Saturday, February 16, 2008

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.

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