Healthcare in New Zealand

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Ambulance vehicles of Hato Hone St John at their Pitt Street, Auckland base St John Emergency Vehicles Auckland.jpg
Ambulance vehicles of Hato Hone St John at their Pitt Street, Auckland base

The healthcare system of New Zealand has undergone significant changes throughout the past several decades. From an essentially fully public system based on the Social Security Act 1938, reforms have introduced market and health insurance elements primarily since the 1980s, creating a mixed public-private system for delivering healthcare. [1] [2]

Contents

In 2012, New Zealand spent 8.7% of GDP on healthcare, or US$3,929 per capita. Of that, approximately 77% was government expenditure. [7] In a 2010 study, New Zealand was shown to have the lowest level of medication use in 14 developed countries (i.e. used least medicines overall), and also spent the lowest amount on healthcare amongst the same list of countries, with US$2510 ($3460) per capita, compared to the United States at US$7290. [8] [9]

History of healthcare

Until well after European contact Māori used natural medicines and spiritual healing. Among the European settlers, professional medical care was expensive and most people diagnosed themselves or sought alternative treatment. [10] In the mid 19th century New Zealand's first public hospitals were created by Governor George Grey and were available for those who could not afford a private doctor. [11] [12]

The Public Health Act 1872 introduced local authority health boards. These were funded primarily by the local ratepayers and subsidised by the national government. There was still a large reliance on private charity to make up any shortfall. From 1909 poorer districts were given disproportionately more funding from the national government. [11] In 1938, the Social Security Act from the First Labour Government attempted to provide government funded healthcare to all. A free health system, with hospital and other health services universally available to all New Zealanders was the vision behind the Social Security Act 1938. This was never fully realised due to ongoing disputes between the medical profession and the Government. Health services evolved as a dual system of public and private health care subsidised through a series of arrangements known as the General Medical Service (GMS) benefits established in 1941. This remained largely unchanged until the late 1970s. From 1984 to 1993 the Labour then National governments introduced major changes designed to get area health boards (later Crown health enterprises) to imitate market forces. [11] [13] User charges were introduced for prescriptions in February 1985 but broader controversial policies introduced by the Fourth National Government between 1991 and 1993 effectively ended largely free provision of primary healthcare, such services being targeted on the basis of income while Community Service Cards (introduced on 1 February 1992) provided additional support. [14] [15] [16] Public hospital charges of $50 for overnight stays were briefly implemented but was later abandoned as the 1993 election approached. [17]

New Zealand has had numerous public health campaigns and initiatives. [18] Children were given free milk between 1937 and 1967 but these were abolished due to budgetary constraints, [19] fluoride is added most drinking water in the country and there have been many anti-drinking (from the 1870s) and anti-smoking campaigns (from the 1960s). [20] [21]

Restructuring of the healthcare system

On 21 April 2021, Health Minister Andrew Little announced a plan to centralise healthcare, abolishing all 20 District Health Boards and creating a single health organisation called Health New Zealand, in a plan to centralise New Zealand's fragmented healthcare system and end what has been characterised as a "postcode lottery" of care. Health New Zealand would be modelled after the United Kingdom's National Health Service. The Ministry of Health also created a Māori Health Authority with spending power, and a new Public Health Authority to centralise public health work. [22] [23]

In October 2021, the Sixth Labour Government introduced the Pae Ora (Healthy Futures) Bill to replace the country's district health boards with the new Health NZ. The legislation also formally establishes the Māori Health Authority and a new public health agency. The Ministry of Health will also play a stewardship role within the reformed health system. [24] The bill passed its third reading on 7 June 2022. [25]

In November 2023 research showed that children with serious trauma were twice as likely to die in hospital compared to Victoria, Australia. [26]

Structure

At present, the Ministry of Health is responsible for the oversight and funding of the twenty district health boards (DHBs). These are responsible for organising healthcare in the district and meeting the standards set by the Ministry of Health. Twenty-one DHBs came into being on 1 January 2001 with Southland and Otago DHBs merging into Southern DHB on 1 May 2010.

