KEY POINTS:
In health, the big parties are chasing the centre ground, promising more and better things for patients.
National and Labour have important policy differences, but they agree on the basic structure of the health system and how much should be spent on it.
Two differences are that:
* National is trying to convince voters Labour has been wasteful in doubling health spending to more than $12 billion over nine years, although the hospital statistics on which it bases its claim are an incomplete record of what the public health system does.
* Labour wants to convince voters National has a "privatisation agenda", but again, the evidence is at best mixed.
After Labour won office in 1999, National struggled to develop an effective opposition on health, dithering before the 2005 election on policy.
But Tony Ryall, who subsequently took up the shadow health portfolio, has made inroads with his appeal for greater "engagement" with doctors and nurses, and his digging for statistics on health system performance.
National's weakness continues to be the questions over whether it would return to its 1990s policies such as competition between health boards and large-scale contracting to private hospitals. This is the question of "trust" that Labour keeps hammering.
In 2005, National promised to halt Labour's progress to universal subsidies for seeing a GP, instead re-invigorating the community services card to target subsidies.
When National issued its 46-page health discussion document last year, it had moved to the centre ground by agreeing that universal subsidies should stay. Removing them, the document said, would be "fraught with difficulty since they are entrenched".
But it omitted to say National would end the fees review system which Labour considers a fees "cap", giving Labour room to crow that National would let fees skyrocket.
National backtracked, and is committed to Labour's primary healthcare fees and fees review policies.
In primary care, Labour has focused on fee reductions, perhaps to the detriment of its other key aim, to oversee a transition from GP-dominated care to multi-disciplinary centres employing the likes of dietitians, nurse practitioners and physiotherapists.
Health Minister David Cunliffe said Labour was proud of its record in primary care - 80 primary health organisations established, 95 per cent of the population enrolled in them, a rising rate of child immunisation, average patient fees of $26, and a million people paying no more than $16 for a consultation.
Ministers have now called for the Health Ministry to report by December on how multidisciplinary family health centres could work and Mr Cunliffe is investigating giving primary health organisations more flexibility s in how they spend their money, as an incentive to implement these.
In a tie-up with elective surgery policy, he has also financed a new move that will give 12,000 patients in primary care greater access to specialist assistance, including diagnostic tests and outpatient and community-based procedures.
There is little between this and National's policy, revealed last year, to encourage the creation of integrated family health centres and to give $13 million a year to accelerate devolution to primary care of services such as orthopaedic assessments, minor surgery and authority to order tests.
National, like Labour, sees this devolution as way of relieving the pressure on public hospitals, enabling them to do more elective surgery.
Mr Ryall portrays the slow growth in the volume of elective surgery - despite rapid population growth since Labour came to office - as a symptom of declining productivity, and says unnecessary bureaucracy is gobbling up much of the health budget.
Mr Cunliffe acknowledges that the bureaucracy has grown, but says managers and administrators were 19 per cent of the health workforce when Labour came to office, and remain at that percentage.
He says Helen Clark's administration has increased doctor and nurse numbers by 5000. And he says elective surgery is a poor measure of hospitals as they are only a small proportion of their total work.
In 2000, 105,109 people had publicly-financed elective surgery. In the latest financial year, the number was 117,458.
The problem for the Government is that in 2006/07, it put up an extra $60 million a year, aiming to increase the annual number of elective operations by 10,000.
The following year, the number went up by 4400, although some of the 2006/07 increase of 7300 is also attributable to the new money - an 11 per cent increase in two years.
Under the new Health Targets, some medical, dental and outpatient procedures are included, and by June this year, the system achieved an 8.7 per cent increase over two years, against a 10 per cent target.
In May, Mr Cunliffe announced an extra $35 million a year for elective surgery, saying about 5000 more patients a year would be treated.
Mr Ryall says patients now have to be sicker to be treated, after Labour enforced its policy of not offering elective surgery to patients if they could not be treated within six months, a move which led to tens of thousands being removed from waiting lists.
National's answer is to commit itself to opening 20 new operating theatres and support facilities solely for elective surgery, including a second public electives hospital somewhere in Greater Auckland. This would cost $36 million over five years. This is above the continuing need for new general theatres, and the Government's existing plans for 21 new theatres.
National says it would train an extra 800 health workers, at a cost of $20 million a year initially, and would make greater and more consistent use of contracts with private hospitals for electives.
But it would not give tax breaks to the elderly who have private health insurance, a policy it dropped because of the economic situation.
Labour portrays National's attitude to the private sector, including its plans for ACC, as one of throwing work the way of its "friends". About 3 per cent of publicly funded elective surgery is done privately, but Mr Cunliffe does not want it to go higher.
He says giving private hospitals large public contracts would result in them taking the easier work, possibly undermining the public sector.
National's plans to ease workforce shortages would include progressively providing 200 more places at medical schools - which now have 365 places a year - expanding the number of state-funded GP training places to 154 from 104, and offering voluntary bonding, in return for student loan write-offs, to graduate doctors, nurses and midwives in hard-to-staff areas.
Labour is likely to implement the Medical Training Board's suggestion of 100 more medical school places, but will not decide until next year's Budget.
The figures:
Public hospitals discharged 603,798 medical, acute surgical and elective surgical patients last year, up 0.8 per cent from 599,024 in 2006-07.
Discharges of elective (non-urgent) surgical patients rose 4 per cent last year, to 117,458.
The annual health budget was more than $12 billion this year, twice as much as when Labour came to office in 1999.
Progress has been slow on Labour's 2005 promise to rebuild the school dental service. Six of the 21 health boards' business cases have been approved. The cost has risen to $130 million, from $100 million.
The average fee for visiting a GP is $26 under the Government's $2.2 billion scheme of universal subsidies and a million people pay no more than $16.
New Zealand's rate of cardiac surgery is 25-45 per cent lower than in comparable countries. The Government has committed an extra $50 million over four years to increase the rate by at least 25 per cent .
