03.07.04
AGENDA
HON. ANNETTE KING
Minister of Health
Interviewed by SIMON DALLOW
This transcript is copyright to Front Page Ltd but may be used provided acknowledgement is given to Agenda and TVOne.
PART 1
SIMON
Since the Labour government came to power spending on health has leapt one more than three billion dollars and will this year reach almost ten billion dollars, that’s an whopping 20% of all government spending. A cornerstone of the government's plan for our health is the primary health care strategy which emphasises preventive care, community involvement and more affordable access to medical services. Whether they know it or not three and a half million New Zealanders are now covered by primary health care organisations or PHOs. The architect of the PHO system is Health Minister Annette King who joins us now.
Good morning Minister, why change the previous system why do we actually need PHOs.
ANNETTE
Well we are really keen to first of all get more affordable primary health care to New Zealanders because primary health care is the first step of the health ladder if you like, and at the moment if you’re really sick you can go into a hospital and it's free, but to get into primary health care then you have to pay quite a large amount of money and for many people it's a barrier. We also wanted to have better integration in primary health care with our health professionals, at the moment it's mainly led by doctors and they're paid a fee for service, what we wanted was team work of health professionals working together to provide prevention as well as treatment services in a team work approach. It is really what's happening in many parts of the world but in New Zealand we've been rather slow to get on board.
SIMON
Why emphasise primary health care over the over providers?
ANNETTE
Well primary health care is made up of many providers, it's not just to about doctors and nurses, in fact our PHOs are being joined by other providers, we've got pharmacists involved in them, in some areas Plunket are joining up, there are many health providers joining together to provide a range of those primary services, services that you need for not only treatment but from health promotion, disease prevention, and so they're working in a team work approach, giving people the sort of information and help they need before they become sick, and that is different to waiting till you turn up at the doctor and you need to be treated for something and you need a pill.
SIMON
Isn't the reality though that you’re just shifting the problem, dumping it on GPs to avoid hospitalisation and the cost associated?
ANNETTE
Well I think that’s what happens now, we dump it on GPs, we say it's their job to fix people when they're ill, the whole emphasis of this is to try and get in early, for example to get in early and find people who have got early stages of diabetes because when you leave a disease like that they end up in hospital with strokes, heart attacks, amputations, blindness and so on. So rather than dumping it on the GPs with a range of health professionals working together we're wanting to get ahead of some of those diseases, try and stop them happening before they happen.
SIMON
But GPs are saying this is just adding to their burden though, and we're having enough trouble retaining the GPs we've got.
ANNETTE
Oh there'd be some that might say that, but I know that a lot welcomed the ability to be able to work with a lot of other health professionals in the team work way in a collaborative way and I was at the GP Conference yesterday and whilst there's always problems in setting up a new system a lot of people can see the value of the team work and the approach we're taking, they're keen to get involved in prevention and early intervention, and so I think that there is a lot of acceptance, after all we have got a large number of PHOs and most of our doctors in them.
SIMON
Who will actually benefit from the PHO system?
ANNETTE
Well I think first of all patients do at the end of the day.
SIMON
How?
ANNETTE
First of all it's because we're making it more affordable to go to your primary health organisation to your health professional.
SIMON
If you say you’re making it more affordable can you then guarantee cheaper doctor's visits for everyone?
ANNETTE
In time we will, as you know.
SIMON
You can guarantee that?
ANNETTE
We will have cheaper doctors for everybody because the money is going in and we saw with the money we put in on the first of July for our over 65 year olds, every PHO around New Zealand reduced the cost of our older people going to the doctor. In the interim PHOs we'd already put the money into the access PHOs early but the interim PHOs over 300,000 older New Zealanders will be getting cheaper primary health care.
SIMON
Every one of them?
ANNETTE
Yes that’s the agreement that we came to by the first of July with all the PHOs.
SIMON
You say in time everyone will receive cheaper fees, how long?
ANNETTE
Well I'm going to announce that very soon, it goes through cabinet on Monday but when we started the primary health care strategy was estimated to take between eight and ten years to implement. What I can tell you it will be accelerated and be much sooner than that.
SIMON
So what are you going to put through cabinet on Monday?
ANNETTE
The timetable for the roll out of the rest of the funding for the implementation of the primary health care strategy. So when we will complete it and how we will finish completing it, as you know we did…
SIMON
Before the next election?
ANNETTE
Oh no the next election's only a year away, no it won't be before the next election, but it was sposed to be eight to ten years.
SIMON
Doesn’t that defer accountability?
ANNETTE
Oh no it's not a matter of deferring accountability it's a matter of ensuring that we've got the money to put into it, after all at the same time I'm putting new funding into primary health care I'm also having to put additional funding into district health boards to provide operations and so on, so it is a balancing act of where you place your funding, but certainly I have been given the green light to put in place the strategy and I've gone for the funding to make it happen much faster.
SIMON
Let's take it back to that grass roots level, how much do doctors actually receive in the way of subsidies under the PHO system?
