Government speeds up health grand plan

By KEVIN TAYLOR

The Government will shortly announce an accelerated rollout of its primary health grand plan.

Two years ago today, when the first two primary health organisations opened their doors, the Government was aiming to extend cheaper primary health charges to the whole country in eight to 10 years.

But Health Minister Annette King has told the Herald that papers now before Cabinet seek agreement for a speedier rollout and that she hopes to make an announcement in the next few weeks.

"I'm not prepared to announce the rollout until its been agreed by Cabinet ... but it is going to be accelerated," she said.

The eight-to-10-year timeframe was based on slow acceptance of the Government's primary health strategy - the biggest change in primary health care since World War II.

"In changes in primary health care in the past there's always been resistance or problems, so it was thought it would take quite a long time to get acceptance of a change," said the minister.

"In two short years we have gone from zero to 3.5 million people covered - which is an amazing achievement considering I was advised that we'd be lucky to get 350,000 enrolled in the first year."

There have been last-minute, behind-the-scenes hitches in the changes taking effect today, which deliver subsidies to interim PHOs for about 300,000 people aged 65 and over.

The hitch has involved a lack of agreement between the ministry and some doctors about how much of the subsidy - $26 a patient per visit - gets passed on in reduced fees.

But despite various hiccups in the past two years, the large cash injection for primary health-care has helped to keep the sweeping reforms off the national political stage.

National Party health spokeswoman Lynda Scott believes part of the reason has been the lack of exposure of the reforms to parliamentary scrutiny.

"There has been no select committee process, no bill before Parliament, the public haven't been informed.

"It's just been a process that the Government's implemented."

But National's policy to abolish what it claims is race-based funding of PHOs and to fund on the basis of individual need has little support from GPs, according to New Zealand Medical Association General Practitioners Council chairman Peter Foley.

He says GPs oppose yet more changes to the system.

But he also criticises the PHO system, saying the biggest problem has been the uneven rollout of subsidies, although he acknowledges the Government is about to act.

"As all New Zealanders can move to a level playing field where they all get eligible for the same benefits, we will see some real advantages," he says.

But he says the rate at which GPs have joined PHOs should not be taken as an endorsement of the system, as they had to join or their patients would have missed out on the benefits.

NZ Doctor editor Barbara Fountain agrees, saying that ultimately the Government is trying to control primary health-care through PHOs.

"They want the same product delivered to the same standard for the same price. There was no choice for GPs because all funding will ultimately go through PHOs.

"They had to come on board because as soon as doctors in one part of town create a PHO people flock to it because of cheaper fees - so doctors in the other area had to get going and start a PHO."

Dr Foley says the association supports the primary health-care strategy and boosted funding, but its implementation through PHOs has been difficult.

Meanwhile, the Ministry of Health cannot yet say what impact PHOs are having on people's health.

It will take at least three to five years before the full effects of the new system on health outcomes will be known.

What is a PHO?

A PHO is a group of health providers through which district health boards implement the Government's primary healthcare strategy.

They include a general practitioner and perhaps nurses, Maori and Pacific providers, pharmacists, dieticians, mental health workers and dentists.

How many types of PHOs are there?

Two - Interim and Access. Access receive bigger Government subsidies so they can charge lower fees. But to qualify they must show that their patient registers have more than half Maori, Pacific Islander, and/or poor people.

Isn't this race-based funding?

It would appear to be, but Health Minister Annette King argues that it is a needs-based funding formula. National promises to abolish the "race-based" funding formula and allocate money based on individual need.

Why is today significant?

The first two PHOs opened their doors on this day two years ago in South Auckland. Five new PHOs will be added today, bringing the total to 73. The Government today also plans extending its subsidies for cheaper healthcare to about 300,000 people aged 65 and over who are enrolled in Interim PHOs.

How many people are covered by PHOs from today?

About 3.5 million - whether they know it or not. The Government says about 2 million receive some form of cheaper primary healthcare.

Have doctors' fees dropped?

In some cases, yes. Access PHO fees range from nothing to $25, says the Ministry of Health. Many offer free healthcare for children under 6. School-age children will be charged less than $10. More than a million patients are enrolled in Access PHOs, mainly in the North Island. The ministry cannot say what Interim PHOs charge because it has not yet analysed a survey, but the National Party claims 1.5 million people may be paying more - a view backed by the NZ Medical Association General Practitioner Council.

What's stopping me signing up to a cheap-fee Access PHO?

Nothing, but providers are monitored by the Health Ministry to ensure their register of patients meets the Access funding criteria. The Medical Association has noticed little patient drift.

PHO funding

YEAR, AMOUNT

2002-03 $48 million

2003-04 $167 million

2004-05$263.8 million

2005-06 $280 million

TOTAL $758.8 million

PHOs may also get other funding on the same basis as other health providers and GPs.