Lecture 6: New Zealand's Health System Flashcards
Define what a Health System is?
A health system consists of all organizations, people and actions whose primary interest is to promote, restore or maintain health (WHO,2000)
Achieving greater access to and coverage for effective health interventions.
What events led to the change of health systems and why?
- In the Early 20th century pandemic led to concerns for maternal health and fitness of soldiers.
- scientific knowledge and understanding about source of diseased increased
- citizens expected that the health care system could increase life expectancy
what allowed health systems to start changing?
The Social Security Act 1938
what are the core principles for health care according to the social security act 1938?
- health care is a fundamental right - universally available for all
- no barriers to access
- preventative not curative focus
- services should be integrated, not fragmented between primary and hospital-based care
what were the issues/oppositions that came from the government funding model?
- the BMA (NZ) argued that full government funding would undermine doctor-patient relationships.
- charging patients a fee-for-service made medical practice seem like selling goods over the counter
- doctors should be able to give full attention to patients without having to worry about giving them a bill
- national health insurance is the best funding method
what things would doctors do to implement that health care plan?
doctors would:
- maintain their independence and private business ownership model
- their ability to directly charge each patient for services provided
- receive subsidy per visit from the government, meaning patients directly paid around a third of the cost
- be permitted to work in public hospitals for which they would be paid a salart, while still being able to work in the private sector.
However, hospital services and maternity care remained free!
what happened as a result of the BMA (NZ) disagreeing with the government’s funding model?
A compromise was reached, which was a Dual system
What are the names of the separate health systems health care providers work in?
- public employment
- private employment
- primary care
- hospital-based care
What are the positives of having a compartmentalised health system?
- primary care opportunities increased through 1990s
- independent practitioner associations
- maori providers/whanau ora
- pharmac managing purchase of medicines
what are the responsibilities/intentions of DHBs?
- Responsible for planning, purchasing and providing health care in their areas
- intended to democratise and decentralise planning and decision making.
what is ACC?
Accident Compensation Cooperation
- a NZ insurance scheme to deliver injury prevention initiatives and no-fault personal injury cover.
Is the NZ health care system universally available?
It depends on your perspective but it is important to consider how available health care is to:
- poor
- maori and pacific
- international students
- disabled people
does the NZ health care system have barriers to access?
- we do have very low cost access clinics but there are 500,000 poor not in a VLCA area
- co-payments for many services including primary care and medications
- dentists
- cost is a barrier for accessing health care for many!
what is a two-tiered system?
30% have private health insurance, then there is public services.
- In NZ access to publicly funded health care services such as access to elective surgery are potentially available to all, but access is rationed
does the NZ health system have a preventative, not curative focus?
- NZ has some MOH targets for increased immunisation and stopping smoking
- some targeted funding
- however, approaches to improving health of populations (alcohol, nutrition, healthy housing) are not often converted to policy