ANNETTE
Well it depends, in an access PHO they're paid on a capitation basis by the number of people who are enrolled in their PHO and they receive money for each person and it does vary, but take the elderly, it was a subsidy of $26 that was given to the PHO to reduce the cost of older people going. Now some PHOs applied the whole $26, some applied a little less than that, but in the main they gave what I think was a fair amount passed on to the patient.
SIMON
Will doctors be obliged to pass on those subsidies in the form of reduced fees, there's some word that doctors don’t want to reduce their fees too far because they feel it will encourage too many visits?
ANNETTE
Oh I don’t think that that has been the argument, the argument from GPs is that they’ve always wanted to be able to set their co-payments, as you know this has been a longstanding dispute between governments and GPs in New Zealand going right back to the late 30s where doctors have maintained the right to set their co-payments, and so they have argued that what we put in as our business, but what they charge is theirs. What I want to see however is that what the taxpayers put in and this is 47 million extra dollars for the elderly, we want to see a real benefit for older New Zealanders and I have to say that the doctors and the PHOs have got behind that and I've been very pleased with the outcome.
SIMON
National of course is claiming that one and a half million of those three and a half million on the register might end up paying more and the GP's Association believes that may be true too.
ANNETTE
Well that’s because, the people who have received subsidies get a reduction but until we have money going in for every New Zealander doctors have the right to increase their charges if there's been an increase in their costs, I mean that’s not unreasonable, so until we have all that money going in they will put up the cost for those who aren’t subsidised, but Simon they did that anyway because we've only been subsidising people with Community Services Card after the 1991 budget that took away the general subsidy that we had. So each year doctors adjusted their fees in line with whatever the cost to them was, they had to cover their costs.
SIMON
Minister of Health Annette King, we'll come back to you after the break.
PART 2
SIMON
Back to Agenda we're with Minister of Health Annette King and we're discussing primary health care organisations or PHOs and the subsidies that are available to doctors under them. Minister the subsidies are greater for Maori and Pacific Islanders isn't that the race based funding that Trevor Mallard's been charged with removing?
ANNETTE
No, in the original funding under the access formula the main component is for age, there is gender, but there also was a small component added for Maori and Pacific based – that in fact had been in many funding formulas under the National Party so that’s where I found some hypocrisy, but the formula does have a component so that we could address as quickly as we could access for Maori and Pacific who were not accessing primary health at this time, and often ended up in our hospitals much sicker than they should, and so it was in the original roll out of the strategy in the access PHOs but of course we've just put money in for the elderly and I haven't heard National saying there's anything wrong in taking an age approach.
SIMON
Well forget the hypocrisy there, what about the hypocrisy here, I mean it is specifically saying that it will benefit Maori and Pacific Islanders regardless of their socio demographic status.
ANNETTE
Well I think if you look at the most recent research that came from the researcher from the Wellington School of Medicine, Tony Blakely, you will see that Maori people in New Zealand first of all die earlier than other New Zealanders but a Maori who has the same socio economic status as their neighbour is going to die earlier. Sorry I'll say that again, a person who is a wealthy Maori is going to die earlier than a poor European on the research that’s been done.
SIMON
Well in your speech to the Medical Association yesterday you said a Maori millionaire living next to a Pakeha millionaire is going to die younger so he still deserves the funding, well why can't he pay for himself?
ANNETTE
Well in the end we're going to cover everybody but at the moment if you are a millionaire and you've got a high user card health card you’re getting subsidised health care. What we want to do over time is to provide funding to all New Zealanders for access to primary health care based on their health need.
SIMON
Why can't it be done now?
ANNETTE
Well it's a matter of putting the money in over time, like we're talking of hundreds of millions of dollars and as I said before the break we have to put the priorities in place, I can't not take it off one part of the health system to give to another.
SIMON
Well you’re giving it to millionaires why can't it be needs based now?
ANNETTE
Oh there's very few millionaires that will be receiving it, we're giving …
SIMON
Regardless why should any of them receive it?
ANNETTE
Well why should anybody go to the public hospital and have it free, because that’s what happens now, we give free hospital care to anybody because they need it, whether they're millionaires or poor, why do we say that primary health care you have to pay for – top dollar for it, isn't this about wanting people to have good health, isn't this about need rather than your wallet?
SIMON
It sounds like closing the gaps to be honest.
ANNETTE
Well it's closing the gaps in health for many New Zealanders. Remember that on the first of July we've just increased the subsidy for all older New Zealanders because we know that older New Zealanders have more health needs. Last year we put in money for those under 18 and that goes right down to our babies, so we know that they have greater health needs than others, so as over time as we put money in we will have everybody covered but we've gone for where the highest needs are first, and I don’t apologise for that.
SIMON
You mentioned to the Medical Association yesterday in your speech that in real terms spending per capita has increased something like 28% I believe?
ANNETTE
That’s right.
SIMON
How long can the government keep increasing health spending faster than inflation? I mean is this just an ever increasing cycle?
