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Table of Contents
- Abstract………………………………………………………….………………………1
- Overview of New Zealand’s Health Care System………………………………………2
- Country Profile
- Health Status indicators
- The Role of Government
- Public vs. Private provision of Health Care
- Funding
- Evolution of New Zealand Health Care System…………………………………………5
- 1870s
- 1900s and 1910s
- 1920s
- 1930s
- 1940s
- 1950s and 1960s
- 1980s
- 1990s
- 2000 to present
- Similarities and Differences of Health Care systems in New Zealand and Canada …….9
- Public vs. Private
- Role of Government
- Health Act
- Funding
- Life Expectancy
- Infant Mortality
- Health Expenditure
- Health Care Professionals
- The World Health Organization
- Advantages and Disadvantages of New Zealand Health Care System…………………..13
- Recommended Management Practice..…………………………………………………..14
- Reasons for the Recommendation.………………………………………………………15
- References………………………………………………………………………………..17
Table of Appendices
1. Basic Health Indicators
2. World Health Report Selected Indicators
2.2. Key to the World Health Report Selected Indicators
3. Infant Deaths: Number of Deaths and Death Rates, by Cause, Sex and Age
4. Life Expectancy
5. Age Standardized Death Rates
6. Structure of the New Zealand Health Care System
7. Key Figures in Health Care Expenditures
8. Historical overview of Health Care in New Zealand
Abstract
This paper provides a broad overview of New Zealand’s Health Care System. A background of the country is provided, followed by a description of health indicators illustrating the health status of the population of New Zealand. The role of the government in health care is outlined, with a focus on recent changes designed to improve the overall health of New Zealanders. Public versus private provision of health care, and their respective funding structures are discussed. An overview of the history of health care in New Zealand illustrates the constant changes experienced by this country. The similarities and differences between the Canadian and New Zealand health care systems are then analyzed. Advantages and disadvantages of the system are highlighted, and recommendations are made so that Canada may benefit from successful health management practices employed in New Zealand.
Country Profile
New Zealand is located in the South Pacific Ocean, approximately 2000 kilometers off the southeast coast of Australia. The country comprises two main islands plus a number of smaller islands with a combined land mass of 269 000 square kilometers. Of the 3.8 million inhabitants, 88 per cent of the population is of European descent and 12 per cent of the population is of Maori or Polynesian descent. The Maori people are indigenous to New Zealand and they represent special challenges to the country’s health care system.
Although New Zealand is often perceived to be a rural country, 80 per cent of the population lives in urban areas, with 50 per cent concentrated in the four main cities, particularly Auckland. The rural population is widely dispersed. While many farming areas are relatively affluent, other rural areas- particularly those with a high percentage of Maori- are characterized by unemployment, substandard housing and poverty.
European settlement from the late eighteenth century had a devastating effect on the health of the Maori population. Infectious diseases, including tuberculosis, typhoid, and venereal diseases, claimed the lives of many. Despite the recent narrowing in socioeconomic and health status differentials between Maori and non-Maori people, the Maori still have a lower life expectancy, lower average incomes, higher unemployment rates, and generally poorer health compared with the rest of the population. (Journal of Public Health Medicine, 1996)
Health Status Indicators
The health status of New Zealand has greatly improved over the last forty years. According to the World Health Organization (WHO), life expectancy at birth in 1997 was 73.7 years for males and 79.1 years for females, however this is low compared to other Organization for Economic Cooperation and Development (OECD) countries (See Appendix 1 for life expectancy and other Basic Health Indicators). In assessing overall level of health, the WHO also calculates a Disability Adjusted Life Expectancy index (DALE). The DALE is a measure of the expectation of life lived in equivalent full health, and this is 69.2 years for New Zealanders; thus New Zealand is ranked 31st in the world on overall level of health. With regards to overall health system performance, New Zealand is ranked 41st in the world, while Canada is ranked 30th (See Appendix 2 for these and other WHO rankings).
