New Zealand cuts health spending to control costs

Abstract

When Robyn Pope was diagnosed with breast cancer in 2008 she was told that she would have to wait two months for mastectomy if she wanted breast reconstruction as part of her treatment in the public health system. Two months may not seem like long time, says Pope, mother of three, who lives on the Kapiti Coast of New Zealand, day lived knowing that you have cancer in your body is like an eternity. underlying reason for the delay was familiar one--funding. Like other countries offering universal health care, New Zealand struggles to meet the steadily growing demand for full range of high-quality health services offered largely for flee to everyone, while remaining cost efficient. In the past eight years, New Zealand's total health expenditure has doubled to 3.6 billion New Zealand dollars (NZ$) (US$ 10 billion). In the face of economic slow down, the government is calling for reform to rein in this expenditure. High-income countries with ageing populations need to look for efficiencies in their health says Riku Elovainio, health economist at the World Health Organization. the pursuit of efficiency should not result in deterioration of the system's quality nor in its equity. Governments that make cuts to primary health care services usually regret this decision, as it can end up costing more in the long run. [ILLUSTRATION OMITTED] While Pope was unhappy about the two-month wait, she says that her primary health care providers--particularly the community oncology nurses--were fantastic and her entire treatment was free. Relief for other patients is now in sight. Reducing waiting times for critical cancer treatment, in particular radiation waiting times, is one of the government's health targets to be achieved by the end of 2011. Some health services, such as those offering cancer treatment, may receive more funding under government plans to improve quality and efficiency, while others face cuts. But the cuts, critics say, mean that fewer services may be available to some population groups and doctors' fees remain prohibitively expensive for some people. The public system in New Zealand is generally quite good and deals well with serious illness, says Don Matheson, Professor of Health Policy at Massey University, Wellington, and former Deputy Director-General, Public Health, for the Ministry of Health. Its patient-centred system and well-coordinated care are seen as exemplary by other countries, he adds. But, he says, equity is a glaring problem. When significant numbers of New Zealanders cannot afford to go to the doctor, this creates knock-on effect through the system--they won't access care and their health outcomes will be worse. While the majority of public services are provided flee to patients, including almost all public hospital treatment, care during pregnancy and birth, and basic dental care for children, most New Zealanders can expect to pay between NZ$ 17 and NZ$ 75 per visit to the general practitioner. Visits to doctors are free for most children aged less than six years and cost less than NZ$ 20 for very low-income earners. According to the Commonwealth Fund's 2010 survey of world health systems, 32% of low-income earners in New Zealand said they did not visit doctor in 2009 due to the fees. Most of the country's primary health care services are organized by Primary Health Organizations (PHOs)--with services provided by groupings of doctors, nurses, counsellors and other health professionals--that provide wide range of first-line curative and preventive health services and serve more than four million people, some 95% of the population. As part of its reform, the government plans to halve the number of PHOs through mergers and closures. So far, the original 81 PHOS that were established since 2002 have been reduced to 70. country's health delivery model is in flux but is currently made up of 20 District Health Boards (DHBs) located throughout the country, funded by the Ministry. …