Big changes hurting efficiency of hospitals: study

Days spent in hospital reduced by almost 40 per cent from 1981-2006. Photo / Sarah Ivey

Researchers have warned the Government to avoid major restructuring of the health system after showing that big-bang changes are linked to declining hospital efficiency.

A Waikato University study found a significant increase in hospital efficiency between 1981 and 2006, measured by a reduction of almost 40 per cent in the number of days people spent in hospital. But it also found temporary deteriorations in efficiency after periods of major restructuring.

The National Government, which promised before the 2008 elections that it would not carry out another round of health restructuring, has embarked on big changes which it refers to as an "administrative shake-up".

They include creating the National Health Board within the Health Ministry to assume ministry functions such as supervising district health boards, funding some national services and overseeing planning for new hospital facilities. An agency to provide back-office functions for DHBs and the ministry is planned, and DHBs will be required to co-operate more with each other within their regions.

But the Government would not initiate mergers of DHBs.

The health system has undergone four rounds of major restructuring under Labour and National since 1988.

Dr Gary Jackson, an author of the study of restructuring and hospital care, yesterday said Health Minister Tony Ryall's changes to the health system were smaller than the four rounds of restructuring, but because of the destabilising effect found with major change, the researchers had urged against it.

"The biggest efficiency gains happened in the eighties, when the reform agenda was much more evolutionary rather than revolutionary.

"We had those big shocks every four years to the system. Each shock slows everything down. One of the overriding messages from the report is don't massively change everything."

Some DHBs might merge with each other and improvements might be needed in rural hospital performance, but overall the DHBs were actually working not too badly, he said.

Dr Jackson said the study found that restructuring in the 1990s was also associated with a reduction in healthcare equity among regions.

This was shown up by a continuation of the reduction in the number of days spent in hospital, but increases in the Waikato and non-metropolitan North Island regions in the numbers on sickness benefits.

He said the measure at the centre of the study, hospital utilisation expectancy, had declined until 2000 but subsequently had started "to sneak back up again slightly".

This was largely associated with the rising age of the population and improved health care which extended the lives of people with chronic conditions such as heart failure.