New Zealand’s infant mortality rate has decreased in the last forty years, but is relatively high compared to other OECD countries. In 1998, the rate was 5.7 deaths per 1000 live births (FAHADINZ, 1999). The major causes of death for infants include perinatal complications, congenital anomalies and Sudden Infant Death Syndrome (SIDS) (See Appendix 3). The New Zealand government reports that when young, unmarried mothers from lower socioeconomic groups with limited education bear children, SIDS is more common (FAHADINZ, 1999)
The major cause of death in the general population of New Zealand is disease of the circulatory system, followed by malignant neoplasms (cancer) (See Appendices 4 and 5). Of particular concern to the government is the loss of life in this country due to mostly preventable causes. Major problems contributing to low life expectancy, especially among the Maori population, include smoking, poor nutrition, drinking and suicide. The New Zealand government estimates that approximately 70 per cent of premature deaths in the 0 to 74 age group are avoidable (FAHADINZ, 1999).
The Role of Government in New Zealand’s Health Care System
The Minister of Health is the head of the New Zealand health care system. This person is a Cabinet Minister and is responsible to the Parliament for the activities of the Ministry of Health. The duties of the Minister of Health are defined in the Health and Disability Service Act of 1993. His or her primary responsibility is to ensure that the government’s health policy objectives for the country are achieved. (FAHADINZ, 1999)
Until recently, the health care system consisted of four regional health authorities (RHAs), which were set up to purchase all primary, secondary and tertiary health services, including disability support services in New Zealand. In effect, this meant that all government funding for personal health services was integrated into a single budget, and that budget was capped, including funding for fee-for-service primary care payments. There were also 23 crown health enterprises (CHEs) which entered into contracts with the RHAs to provide services alongside private hospitals or other private providers. CHEs were independent business entities, governed by a government appointed board of directors. Under the legislation, CHEs were required to act as successful and efficient businesses while exhibiting a sense of social responsibility. (Journal of Public Health Medicine, 1996 - See Appendix 6).
The New Zealand health care system is currently undergoing change designed to focus on improving the overall health of all New Zealanders. These changes are being guided by overarching strategy for the health and disability sector, specifically the New Zealand Health Strategy and the New Zealand Disability Strategy.
The changes are being implemented through the New Zealand Public Health and Disability Act 2000. This legislation allows for the creation of District Health Boards- a key step in moving to a population based health system. The 21 District Health Boards will have a mixture of locally elected members and members appointed by the government to compensate for skill shortfalls. The Boards will have overall responsibility for assessing the health and disability support needs of communities in their regions, and managing resources to best meet those needs. Services will either be provided from public facilities owned by the District Health Boards or purchased from private providers. (13th Commonwealth Health Ministers’ Meeting, 2000).
Public vs. Private Provision of Health Care
Overall, there are approximately 80 public hospital facilities in New Zealand including age related care and disability service facilities. The majority of beds in New Zealand (77 per cent) are in public hospitals (Shah, 1998). Patients with highest priority are treated first, while those patients presenting less urgent cases are placed on waiting lists. Priority setting for public health services is determined through clinical guidelines set forth by the Health and Disability Services Act of 1993. (MJA, 2000).
Public health services are often inter-sectoral activities. Current health initiatives in New Zealand include Child Health, Maori Health (which aims to increase the number of Maori health care workers in New Zealand), Youth Suicide Prevention, Strengthening Families, Immunization programs, the National Breast Cancer Screening Program and National Drug Policy (for reducing the use of tobacco, alcohol, and illicit drugs). (FAHADINZ, 1999).
Primary care from a general practitioner (GP) usually must be paid for privately by the patient on a fee-for-service basis, although the government subsidies most fees for children under the age of six. The government tries to ensure that access to GP services is not impeded for those with low incomes or those who have high health needs. It subsidizes about 70 per cent of the over 11 million visits to GPs each year.
Private hospital services must be paid for by patients. Private beds make up approximately 23 per cent of the total number of hospital beds in New Zealand. Private hospitals are usually smaller facilities with services limited to specialized procedures. Often, since waiting lists for surgery in public hospitals are so long, patients will opt to have their surgeries done in private facilities in order to have them done promptly. (FAHADINZ, 1999)
Funding
Approximately 77.5 per cent of health expenditure in New Zealand is publicly funded and each year nearly NZ $7 billion is allocated to health services in this country. New Zealand is unusual among developed countries, however, in only funding about 40 percent of first contact services through Vote Health in what is otherwise a predominantly publicly funded system. (See Appendix 7 for key figures in health care expenditures).