The boards for each district health board are elected in elections held every three years, with the exception of one of the eight board members, who is appointed by the Ministry of Health.

The DHBs oversee the forty-six primary health organisations established throughout the country. These were first set up in July 2002, with a mandate to focus on the health of communities. Originally there were 81 of these, but this has been reduced down to 46 in 2008. They are funded by DHBs, and are required to be entirely non-profit, democratic bodies that are responsive to their communities' needs. Almost all New Zealanders are enrolled in a PHO, as there are financial incentives for the patients to become enrolled.

The Northern Region DHBs also use shared services provided by the Northern DHB Support Agency and HealthAlliance. These services deliver region-wide health initiatives and shared IT services and logistics.

In Christchurch, the Canterbury District Health Board has been successful in redesigning services to reduce hospital use. Some of this transformation was precipitated by the 2010 and 2011 earthquakes when several healthcare buildings were damaged or destroyed, and also 2019 mosque massacre as the several healthcare also response to the terrorist attacks. It now has lower rates of acute medical admissions, low average lengths of stay, fewer readmissions in acute care, fewer cancelled planned admissions and more conditions treated out of hospital. [27]

Public vs. private payment

Healthcare spending vs life expectancy for some countries in 2007 Life expectancy vs spending OECD.png
Healthcare spending vs life expectancy for some countries in 2007

Hospital and specialist care in New Zealand is totally covered by the government if the patient is referred by a general or family practitioner and this is funded from government expenditure (approx. 77%). [7] Private payment by individuals also plays an important role in the overall system although the cost of these payments are comparatively minor. Those earning less than certain amounts, depending on the number of dependents in their household, can qualify for a Community Services Card (CSC). This reduces the cost of after-hours doctors' visits, and prescription fees, as well as the cost of visits to a person's regular doctor.

Injuries which occur as a result of "accidents", ranging from minor to major physical but including psychological trauma from sexual abuse are generally covered by the Accident Compensation Corporation (ACC). This may include coverage for doctors visits and lump-sum payments.

Waiting lists

In New Zealand's public health system it is typical for medical appointments, particularly surgeries to have a waiting list. District Health Boards are typical judged in the media and by government in part based on the length of these lists. In 2016, it was inferred that many people required surgery but were not put on the official list. [28] Research projected that of all the people who had been told they needed surgery less than half were on the official list. However, the main concern noted by health industry observers was the overall increase in waiting time, about 304 days. [29]

Telehealth

In 2018 the Northern Region district health boards, Northland, Waitemata, Auckland and Counties Manukau developed a telehealth system with a unified video, audio, content sharing and chat platform provided by Zoom Video Communications which is intended to lead to a more integrated health system in the Northern Region. This should enable real-time consultations between clinicians in hospital, primary care and the community, and between patients and their care providers. [30]

Healthcare organisations

The list of well-known Healthcare organisations in New Zealand are: [31] – Geneva Healthcare – Counties Manukau Homecare Trust – Healthcare of New Zealand Holdings Ltd – Healthvision – Life Plus Ltd – Healthcare NZ – Royal District Nursing Service New Zealand

Abortion

Abortion is legal upon request in New Zealand. [32] According to figures released by Statistics New Zealand, the number of abortions rose from 8.5 per 1,000 women aged 15‒44 years in 1980 to 14 per 1,000 women in 1990. By 2000, this figure had risen to 18.7 per 1,000 women aged 15‒44 years but has since declined to 13.5 per 1,000 women as of 2018. [33]

Medications

The Pharmaceutical Management Agency of New Zealand (PHARMAC) was set up in 1993 to decide which medications the government will subsidise. In general, PHARMAC will select an effective and safe medication from a class of drugs, and negotiate with the drug manufacturer to obtain the best price. There are approximately 2,000 drugs listed on the national schedule that are either fully or partially subsidised.

