It would be a reasonable expectation that all DHB’s would have in place quarterly reporting processes in time for the second quarter reports. The longer DHB’s take to achieve this, the more reason they provide both Governments and consumers with reason to ask why? A lack of transparency can lead to speculation, which is often incorrect, and can also lead to a suggestion that these DHB’s have something to hide.

Australia moves towards primary health care

The Rudd Government health strategy signal a move towards increased expenditure on primary health care. This assumes the consumer will take greater responsibility for their own health. It also suggests an increased level of expenditure by the Federal Government on creating awareness amongst the public off the consequences of poor nutrition, low levels of exercise, excessive imbibing and inadequate self care.

A recent media release by Federal Minister for Health and Ageing, Nicola Roxon, outlined the following:

• National Preventative Health Strategy to tackle issues of alcohol, tobacco and obesity
• An increased focus on preventative health care to be included in Australian Health Care Agreements with the State Governments.
• A review of the Medicare fee schedule

With the exception of the review of Medicare fees, which may or may not, increase the cost to the Federal Government, the other two outcomes require substantial, and prolonged investment, in creating public awareness. As has been witnessed by the billions spent over decades to create awareness of issues associated with driving motor vehicles, it will likely take the same level of investment, maybe even greater, to shift the perception of the public away from their current expectation that the health system will cater for all their needs; to a perception where each individual takes personal responsibility for their own health outcomes.

As suggested in an earlier entry to this blog, one impediment to consumers taking responsibility for their own health outcomes is the perceived low cost of health care. It would be easy to simply suggest the Government should increase the cost to the individual in an effort to discourage each of us from living decadent lifestyles. This is unlikely to be effective. Our past experiences with raising direct costs associated with motoring, smoking and drinking alcohol have shown that such increases rarely, if ever, have a sustained impact upon consumption. On the other hand, extended and comprehensive public campaigns have served to raise awareness amongst consumers.

If, as the Government appears to believe, the answer lies in primary care, in creating increased awareness, in providing information and education and in the consumer taking responsibility for their own health outcomes, then the program to achieve this is likely to consume the major slice of health spending by the Federal Government.

Add to this an expectation that each State Government will increase their focus on preventative health, suggests also that a significant portion of State Government spending on health will be directed towards education and public awareness. For every dollar spent on preventative health, one less dollar is available to spend on maintaining and expanding the hospital sector.

Now here is the rub. Assuming the Rudd Government has set the correct long-term strategy and assuming State government health ministers will be able to stand the heat and maintain a good working relationship with Federal ministers and assuming subsequent Federal Governments continue in this direction then at some point in the future people will spend less time visiting their GP or specialist and less time in hospital. At that point the savings from reduced health costs may equal the cost of Medicare. When this occurs both the cost of maintaining Medicare and the public hospital system will become sustainable.

In setting this direction the Rudd Government has lifted the lid on the Pandora’s Box of public healthcare and it may not be possible to ever put the lid back again. It is possible, the consequences of this direction, though not highly visible at present, may revolutionise public health delivery throughout Australia for ever.