Can New Zealand have a world-class health system? 8 steps that need to be taken

THREE KEY FACTS

• New Zealand is currently 485 GPs short and “will struggle to train or bring in enough international medical graduates to meet this demand”, a briefing to Health Minister Dr Shane Reti has warned.
• A survey of 220 general practice staff found four out of five had stopped or limited their enrolments over the previous three years.
• After-hours medical services in some regions are on the verge of collapse, as overworked GPs signal they can no longer provide cover or the funding falls short.

Dr Art Nahill is an Auckland-based specialist general physician, medical educator and writer with 30 years of experience. Dr Maple Goh is a clinician with public health training from Harvard University, focused on health equity, global health, and international health systems.

OPINION

As New Zealanders, we have always taken pride in our ingenuity in the face of tough challenges – Number 8 wire and that sort of stuff.

We love “punching above our weight” and showing the world the innovation that can be found within our little corner of it. It is now time to apply these qualities to addressing our current healthcare crisis, a word which we will use even if politicians are unwilling to.

The myriad ways our current health system fails to keep us healthy or treat us when we are sick have been well described. There are many places in the country where medical care is inaccessible. Solutions cluster around spending more money and the blanket training of more doctors and nurses.

What we really need, however, is a system that focuses far more resources on health promotion and early intervention than our current one, which has evolved to treat well-established diseases.

What we really need is to expand and diversify our healthcare workforce to better align with the needs of our communities. This means training a broader range of healthcare providers who can serve effectively in various settings, including rural, remote and under-served areas.

Here are eight steps that we believe can help shift our healthcare system to one that is better able to provide better and equitable care to all New Zealanders. The challenges to their implementation will be formidable, from financial to logistical. But we believe New Zealanders are up to these challenges:

• Healthcare reform must be addressed urgently and must cease being fodder for political squabbling. We need to marshal the best minds from across the stakeholder spectrum to design, implement and evaluate a healthcare system that can deliver cost-effective and equitable care of the highest quality. We must move ahead with healthcare reforms based on data, consensus and long-term vision.
• The Government must help facilitate the creation of healthy choice environments by immediately addressing how its tax, zoning and other regulatory policies help perpetuate inequity and contribute to ill health. Milk should cost us less than a 1.5-litre bottle of fizzy drink. The close association between levels of deprivation and access to obesogenic food is well described. Studies have also found that poorer neighbourhoods in New Zealand have significantly more liquor outlets than wealthy suburbs, along with more alcohol-related harm. We must acknowledge and address the ways such toxic environments fuel the tsunami of disease under which the healthcare system is currently drowning.
• The reach and scope of community-based primary care must be drastically expanded. Given the current and projected shortfall of GPs and the time lag time required to train them, we must quickly expand our para-professional workforce. Community Health Workers (CHWs) already do invaluable work in some New Zealand communities, but we need many more of them, and the services they provide should be significantly broadened. The health system needs a workforce of embedded CHWs specifically trained and supported to provide health education, green prescriptions, immunisations, cancer screening for some common cancers, chronic disease management and even some kinds of acute care. This workforce should be chosen and trained from the communities they would serve, to which they already have close ties and about which they have essential local knowledge. They should be enabled to provide care in people’s homes, marae, schools, places of work and worship. This CHW workforce should be supported by clinical support tools and communication technology that would connect them to the most local GP practices for consultation and supervision.
• Higher rates of graduates entering and staying in the primary care workforce should be achieved through bonding and debt forgiveness schemes for medical students, as well as higher rates of pay for GP trainees and registered GPs, particularly for those choosing to serve in remote and rural areas. We must significantly improve the remuneration of GPs relative to other medical specialties in order to entice and retain quality people into this critical workforce.
• The number of training spots available in New Zealand should be adjusted based on projected workforce needs, allowing for proactive management of shortages. By aligning training positions with anticipated demand, the system can ensure long-term sustainability and prevent an oversupply of trainees in specialties where they are not needed.

"We must significantly improve the remuneration of GPs relative to other medical specialties in order to entice and retain quality people into this critical workforce." Photo / Getty Images

• The effects of private specialist and hospital care on the quality, timeliness and equity of services offered within the public health system must be urgently studied. In the current environment, a two-tiered healthcare system is being created whereby those who can will purchase private health insurance and those who cannot are forced to rely on a decimated public system. We need to urgently address the issues driving doctors away from the public system into private care.
• We need a national electronic health record to better care for individual patients and to better capture data on the changing health needs of our communities.
• Eventually, we must aim to remove financial barriers to preventative primary care.

This is by no means a definitive list of possible fixes for our failing healthcare system, but we offer them in the hope that they may serve to initiate dialogue.

Number 8 wire won’t fix things this time – and we can ill afford to wait much longer for viable solutions.