In a sample of 13 developed countries New Zealand was thirteenth in its population weighted usage of medication in 14 classes in 2009 and also in 2013. The drugs studied were selected on the basis that the conditions treated had high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross border comparison of medication use. [34]

Sildenafil was reclassified in New Zealand in 2014 so it could be bought over the counter from a pharmacist. It is thought that this reduced sales over the Internet and was safer as men could be referred for medical advice if appropriate. [35]

Emergency service

Most emergency and non-urgent ambulance transportation is carried out by the charitable organisation St John New Zealand. In Wairarapa and the Wellington Region ambulance services are provided by the Wellington Free Ambulance organisation. [36]

Performance

An investigation into the death of a patient in the emergency department at Middlemore Hospital on 15 June 2022 concluded that the department was unsafe for both patients and its staff. On that night it was at least 30% over-capacity – but this was “…not an isolated day.” Nor was it unusual. The report said "As emergency departments continue to struggle with ever-increasing presentation numbers, delays in admitting patients to wards and significant ED overcrowding, announcements in ED waiting rooms regarding delays in assessment/treatment occur at an increasing frequency throughout EDs in Aotearoa New Zealand." Margie Apa of Te Whatu Ora accepted the conclusions of the report. [37]

See also

Related Research Articles

<span class="mw-page-title-main">Ministry of Health (New Zealand)</span> New Zealand government ministry

The Ministry of Health is the public service department of New Zealand responsible for healthcare in New Zealand. It came into existence in its current form in 1993. The organisation was founded in 1901 as the Department of Public Health in 1901, and was renamed to Department of Health in 1922.

<span class="mw-page-title-main">District health board</span> Defunct health provider in New Zealand

District health boards (DHBs) in New Zealand were organisations established by the New Zealand Public Health and Disability Act 2000 under the Fifth Labour Government, responsible for ensuring the provision of health and disability services to populations within a defined geographical area. They existed from 1 January 2001, when the act came into force, to 30 June 2022. Initially there were 21 DHBs, and this was reduced to 20 organisations in 2010: fifteen in the North Island and five in the South Island. DHBs received public funding from the Ministry of Health on behalf of the Crown, based on a formula that took into account the total number, gender, age, socio-economic status and ethnic mix of their population. DHBs were governed by boards, which were partially elected and partially appointed by the minister of Health.

District Nurses work manage care within the community and lead teams of community nurses and support workers. The role requires registered nurses to take a NMC approved specialist practitioner course. Duties generally include visiting house-bound patients and providing advice and care such as palliative care, wound management, catheter and continence care and medication support. Their work involves both follow-up care for recently discharged hospital inpatients and longer-term care for chronically ill patients who may be referred by many other services, as well as working collaboratively with general practitioners in preventing unnecessary or avoidable hospital admissions.

A formulary is a list of pharmaceutical drugs, often decided upon by a group of people, for various reasons such as insurance coverage or use at a medical facility. Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication. Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed at a particular hospital, in a particular health system, or under a particular health insurance policy. The development of prescription formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs.

The Pharmaceutical Management Agency, better known as Pharmac, is a New Zealand Crown entity that decides, on behalf of Te Whatu Ora – Health New Zealand, which medicines and pharmaceutical products are subsidised for use in the community and public hospitals.

<span class="mw-page-title-main">Auckland District Health Board</span> District health board in the Auckland Region

Auckland District Health Board (ADHB) was a district health board that provided healthcare in the Auckland Region in New Zealand, mainly on the Auckland isthmus. This district health board existed between 2001 and 2022 and was governed by a part-elected, part-appointed board. In 2022, its functions and responsibilities were subsumed by Te Whatu Ora and Te Aka Whai Ora.

Contraceptive rights in New Zealand are extensive. There are many options available to women seeking contraception. There are also options for men. Government funding keeps the cost of most types of contraception low in most cases. Family planning options in New Zealand are generally in keeping with the United Nations stance towards sexual and reproductive rights although the country has received criticism in some aspects.

<span class="mw-page-title-main">South Canterbury District Health Board</span> District health board of New Zealand

The South Canterbury District Health Board was a district health board with the focus on providing healthcare to the Timaru, Mackenzie, Waimate districts in New Zealand. In July 2022, it was merged into the national health service Te Whatu Ora.

