Playing politics with the Public Health

Dr Bryce Wilkinson
Insights Newsletter
26 June, 2020

The public health system is a political football.

Every change of administration is an opportunity to boot the ball at a different set of goalposts. Occasionally, all it takes is a change of Minister.

Professor Robin Gauld, director of the University of Otago’s Centre of Health Systems and Technology, has published at least two books and a substantial academic article on the structural instability of New Zealand’s healthcare system since the 1980s. The phrases in the titles, such as “Revolving Doors” and “One Country, Four Systems” set the scene.

Last week, the Government released the Health and Disability System Review panel’s restructuring proposals. They roundly reject the structure put in place by the Helen Clark-led Government in 2001.

The 2001 changes abolished the over-arching Health Finding Authority (HFA) and created 21 District Health Boards run by publicly elected personnel who lacked conventional board room expertise. As a result, the post-2001 system had no effective system-wide funding and purchasing coordinating function.

To their credit, the Treasury, State Services Commission, Te Puni Kokiri and the Crown Company Monitoring Advisory Unit advised the Government in 2001 its proposals were ill-justified. They were right. Multifactor productivity for health care and social assistance grew at 5.1% pa between 1997-2000 and at less than 0.1% pa between 2000 and 2018.

The Review panel’s kick at the ball would get rid of elected boards and create two new central agencies – the Health NZ and a Maori Health Authority – but with no clarity about the interface between their roles. Health NZ’s board will be the embodiment of conflicts of interest.

Those worried about a hidden drive for efficiency and accountability can relax. It will set out national-level plans along with regional, strategic, annual and asset plans – inevitably of a top down over-prescriptive nature.

However, anyone worried the system will muzzle the voice of end-users are right to be concerned. Users will remain disempowered by a politicised tax-funded system. Value-for-money price signals will remain muted and dominant government providers will naturally favour their own.

The Review’s proposals do not seem based on any clear diagnosis of the problems or offer clarity about why this new structure is the best way of fix them.

One thing is for sure: this won’t be the last time the health system is booted around the paddock.

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