What health reforms mean for you

By FRANCESCA MOLD

Parliament passed the New Zealand Public Health and Disability Bill on December 7. The major changes kick in on New Year's Day.

What are the big changes?

The most noticeable difference is that 21 district health boards are being set up. They will receive a large amount from the Government each year to pay for health services for people living in their area.

These include hospital care, mental health services, GPs and other community care.

The Health Funding Authority, which was responsible for buying health services on behalf of the Government, has been disbanded.

The Ministry of Health will take over its job by holding funding contracts with the district health boards and monitoring their performance.

The bill also gets rid of the previous directive for the public health system to operate in a commercial and competitive way. District health boards will be encouraged to work together to get the best deals for their populations.

National committees have been set up to advise on issues such as public health, ethics and causes of death.

What is the timetable?


The district health boards come into force on January 1.

They will not be in charge of their own money until July 1, when they have proved to health officials that they are ready. At first the boards will be responsible for hospital and primary health care but will gradually add other responsibilities until they are fully functional by July 2002.

How much will the restructuring cost?

This is a slightly murky area. The Government believes savings made by the changes will ultimately pay for any of the costs, but it has also set aside $20 million in case.

In June, health officials predicted that $12 million would be needed, but that figure is being reworked as several last-minute additions to the reform, including a public health directorate requested by the Alliance, are likely to add to the cost.

The National Party has said that if it wins power at the next election it will not disband the Coalition's health boards. This means there are unlikely to be major additional costs if the Government changes.

How will the changes affect me personally?


It is unlikely that people will notice much difference in the way things are run. Officials have planned a very gradual changeover to ensure things go smoothly, but there are bound to be hiccups as boards take over responsibility for money and services in their areas.

An important change for people who want a say about where their health dollar is being spent is that, from January 1, they can go to board meetings. Previously, all hospital business was carried out by board members behind closed doors.

The Government hopes the new openness will make boards more accountable and help people understand where their money goes.

As funding for district health boards will depend on the population, some areas are likely to start receiving extra money over the next few years.

This will filter down to improve health services for areas that traditionally have more people on low incomes, a large Maori and Pacific population and high rates of disease.

The population formulas have not yet been worked out. The Ministry of Health says money will not be withdrawn from district health boards which under the population formula appear to be getting too much funding. Those with gaps will have their money boosted gradually over the next few years.

How can we be sure health boards will spend money wisely?


People will be able to vote seven representatives on to their health board at elections every three years.

This means that if people feel a board member is not performing well, they can vote to replace him or her at the next election.

The first board members were appointed by Health Minister Annette King in August. The first elections will be held at the same time as local government voting next October.

The Health Minister will continue to appoint up to four members and each board must have at least two Maori representatives.

The district health boards will have to produce strategic and annual reports which must be submitted to the Government for approval.

They will no longer be allowed to borrow from the private sector. The Government is setting up a special unit within the Treasury to deal with loan applications for capital expenditure. The Director-General of Health, Dr Karen Poutasi, says this will make borrowing less costly for health boards and will not affect hospitals' plans to modernise their facilities.

The boards will have a certain amount of freedom when it comes to deciding where to spend their money, but there will also be strict national criteria outlining what services they must provide. Boards will also have to meet benchmarks and targets set by the Ministry of Health to prove that they are improving the health of their population.

For example, a board may demonstrate it is improving prevention and treatment of diabetes by showing that fewer people have had to have limbs amputated because of the disease.

The benchmarks will be based on the New Zealand Health Strategy - a document which lists the Government's objectives for the next 10 years.

The main areas the Government wants boards to focus on are reducing smoking, improving nutrition, reducing obesity, boosting people's physical activity, slashing suicide rates and alcohol and drug abuse. The Government has also made a priority of the need to reduce cancer, heart disease, diabetes, violence in families and schools and improve dental health.

Statistics from each district health board will be published annually so people can see what is happening in their area, compared with the rest of the country.

Can a board be punished if it doesn't perform?

If boards fail to measure up to expectations, they can be dealt with by the Health Minister. The minister can direct them to take certain action, or can appoint an official to monitor the board's actions and report directly back.

The minister can sack the entire board and replace it with a commissioner, as happened in Gisborne this year. The minister can also choose to sack just the chair or deputy chair or remove some of the board's responsibilities.

What happened to the controversial clause which people feared would give Maori preferential treatment?

The first version of the bill stated that the legislation must be interpreted in a manner consistent with the Treaty of Waitangi.

This sparked an outcry that treatment would come to depend on a person's skin colour rather than the degree of illness the patient was suffering from.

As a result, the clause was watered down. It now says the treaty responsibility will be honoured by including Maori in decision making but no one will receive preferential treatment based on race.

What are some concerns about the changes?


People are worried that hospitals will gobble up all the money given to the district health boards and that GPs and other community care agencies will miss out.

Health officials say that because the concern has been clearly identified, boards will be careful to ensure that both get the money they need.

The Government has also sent a clear message to boards that it favours preventing illness rather than spending money on treating people in hospitals.

Another concern is that people will receive a different quality of care depending on where they live.

But health officials say national guidelines outlining the kind of care boards are obliged to provide will be put in place to ensure that this does not happen.

THE FIRST OPEN MEETINGS


* Auckland Healthcare (central Auckland) - February 1

* South Auckland Health (Counties/Manukau area) - a date will be decided tomorrow

* Waitemata Health (North and West Auckland) - February 7

* Health Waikato (central North Island and Coromandel Peninsula) - February 14

* Lakes (Rotorua) - no date set yet

* Northland Health (north of Auckland) - February 26

* Venues for the meetings will be announced closer to the date