<span class="mw-page-title-main">Canterbury District Health Board</span> District health board in New Zealand

The Canterbury District Health Board was a district health board with the focus on providing healthcare to the Canterbury region of New Zealand, north of the Rangitata River. It was responsible for roughly 579,000 residents, or 12% of New Zealand's population. The Canterbury District Health Board covered a territory of 26,881 square kilometers and was divided between six territorial local authorities. In July 2022, the Canterbury DHB was merged into the national health service Te Whatu Ora.

<span class="mw-page-title-main">Capital and Coast District Health Board</span> District health board in Wellington, New Zealand

The Capital and Coast District Health Board (CCDHB) was a district health board with the focus on providing healthcare to Wellington City, Porirua City and the Kāpiti Coast in New Zealand. The CCDHB employed about 6000 people across the Wellington Region. It was disestablished on 1 July 2022, with its functions and responsibilities being taken over by the national health service Te Whatu Ora.

<span class="mw-page-title-main">Mental health in New Zealand</span>

Mental health in New Zealand generally follows the trends of mental health in other OECD countries. New Zealand's 'outdoor life style' and high standard of living are balanced by isolation and a self-reliant culture, which discourages asking for help. Historically, people with mental health problems were institutionalised, whereas now the focus is on care in the wider community. The stigma around poor mental health has been lessened in recent years as a result of this change and public education campaigns. However, New Zealand's minorities and youth continue to be over-represented in the negative mental health statistics.

<span class="mw-page-title-main">Bay of Plenty District Health Board</span> District health board of New Zealand

The Bay of Plenty District Health Board was a district health board with the focus on providing healthcare to the Bay of Plenty area of New Zealand. In 2022, the Bay of Plenty DHB was dissolved as part of a national overhaul of the district health board system. Its former functions and responsibilities were assumed by Te Whatu Ora.

<span class="mw-page-title-main">Hutt Valley District Health Board</span> District health board in New Zealand

The Hutt Valley District Health Board was a district health board that provided healthcare to the cities of Lower Hutt and Upper Hutt in New Zealand. In July 2022, the Hutt Valley DHB was merged into the national health service Te Whatu Ora.

<span class="mw-page-title-main">Northland District Health Board</span>

The Northland District Health Board is a district health board with the focus on providing healthcare to the Northland Region of New Zealand. In July 2022, the Northland DHB was merged into the national health service Te Whatu Ora.

<span class="mw-page-title-main">Southern District Health Board</span>

The Southern District Health Board was a district health board which provided healthcare to an area covering the southern half of the South Island of New Zealand. In July 2022, the Southern DHB was dissolved as part of a nationwide overhaul of the district health board system. Its former functions and responsibilities were taken over by Te Whatu Ora.

<span class="mw-page-title-main">Tairāwhiti District Health Board</span> District health board in Gisborne District, New Zealand

The Tairāwhiti District Health Board, branded as Hauora Tairāwhiti since 2015, was a district health board with the focus on providing healthcare to the Gisborne District of New Zealand. In July 2022, the Tairāwhiti DHB was merged into the national health service Te Whatu Ora.

<span class="mw-page-title-main">Waikato District Health Board</span>

The Waikato District Health Board was a district health board that provided healthcare to the Waikato region of New Zealand.

<span class="mw-page-title-main">Waitematā District Health Board</span> District health board of New Zealand

The Waitemata District Health Board was a district health board that provided healthcare to people living in the area that used to be covered by North Shore city, Rodney District, and Waitakere City in New Zealand. It was abolished on 1 July 2022, and replaced with Te Whatu Ora.

<span class="mw-page-title-main">West Coast District Health Board</span>

The West Coast District Health Board was a district health board with the focus on providing healthcare to the West Coast region of New Zealand. In July 2022, the West Coast DHB's functions and responsibilities were taken over by the national health service Te Whatu Ora.