Private funding accounts for 22.5 per cent of total health expenditure in New Zealand and it comes from two main areas: individual out-of-pocket payments and private health insurance. Most private funding is out-of-pocket payments. Almost half the population have some private health insurance, but this accounts for only 6 percent of total health expenditure. Private health insurance does not provide comprehensive cover and is most commonly used to claim reimbursement for primary care user fees, elective surgery in private hospitals and specialist outpatient consultations. Total health expenditure has increased only marginally in the last twenty years, although the proportion funded by the state has been falling gradually. (Journal of Public Health Medicine, 1996).
Evolution of New Zealand Health Care
1870s
The first mention of an organized public health system in New Zealand occurred in 1872 when the Public Health Act was passed. The Act was responsible for setting up central and local boards of health and defined the power that these boards held. New Zealand was very concerned with quarantine and The Act gave detailed information about the rights of the local boards in regards to quarantining marine crafts. (MacLean, 1964)
A new Public Health Act was passed in 1876 to deal with issues regarding the boards of health. The Act replaced provincial central boards of health with a central board of health for the whole colony with the local authorities still maintaining their function as local boards of health. The new Public Health Act also had powers in regards to food handling, and sanitation. Both of these issues were important to ensure that spread of contamination and disease was prevented. (MacLean, 1964)
1900s and 1910s
In the year 1900 another Public Health Act was passed in response to the threats of the bubonic plague. The new Act reformed the health laws and in 1901 a Department of Public Health was set up (http://www.stats.govt.nz/default.htm). This department came under the control of a Minister of the Crown. This Department of Public Health was given high powers, including the power to override local authorities. In 1908 The Act consolidated with amendments to become the Public Health Act 1908. A Chief Health Officer and district health officers staffed the Department of Public Health. These individuals were required to be medical practitioners who agreed to not practice medicine while in term and also to have extensive knowledge of sanitary and bacteriological science allowing them to deal with issues of sanitation to aid in preventing the spread of infectious disease, including leprosy, bubonic plague, and smallpox. (MacLean, 1964)
1920s
The next major act to be passed was the Health Act 1920. This act was passed as a result of the reorganization of the structure and functions of the Department of Public Health. At this time the powers of the district health officers was reduced and the local authorities were given an increase in autonomy. It is in this act that the Department of Public Health name was changed to The Department of Health. In the passing of this act a Board of Health was organized to assume many of the responsibilities of the district health officers and also to oversee the actions of the local authorities (MacLean, 1964).
1930s
The year of 1938 brought about the passing of the Social Security Act. This act aimed to help the people of New Zealand by providing medical treatment and benefits. This was provided to ‘maintain and promote the health and general welfare of the community’ (Koopman. et al., 1997). This act was introduced in response to the post-war welfare state and is credited with providing the representation of the main features of the state until 1991 (Koopman et al., 1997). Another important implication of this act the implication it had on the rest of the world. In passing the Social Security Act New Zealand became the first country in the world to develop a public hospital service allowing an open-ended policy that would ensure universal access to all citizens.
1940s
Major changes took place in the 1940s as implementation and amendments of the Social Security Act took effect and changed the way New Zealander’s obtained health care. The public system in place was primarily tax-funded and the government share of public health care funding jumped from less than 40% to almost 80% over the next twenty years (Blank, 1994). This increase was supported by the state as they believed that “access to health should be based on need, not on ability to pay” (Blank, 1994).
1950s and 1960s
In the 1950s and 1960s changes in the health care system began to take place as the system started to shift from primary and preventative care towards curative medicine with pressure from the public to increase their level of technological medicine availability. This resulted in an influx of professionals searching to cure diseases rather than trying to prevent disease from occurring. The shift away from preventative medicine resulted in a decrease in money from the government for primary care as the money was instead spent on curative medicine. (Blank, 1994)