Health policy Q&A: Judy Turner

The Herald invited politicians to answer questions at a range of policy forums - so far we have covered tax and the economy, transport and education. Today we examine health.

Below are edited highlights of the 45-minute question and answer session with United Future spokeswoman Judy Turner.

What do you think is the biggest issue facing the health service, and then what would your party do to tackle it?

Workforce. We have got to look at how we attract top people to train in medicine and how do we hold on to the ones we train. So we've got to look at what we charge them in terms of student fees, we need to look at bonding and scholarship arrangements so they can avoid debt in the first place, and we need to look at the way we attract people to health - what is it that makes people choose medicine over some other field of science.

How would you introduce bonding?

I think the best way is to offer a range of options rather than a one size fits all, so people can plan their futures and say, I don't mind being bonded for three, four, five years to NZ. There may be scholarship options, there may be options where we forgive debt for every year you work in New Zealand.

Should we pay doctors and nurses more?

I think the recent wage round for nurses is great. Yes, I think we have to stay relative on a global basis. We can't afford not to.

So how would you pay for that? What goes in the health budget?

We're concerned that the current level of funding in health is unsustainable. I think we're coming to a place where things like the rationalisation of district health boards could be considered. I agree with the minister that it was important to get each district health board fiscally up to speed rather than rationalising them and find that one was carrying the deficits of another. But certainly within the Auckland region one of the ways of savings is by working co-operatively between the three main district health boards. So the process is already naturally occurring and we could start to roll that out.

What's party policy on GP visits?

We'd like each New Zealander in the month of their birthday to have a warrant-of-fitness check - in a preventative sense, so that you're actually seeing a doctor not because you're sick, but because we want to keep you well. We're talking about your basic blood pressure, listening to your heart, checking your cholesterol. It would cost up to $112 million of the current funding.

We'd also like to prioritise free doctors' visits for adults who are heading families, rather than for age groups. Because you often get a family budget that is stretched to breaking point, trying to afford GP visits for children and for adults.

What about Pharmac?

We have talked about a medicine strategy for NZ which we don't have. We have Pharmac, who have sort of morphed into their current role. They started as one man trying to buy some generic medicines, now they are policy drivers in terms of what's subsidised and what's not. They are budget driven rather than health outcomes driven.

So you do think that the health system is not acting cost-effectively because there are drugs that are not funded by Pharmac or are too tightly restricted by Pharmac?

I suspect that's true, but actually we don't know the answer as nobody has developed a strategy and looked at the costing.

Why subsidise wealthy people to go to the doctor when poorer people could benefit more from the money?

Where do you draw the line? I think for years middle-income people have missed out on health in that regard and have felt unfairly marginalised - they're the sort of people who earn $10 too much a week to qualify and yet often are struggling. The problem we've had is where do you arbitrarily draw the line as to who's wealthy enough and who's not? I think that the incremental way the Government is rolling out funding is good. All we're asking is for a re-prioritising of that towards families. Family life is seasonal but it's the time where you could most do with some support and help and where things are most important.

One of the things that we need to constantly be looking at is how do we improve the overall health of NZers so that they cost us less. That's why I get a bit disturbed when people get emotive about things like race-based funding in health. Maori statistics and diabetes is well recognised, and I think anything that brings that down is going to allow more health dollars for the rest of us, and it should be done. I think a lot of people get anxious because it feels like an eternal gravy train of funding towards Maori needs, but I don't think it needs to be. You just need to define when you get Maori diabetes to an improved level, then they come in with the general pool. It's foolish for people to get hung up about that type of funding when it's ultimately going to do all of us good.

How would you get waiting lists down?

We're suggesting the establishing of a contestable fund for elective surgery, so that both the public and the private health providers can tender to perform operations. We see that in the short term as a way of clearing some of the backlog.

Are you confident that the contestable idea wouldn't inadvertently undermine the viability of public acute hospitals?

I don't think it would. It certainly doesn't appear to have with ACC - it's just tended to give us extra options, so I think it's great.

Does it also have the possibility of undermining smaller hospitals - how would Te Kuiti Hospital stack up against Waikato Hospital for cataract surgery?

We're looking at priorities for hospitals rather than people. If I need a cataract and I can get it tomorrow by travelling, that's what patients want, they want it now so they can get up and running again, so we've got to be careful we don't protect hospitals above people.

If you were in government, you would realistically not be able to implement your full health policy. What are the real priorities of all the things that we've discussed?

I think our GP visits would probably be a high priority. It's unclear at this stage that the Government is fully delivering on what they had hoped. Certainly the co-payments for patients is still quite high. We're talking about $20 for families, $20 for an adult and $10 for a child as the upper limit of what people should have to pay. Some of these 45,000 parents who aren't subsidised are spending an average of $43 for a GP visit. When you look at the average wage, that's 10 per cent of their net income in a given week spent on a doctor's visit if they have to go as an adult. That's a lot.

* Jargon explained

PHO: A primary health organisation. A group of GPs, nurses or other health professionals, funded by the Government through subsidies.

DHB: A district health board. Runs the hospitals and other public services in an area.

IPA: An independent practitioners association. Basically a group of doctors.