Health New Zealand - Te Whatu Ora is the primary publicly funded healthcare system of New Zealand. It was established by the New Zealand Government to replace the country's 20 district health boards (DHBs) on 1 July 2022. Health New Zealand is charged with working alongside the Public Health Agency to manage the provision of healthcare services in New Zealand.

References

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  3. ↑ "ACC Payout for Illegal Overstayer | Scoop News".
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  10. ↑ "Primary health care – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 27 December 2018.
  11. 1 2 3 "New Zealand Health System Reforms" . Retrieved 27 December 2018.
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  13. ↑ "5. – Primary health care – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 27 December 2018.
  14. ↑ Community Service Cards Authored by Steve Maharey, former Minister of Social Development
  15. ↑ New Zealand Parliamentary Debates, 19 September 1985, pg 6,971
  16. ↑ Healthcare
  17. ↑ "Linda Bryder, 'Hospitals – Hospital funding and patient entitlement', Te Ara – the Encyclopedia of New Zealand". Te Ara – the Encyclopedia of New Zealand. Retrieved 11 December 2019.
  18. ↑ McLintock, Alexander Hare; Francis Sydney Maclean M. B., B. Chir. "Public Health". An encyclopaedia of New Zealand, edited by A. H. McLintock, 1966. Retrieved 27 December 2018.
  19. ↑ "End of free school milk". nzhistory.govt.nz. Retrieved 27 December 2018.
  20. ↑ "4. – Public health – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 27 December 2018.
  21. ↑ "The history of tobacco in New Zealand". Cancer Society NZ. Retrieved 27 December 2018.
  22. ↑ Manch, Thomas; Witton, Bridie (21 April 2021). "Government announces radical plan to centralise healthcare, will abolish DHBs". Stuff . Archived from the original on 20 April 2021. Retrieved 16 November 2021.
  23. ↑ Quinn, Rowan (21 April 2021). "Major health sector shake-up: DHBs scrapped and new Māori Health Authority announced". Radio New Zealand . Archived from the original on 21 April 2021. Retrieved 16 November 2021.
  24. ↑ "Hopes and doubts as health system overhaul kicks in". 1News . 1News. 30 June 2022. Retrieved 15 August 2022.
  25. ↑ "New Health System Act passes third reading in Parliament". 1News . TVNZ. 8 June 2022. Archived from the original on 7 June 2022. Retrieved 10 June 2022.
  26. ↑ "Shocking rate of trauma deaths among NZ kids revealed". 1 News. Retrieved 16 November 2023.
  27. ↑ "International examples of prudent approaches to healthcare". Public health Wales. Prudent Healthcare. Retrieved 11 July 2015.
  28. ↑ "Who is missing out on surgery? Government releases first figures of 'phantom waiting list'". 6 March 2016.
  29. ↑ "Thousands missing out on surgery, funding boost fails to make dent in 'phantom waitlists'". 10 April 2016.
  30. ↑ "Northern district health boards in New Zealand implement new cloud-based telehealth service". Healthcare IT News. 13 November 2018. Retrieved 22 November 2018.
  31. ↑ "Auckland Health Providers List". Home and Community Health Association.
  32. ↑ "New Zealand passes law decriminalising abortion". BBC News. 18 March 2020. Retrieved 24 March 2020.
  33. ↑ "Abortions". Statistics New Zealand. Archived from the original on 5 August 2019. Retrieved 13 October 2019.
  34. ↑ "International Comparison of Medicines Usage: Quantitative Analysis" (PDF). Association of the British Pharmaceutical Industry. Archived from the original (PDF) on 11 October 2017. Retrieved 2 July 2015.
  35. ↑ "Viagra from the pharmacist: insight from reclassification in New Zealand". Pharmaceutical Journal. 31 January 2018. Retrieved 2 April 2018.[ permanent dead link ]
  36. ↑ "Ambulance services". www.stjohn.org.nz. St John. Retrieved 5 May 2019.
  37. ↑ "Middlemore patient death: Hospital slammed over woman's death in damning report". NZ Herald. 17 October 2022. Retrieved 9 November 2022.
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