Editorial: Board takes action for good health

At first glance, the Auckland District Health Board has taken a somewhat draconian approach in demanding that New Zealanders provide proof of identity to qualify for free care. Some people will cavil. We are not, after all, accustomed to producing our passport or birth certificate when seeking access to public services. Undoubtedly, the vast majority would agree it is a shame that such a measure has been deemed necessary. But in terms of the bigger picture, and especially the board's underlying $100 million deficit, it is difficult to take issue with the imposition. Financial reality has left the board with little option.

The move is part of a clampdown on treatment for ineligible foreigners, which left it with $2.9 million in bad debts at the end of the June year. This sum has been a charge on the New Zealand taxpayer, but with such debts on the rise, the Government is showing less inclination to provide compensatory funding. That is not unreasonable, given that automatic cover provides little incentive for health boards to exercise strict cost control.

Earlier this year, the Auckland board conceded its culture in this area was not all it could be. Could that be the reason this identity clampdown trails a similar move in South Auckland? The Counties Manukau District Health Board says its procedure has more than halved the $3 million annual debt previously run up by ineligible foreigners. This appears to have been achieved without any great antagonism. Indeed, qualms may have diminished when it was recognised that no patients needing acute care were being turned away and that proof of patient eligibility needed to be produced only once.

In the bigger scheme of things, of course, any saving from this source will amount to a relatively small proportion of the Auckland deficit. The board faces the task of making more significant inroads without incurring a substantial public backlash. A board presentation to ministers in June demonstrated the scale of the problem by equating the eradication of the deficit to the scrapping of more than 1000 jobs. The board was quick to scotch any suggestion that cuts of such magnitude were planned, but it is clear there will be changes in the services it provides.

In all likelihood, much of this will fall in areas where the board feels it is being unfairly burdened. Until now, this has centred on preventing ineligible foreigners cashing in on the public health system. An earlier, well-publicised move against this practice involved non-resident women who were taking advantage of this country's birthcare arrangements.

Now, perhaps, the board's focus will be on non-Aucklanders. The Auckland City Hospital's specialised equipment means that it will always fulfil a nationwide role. But there could, quite legitimately, be more discrimination in the services provided to patients from other districts. Certainly, there should be no debate about the cost of treatment of people who are injured or fall ill while visiting Auckland being met by their local health board.

The Auckland board's deficit defies an easy solution. But the first step is clearly a focus on controlling costs - and of ensuring that costs are incurred in providing healthcare for the people of its district. To concentrate, as it were, on the board's core business. The demand for identification is a move in the right direction, even if it may irritate and cause minor inconvenience. For the board's good health, it should have been done even earlier.