Lecture 18: the health system, health services, access to and quality of care

Question 1

what is the structure of the NZ health system?

Answer 1

• Minister of Health
• Ministry of Health
• Public Health Agency
• Maori health authority and Health NZ
• commissioning and provision of health care services
• also includes ACC and PHARMAC

Question 2

what is the purpose of Pae Ora (healthy futures) Act 2002?

Answer 2

• protect, promote and improve health of all New Zealander
• achieve equity in health outcomes, especially for Maori
• build towards pae ora (healthy futures) for all New Zealanders

Question 3

what does Pae Ora (healthy futures act) 2022 do in the health system? what are its components?

Answer 3

• it establishes the new health system
• key components:
  Set out:
  role of minister, objectives and functions of te whatu ora and te aka whai ora, iwi-maori partnership boards, overview of important health documents, code for consumer and whanau engagement
• it has a descriptive tiriti clause and an operative tiriti clause which gives effect of the Treaty in the health system

Question 4

what are the sources of funding for the health system?

Answer 4

• Vote health
• ACC
• other government agencies
• local government
• private sources (out of pocket payments and private insurance)

Question 5

what are the challenges of funding?

Answer 5

• cost increases - inflation
• population increases
• ageing population
• increasing health needs - long term conditions, chronic disease

Question 6

what are maori providers?

Answer 6

• owned and operated by Maori organisations
• most do no have GP clinics
• many are small
• all around country
• Maori led PHOs (several types)

Question 7

what are the challenges for Maori providers?

Answer 7

• funding (only recently funding has been equal)
• monitoring/reporting
• workforce
• distribution relative to Maori population
• data and digital

Question 8

define access to care

Answer 8

being able to make use of personal health services to achieve the best health outcome at the time they are needed

Question 9

define quality of care

Answer 9

doing the right thing, to the right people, at the right time

Question 10

what doe access to care and quality of care do?

Answer 10

• both contribute to health outcomes
• ethnic differences in access and quality of care contribute to inequities in health outcomes

Question 11

what are the types of barriers to accessing care?

Answer 11

• system level
• service/provider/organisational level
• provider/patient
• patient level

Question 12

what are the system level barriers to accessing care?

Answer 12

are services available
- publicly funded
- geographic availability - distribution and location

Cost of hospitals, GPs, pharmacy, radiology

Question 13

what are the serve/provider/organisational level barrier to accessing care?

Answer 13

• opening hours
• appointment availability
• active follow-up where needed
• physical access
• geographic - proximity to patient
• cost

Question 14

what are the provider/patient level barriers to accessing care?

Answer 14

• relationship with patients including trust, confidence, continuity
• cultural safety/competence
• health literacy/communication skills

Question 15

what are the patient level barriers to accessing care?

Answer 15

• previous negative experiences/mistrust
• health literacy
• transport
• competing priorities e.g. employment, childcare