New Zealand Health Profile 2012

Ministry of Health's mission, vision and objectives

The Ministry of Health is a policy advisor to the Minister of Health, an agent of the Minister for monitoring and overseeing District Health Boards (DHBs), a funder of DHBs and national services (such as national screening services), and a provider of regulatory and other functions (e.g. public health).

The overall strategic objective of the Ministry of Health is “better, sooner, more convenient” services, thereby contributing to the Government’s goal of all New Zealanders leading longer, healthier and more independent lives. The immediate term strategic priorities feeding into this overarching objective are outlined in the Ministry’s Statement of Intent:

• 1. Providing greater value for money.
• 2. Increasing clinical leadership.
• 3. Reducing waiting times for elective services, emergency departments and cancer treatment.
• 4. Devolving more services to primary and community settings.
• 5. Making the system more adaptable and resilient to deal with the challenges ahead.

Organization of health services and delivery systems

The New Zealand Public Health and Disability Act 2000 established DHBs. Governed by boards of directors that include locally elected members and ministerial appointees, the 20 DHBs are responsible for planning, funding and delivering most publicly funded health services to New Zealanders. DHBs’ provider arms encompass hospital care, specialty care, community nursing and other functions.

Primary health care is provided by primary health organizations (PHOs), which contract with DHBs for the bulk of their funding. The first PHOs were introduced in 2002 as the cornerstone for implementation of the Primary Health Care Strategy. There are now 4.2 million people enrolled in over 70 PHOs (more than 96% of the New Zealand public), spanning the vast majority of general practitioners and practice nurses. Governed by non-profit boards of directors, PHOs contract with DHBs to offer a range of preventive and curative services, as well as an increasing array of population health services. All New Zealanders enrolled with PHOs can avail themselves of low or reduced-cost primary care services, including office-based general practice care and pharmaceuticals (maximum of NZ$ 3.00 copayment).

Much health care is delivered by nongovernmental organizations (NGOs). These include providers with national contracts, such as the Royal New Zealand Plunket Society, which provides child health services, and providers that contract with their local DHB, such as community-based NGOs providing services to people with experience of mental illness. There are also approximately 275 Māori health and disability providers that are Māori-owned and Māori-governed.

A wide range of health information is collected nationally and held in various collections maintained by the New Zealand Health Information Service (NZHIS), and is used for a variety of analytical and research purposes at the national, regional and local levels. Uses of the data include: monitoring contracts with providers, forecasting and setting of annual budgets, analysis of health needs, policy formation, assessment of policy effectiveness, performance monitoring and review, reporting and ad hoc queries, monitoring of health care strategies, and research into service provision.

Key national data collections include:

• The National Health Index is the cornerstone of health information. It was established to provide a mechanism for uniquely identifying every health care user by assigning each a unique number (known as the NHI number).
• The National Minimum Dataset uses a single, integrated collection of secondary and tertiary hospital health discharge data.
• The Cancer Registry is a population-based tumour register of all primary malignant diseases, active since 1948.
• The Mortality Register contains coded causes of death for New Zealanders who die in New Zealand and is based on the legal death certificate, or coroner’s report, and autopsy reports. A complete data set of each year’s mortality data is sent to the WHO each year to be used in international comparisons of mortality statistics.
• The Mental Health Information National Collection contains information on specialist mental health and alcohol and drug services. This collection contains comprehensive information from DHBs and approximately 10% of NGOs.
• The National Booking Reporting System provides information, by health specialty and booking status, on how many patients are waiting for treatment, their assigned priority, their booking status and also how long they have had to wait before receiving treatment.
• The National Non-admitted Patient Collection (NNPAC) provides national consistent data on non-admitted patient (outpatient and emergency department) activity.
• The principal purpose of the Health Practitioner Index (HPI) is to uniquely identify health practitioners and to hold that information in a central, national database for use by the New Zealand health and disability sector.
• The Sector Services is a business unit within the Ministry of Health’s Information Directorate that provides information and reports relating to health claims, provider payments and entitlements.

Total Vote Health expenditure amounted to NZ$ 12 716 million (US$ 9146 million) in 2009/2010, while DHB appropriations totalled NZ$ 9700 million (US$ 6977 million). Most DHB funding is allocated using a population-based funding formula that gives each DHB the same opportunity, in terms of resources, to respond to its population’s needs.

New Zealand has historically had a system of cost-sharing for doctors’ visits and prescription drugs. The Commonwealth Fund 2007 International Health Policy Survey showed 12% of New Zealanders faced no out-of-pocket medical costs in 2007, while 10% faced more than US$ 1000 in out-of-pocket payments.

