Ian McPherson: Healthcare needs immunity from politics


Sustaining an enviable public system demands a focus beyond the election cycle.

Keeping the healthcare system afloat will require smarter use of resources. Photo / Dean Purcell
Keeping the healthcare system afloat will require smarter use of resources. Photo / Dean Purcell

In an election year, it can be easy for the big issues, such as health, to become just political footballs. Voters will hear a lot about more services, more funding, less waiting. But perhaps more than any other issue, health is too important to just be used to win votes.

Access to quality healthcare is a strong measure of social maturity. It's the difference between quality of life and ongoing pain or disability.

The reality is that keeping the healthcare system afloat will require the brakes to be put on new spending, it will require smarter use of resources and perhaps more individual contribution - not a great election year message.

Treasury's 2013 "Affording Our Future" fiscal statement highlighted the future cost of healthcare as one of the biggest challenges facing the New Zealand economy.

Due to rising demand for services, the New Zealand Institute of Economic Research (NZIER) estimates health will increase from 21 per cent to 32 per cent of all Government spending by 2050 - a 153 per cent increase.

What will be the implication for education, superannuation, police, social welfare and transport?

And the crunch in healthcare funding is not some far-off problem. The NZIER estimates the country has only around eight years to make a change to historic spending patterns before health costs start to seriously impact the Government's ability to keep the country within budget.

At the same time, our health system must adapt to cope with demographic changes, an ageing population, the increasing prevalence of chronic disease, new and expensive technologies, labour force challenges and growing public expectations around quality, service and treatment options.

It's a big task. It will require strong leadership and a willingness by all parts of the sector to put aside politics and take a long-term view. Research recently undertaken by Massey University found that politics, at all levels, was overwhelmingly seen as the key barrier to implementing solutions necessary to resolve health funding issues.

Thinking beyond the three-year political cycle will be essential. It may mean making some tough, even unpopular, decisions in the public health system. It may mean changing our focus, spending less in some areas and more in others. But before alarmists' placards are raised, this may not necessarily translate into compromising essential healthcare services.

This week, more than 50 key thinkers and influencers will gather in Auckland for a think tank to discuss proposed solutions to the healthcare funding crisis.

The Massey University research, which includes input from many of those attending the think tank, found that modifying or even reducing demand for healthcare was seen as the single most important strategy to avoid a future funding blowout.

A strong theme emerged of keeping people well to begin with - investing in and improving public health education, health literacy and preventative behaviours.

There were also calls for better integration between primary care and hospital-based services, and greater efficiency of the system as a whole.

Other, perhaps controversial, suggestions were based around funding and allocation - such as introducing user charges on certain services, incentives for providers based on patient outcomes, or making a greater personal contribution towards healthcare costs for those who can afford to.

Any changes must be carefully thought through and future implications considered. Implementation needs to be done in a measured and managed way. Good communication with the public will be vital - not only what is happening, but why it is so necessary.

Maintaining a financially viable health system is a long-term project that needs greater immunity from political whim - and it needs to start today.

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