ANNETTE
Well unfortunately health has a great demand, I mean there is a demand in every part of the health sector which it's in pharmaceuticals or operations or primary health care and that is a world wide trend and all countries face the difficulties of the health demand, but we believe in New Zealand that it is a priority to put in place as much as we can in terms of appropriate health care, early intervention, timely access to operations and so on and we've been committed to improving the amount of money we were putting into health. The Minister of Finance would say it can't go on indefinitely but we have made a commitment to lift the level of funding to so that we can get the better access to health care.
SIMON
So it can't go on indefinitely but when can we see the results, when can we see Maori and Pacific Islanders not over represented in poor health?
ANNETTE
Well some of the recent statistics over the last three years show there has been a slight improvement in mortality for Maori people, but these things do take time, we measure them over decades not over – you know over weeks and over a year. I think all New Zealanders want to see us have the best health we possibly can, and I don’t believe New Zealanders want to see big disparities between people's health, and so I think the commitment to trying to improve health is one that people agree with and primary health care is really the area that you've gotta do it in, it's no good waiting until they end up in hospital, the outcomes from operations is not going to be that the outcomes you can get by stopping someone having a heart attack.
SIMON
It does seem to be a funding bottomless pit though and prior to the last elections Steve Mehary floated the idea of a dedicated health tax, what happened to that?
ANNETTE
Well we have looked at the idea of a dedicated health tax, we haven't gone any further in that we have said that we needed to set out what our priority was for spending, put the money into it anyway, and so we've taken it from general taxation rather than a piece of taxation that’s set aside and we've made that commitment. So we haven't gone any further with a dedicated tax we have put the money in, but you would think when you hear some of the critics that we haven't put any money in at all.
SIMON
Well you've put plenty of money into an extensive building programme, 800 million dollars to go towards infrastructural buildings that’s a lot of operations missed out on.
ANNETTE
Well you can't do operations in tin sheds you have to do them in hospitals.
SIMON
Well no one's talking tin sheds but where do you draw the line?
ANNETTE
Have you been to Wellington lately, I mean Wellington has waited for years and years for a new hospital.
SIMON
We're not just talking Wellington you've got new hospitals springing up everywhere.
ANNETTE
Well no, let me go through them. Wellington has waited years and years, 305 million for Wellington, up there in Auckland signed off late 1999 was almost a half a billion dollar new hospital bringing three on one site. There's a new hospital in Waikato, extensions to their hospital, none of these are new actually they add to what's there and build around them, but we have to build in our infrastructure as well Simon you can't just put the money into operations you've gotta have the infrastructure to provide it in. Some of them are so old, if you take the Invercargill Hospital, very old very run down, at the end of the day you've got to invest. What you shouldn’t do is wait too long so you end up having to invest a whole lot more.
SIMON
It's hard to say to the people who are on the waiting lists though, isn't this about satisfying the DHBs rather than those patients?
ANNETTE
Oh certainly not, I mean people are really excited when they actually get a better facility. We've announced the new funding for Thames, old hospital over in Thames, they have a lot of people there, they have waited years to have improvements to their hospital, they thought in fact it would probably be closed down because it was so rundown, so people do want to see investment in their local hospitals, people love their local hospitals but they don’t like them if they aren’t efficient and they're falling down or they've been so neglected so you've got to invest on one hand into capital investment, but you also have to ensure that you've got money going into services and we've certainly increased money into services for New Zealanders.
SIMON
At what point do you actually have to bite the bullet though, I mean because of the funding bottomless you can always want new hospitals, the hospitals want new equipment all the time, what point do you bit the bullet and accept that it has to be user pays?
ANNETTE
Well I think that New Zealanders in the main believe that we should have comprehensive health care that’s affordable, it's not totally free as you know we pay for dentistry in New Zealand as adults, we certainly pay for some tests, we still pay for some primary health care, there is still a co-charge, so there is some user charges anyway. But I think most New Zealanders believe this is one part of social policy where you ought to have good access available, access for most New Zealanders when they need it.
SIMON
Is the only alternative in the long run letting bureaucrats decide who lives and dies? I mean this is being taken out of the clinical area the resources issue means at the end of the day bureaucrats must determine who gets operations who lives and dies.
ANNETTE
Well that’s not true.
SIMON
That 800 million dollars building programme as I say that money could have been spent, some of it at least could have been spent on operations.
ANNETTE
Oh but come on Simon, it's a ten billion dollar budget, 800 million is over a number of years to build up the infrastructure that provides operations, so I think you've gotta keep it into context, and bureaucrats don’t decide who gets operations, at the end of the day there will always be a limitation on what you can do. If you want to throw even more money at it you can do even more, but there is a limit to what you can put into it. At the end of the day the decision's on who gets an operation is a clinical decision based on a clinical assessment within the resources that are there.
SIMON
Limited by the resources available. Minister of Health, Annette King, thank you very much for your time this morning.
ANNETTE
Thank you.
Copyright to Front Page Ltd but may be used PROVIDED attribution is made to TVOne and Agenda
