National must have swallowed hard to admit that scrapping universal subsidies for primary health care would cost it too many votes at next year's election.
Through Labour's five-year introduction of universal subsidies, National has preferred its old system of targeted GP subsidies - aimed at the poor andthe very sick.
But now in its health policy discussion document, released yesterday, National in effect acknowledges that universal subsidies are part of the new centre ground of health politics and it proposes they be retained. Removing them would be "fraught with difficulty since they are now well entrenched".
This large nod to pragmatism characterises the 51-page document, which reads like a best-of in the health sector. Clearly argued, it offers solutions to a wide range of problems, from emergency department overcrowding to the low uptake of health insurance.
There is no hint of the massive structural change that marked National's 1990s health reign, but no strategist would want to frighten voters with such unpopular changes.
National has long sworn off abolishing the 21 partially-elected district health boards and the paper states there is an "ongoing role for Primary Health Organisations".
It does suggest greatly increased co-operation of DHB funding arms through "shared-service networks". This is two steps back to National's old Health Funding Authority, but only one step ahead of the co-operation that already exists between clusters of DHBs.
The paper draws on some of the numerous good ideas that are already improving health services in New Zealand and overseas. One is to have separate hospitals for acute and elective patients, to stop acute demand gobbling up elective surgery resources - a scheme already used by the Counties Manukau DHB.
A degree of structural change is foreshadowed for some general practices, through the carrot of financial incentives to Primary Health Organisations and the stick of central direction to DHBs. National wants to see the creation of Integrated Family Care Centres, which would cover numerous primary health services from GP consultations to podiatry and counselling. They would be DHB-funded to provide an expanded range of minor surgery not often done in primary care, some hospital outpatient clinics, x-rays and some laboratory testing.
Now voters are invited to tell National what they think.