The health and disability workforce delivers services to over four million people and comprises over 160 000 health workers. Of these 160 000 health workers, 88 000 are registered practitioners under statutory regulation. The remaining unregulated workforce includes those providing care and support in both residential and home-based settings, community health promoters, some technicians, service and food workers, and administrators.
 

New Zealand’s health and disability workforce can be characterized by:

• an ageing workforce with, for example, 80% of dental therapists and 77% of midwives aged over 40 years;
• an increasing trend towards specialization and sub-specialization among doctors;
• an increasing reliance on overseas-trained doctors (43%) and nurses (23%) compared with other developed countries;
• supply pressures in some professions, particularly midwives, junior doctors and some medical specialties, including general practitioners;
• supply pressures in some rural areas of New Zealand;
• an underrepresentation of Māori and Pacific peoples in the health professions; and
• significant wage settlements in recent years for most clinical workforce groups (particularly senior doctors and nurses) employed by DHBs, reflecting government policy and funding decisions in relation to gender and state sector and economy-wide pay equity, and the need to maintain a competitive position in an international labour market for medical and nursing staff.

Increasing health service demand is predicted due to the interplay of factors including an ageing population and resultant growth in chronic diseases and the associated increased complexity of need; expansion of the scope of the health system arising from new medical technologies; and increased public expectation of what the health system can deliver. New Zealand is developing a stronger and more coordinated national approach to strategic workforce planning to assure a workforce that can deliver the services needed. Key priority areas for workforce planning and development include:

• retaining more of New Zealand’s skilled health professionals by ensuring they are fully engaged and satisfied in their employment, and that their expertise is being used in the best way to treat patients;
• boosting the workforce in areas and specialties that are hard to staff, focusing particularly on rural and provincial areas, and on the workforce needed to support and deliver elective services;
• moving New Zealand towards self-sufficiency in health workforce training; and
• understanding likely future gaps in workforce and skills across critical services, and identifying the actions needed to fill them.

Based on the Pacific Leaders’ vision, the Pacific Plan was adopted by Pacific Islands Forum countries in November 2005 as a blueprint for strengthening regional cooperation and integration. It covers the most significant common development challenges the Pacific island countries face and is seen to be, not just regionally, but also nationally owned. Health is embodied in the Pacific Plan under strategic objective No. 6. – Improved Health.
Challenges to health system strengthening

Rising public expenditures, workforce shortages, an ageing population, new technologies, persistent inequalities and a growth in long-term conditions are the main pressures on the New Zealand health system.

There are clear signs that the health system is contributing positively to the health of New Zealanders, such as increasing life expectancy, lower infant death rates (28% in the last decade), declining death rates from cardiovascular disease (10% between 2000 and 2004), and a reduced the gap between Māori and non-Māori mortality rates (approximately 15% between 1996−1999 and 2001−2004). These results have been achieved by a system that, overall, compares well from an efficiency standpoint with comparable countries.

Adjusting for cost-of-living differences using US$ PPP, New Zealand was spending US$ 2510 per capita on health in 2007, compared with the OECD average of US$ 2984, which is about the level of health spending expected across OECD countries given New Zealand’s per capita income as measured by GDP. To use another measure of health expenditure, by 2007 New Zealand was spending 9.2% of GDP on health, slightly higher than the OECD average of 8.9. A very recent health system efficiency analysis, using 2007 data, showed that New Zealanders are living longer lives than would be predicted from GDP when compared with other OECD countries, achieving 1.7 more years of life expectancy than expected from GDP, while spending only slightly more (US$ 189 PPP) on health than expected from GDP. New Zealand also performs especially well on the international stage for controlling growth in pharmaceutical spending per capita, which on average is two times less than Canada and 2.5 times less than Australia. However, further productivity gains are needed to keep moving the country in the right direction in terms of improved systems outcomes, with proportionately smaller increases in the level of government health spending in the near future.

While progress is being made in reducing inequalities in health outcomes between population groups, some remain. Māori and Pacific peoples have poorer health than non- Māori and non-Pacific people, and people with low socioeconomic status have poorer health than those with higher socioeconomic status. Five-year cancer survival rates, cardiovascular disease mortality and diabetes diagnosis show marked disadvantages for Māori compared with non- Māori people, while Māori and Pacific women and women living in deprived areas are less likely to receive cervical or breast cancer screening.

The causes of inequality are complex. The health and disability sector needs to continue to provide services that act to reduce inequalities between groups and to work across sectors to address the unequal distribution of the social determinants of health.