Ailing figures make health major issue

By JAN CORBETT

When it comes to health policy, the key difference between the two major parties is that Labour sees health as wrapped up with welfare issues such as child poverty while National tends to focus on administrative structures, says Toni Ashton, a senior lecturer in health policy at the Auckland School of Medicine.

The reality of our public health system today is that we see:

 Hosplitals advising patients their condition is not serious enough to qualify for treatment.

 The drug funding agency Pharmac routinely accused of denying New Zealanders life-saving medicine.

 Third World diseases such as tuberculosis back as a problem in poor urban areas.

And although no one advocates re-institutionalising the mentally ill, the breakdown of community care resulting in people with schizophrenia neglecting their medication has been blamed for the 1996 Raurimu massacre and the murder this year of West Aucklander Malcolm Beggs.

Labour promises to put more money in that direction.

Next to welfare, health is the second-largest area of Government expenditure, consuming $6.4 billion over 1998-99.

It seems to be a budget item which always attracts criticism that no enough is spent, however much total spending increases.

Government funding of public health has increased, from $1435 for each citizen in 1992 to $1631 last year, inflation adjusted.

But at the same time, our health status relative to the rest of the developed world has slipped.

The most recent OECD figures show that out of 29 countries we rank in the bottom half on the key indicators of life expectancy, infant mortality and birth weight.

Toni Ashton doubts there is any developed country that has solved the problem of providing expensive medical treatments to everyone instantly, but New Zealand differs because we pay more to see our GP than people in other countries. It costs around $10 in the US. Only the Alliance has free primary health care in its policy.

One of the key features in Labour's policy is removing the rigidity from the surgery booking system and giving clinicians flexibility to decide who qualifies and who doesn't.

Yet one of the virtues of the booking system, says Toni Ashton, is that it prevents those who scream loudest getting surgery ahead of those who meekly accept their position even if their need is greater.

But it also means those who do not meet the criteria – and the threshold is determined by the budget – disappear from the statistics. Labour says it will change that.

It also wants to replace the Health Funding Authority with local health boards with the majority of members elected. That is in keeping with Labour's promise to remove the profit motive in health and remodel it as a community service.

Elected boards focus more on delivering services than making money, says Toni Ashton.

National promises the status quo.