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Health Sector Reforms

 

Labour Government Reforms
Reforms 1990-1999 - The Market Model of Health

Gender Equity and Health Sector Reforms

June 2006 Women's Health Watch

Sweeping health care reforms have shifted the structure of health care throughout the world in the past twenty years.
Largely, health care has become more market oriented. In much of the developing world this has been dictated by international financial institutions and put in place through structural adjustment policies. These nations have responded to the wants of the international financial institutions such as the World Trade Organisation and the World Bank by increasing the tendency toward decentralisation and privatisation or a refocus in financing.
The World Health Organisation has done an evidence report on the effects of health care reforms on gender equity. The 2005 report found that health sector reform programmes affect women and men differently due to their respective positions as users and producers of health care. However most reform programmes do not take gender equity into account when designing changes to the health care system and may lead to increasing inequalities. This is a summary of the report findings... Read More

 

New Zealand Public Health and Disability Bill WHA Submission to the Health Select Committee

2000

The bill and media statement by Annette King (17 August 2000) set out purposes for the Bill. These can be summarised as:

Rebuild New Zealand's public health service Restore community involvement and ownership Restore public confidence and health professional confidence Achieve best health and disability outcomes Ensure a population health focus Replace the current commercial and collaborative model with a cooperative and collaborative approach.

WHA is in substantial agreement with these purposes.

We support the approach of incorporating the Treaty of Waitangi into the Bill.

The Bill gives effect to the New Zealand Health Strategy which sets high level health sector principles and public health goals. The mechanism for delivering the strategy (and the Disability Strategy) is the Bill. The other relevant document is The Future Shape of Primary Health Care... Read More

Editorial- A dummy's guide to the new health act

December 2000 Women's Health Watch

Even seasoned health campaigners have been flummoxed by the horse-trading that went on during the passage of the New Zealand Public Health & Disability Act. The new Act abolished the Health Funding Authority and establishes 21 District Health Boards, with part elected members, but what else does it do?

So many changes took place as the Bill became law, with even National getting its spoke in, that there has been considerable confusion as to what happened and what it all means. I decided to find out... Read More

Here we go again

September 2000   Women's Health Watch 

Sandra Coney comments on three major planks of the Labour Government's health reforms

Labour is well down the track with its health reforms. The three major planks of its new approach have been released.

  • New Zealand Health Strategy
  • New Zealand Public Health and Disability Bill
  • Primary Health Care Strategy...
From a consumer perspective, the prospect of greater engagement with the sector will vary greatly from DHB to DHB and PCO to PCO. As Hospital and Health Services (HHSs) prepare their transitional plans they have engaged consumers to varying degrees from a little to not at all. Perhaps the best tactic is to build relationships with newly appointed board members. There was generally a high calibre of persons appointed. This may be a more effective route for dialogue over the future.... Read More
 

Redrawing the health sector- Editorial issue 52

February 2000 Women's Health Watch

Sandra Coney has recently been appointed as a consumer representative on the New Zealand Health Strategy Sector Reference Group. She reviews where we're heading in health... Read More

Maternity Care - A decade of change

December 1999 Women's Health Watch

Brenda Hinton reports on the state of New Zealand's maternity services

New Zealand's Maternity Services have undergone numerous changes since the passing of the Nurses Amendment Act in September 1990. Prior to this legislative change, only medical practitioners could take responsibility for the care of women and their babies during the childbearing cycle. Midwives had to work under the 'supervision' of a medical practitioner and, apart from a small number of domiciliary midwives who provided care to women in their own homes, most provided labour, birth and postnatal care in hospitals. Since the passing of the act, an increasing number of midwives have moved out of hospital employment and into community- based midwifery practice.

The Health and Disability Services Act 1993 initiated a two-and-half-year long negotiation process between maternity provider groups and the Regional Health Authorities. These negotiations culminated in the introduction of the notice pursuant to Section 51 of this Act, which prescribed the way maternity services would be provided and paid for. Section 51 required women to chose a single Lead Maternity Carer (LMC) who would budget-hold for the modules of service required by the woman and her baby during the childbearing cycle. LMCs would now carry the risk for women who might require more than the services paid for in the contract... Read More

Searching for a cure for the worried sick New Zealand after eight years of health reform

December 1999 Women's Health Watch

Sandra Coney discusses the health of our health system in this address, which she gave at the Coalition for Public Health's Conference on 'Options for Health', in Wellington. This speech was written before the election and therefore the Government it refers to is the National Government.. .Read More

Maternity services under the spotlight

April 1999 Women's Health Update

Women are the first group to be targeted for their views on New Zealand's troubled maternity service following the announcement of a Maternity Services Review.

The new maternity scheme has been contentious since it was introduced in 1996. Women must now choose a lead maternity carer who is responsible for managing a woman's care and her 'pregnancy budget' throughout pregnancy, labour and postnatal budget. Lead maternity carers can be general practitioners, midwives or specialists... Read More

The Future of the Health System

December 1997 Women's Health Watch

This paper was given by Sandra Coney to the Annual Conference of the Association of Salaried Medical Specialists in November 1997.

From the way Bill English has been talking lately, it is clear that he has nailed his flag to the mast of managed care. He disguises what this means by talking about giving 'the community' the power to organise health care because this brings decisions nearer to people's needs.

By the community, he does not mean those of us working in community organisations, nor does he mean the public. He means private sector general practice, organised as IPAs.

Giving GPs this gatekeeping role is dressed up as in words like 'coordination' and 'integration'. English maintains that GPs are the best people to decide what patients need. GPs and hospital specialists are going to cooperatively and harmoniously decide what is best for patients, although he doesn't explain how this partnership of equals will operate given that the GP in all probability will hold the purse strings. Nor does he illuminate where the patient has a say in this medical decision-making model.... Read More

Open Letter To the Uninformed: Managed Care Means Damaged Ethics

published in Health Care Analysis Vol5:3 252-258 (1997)

Dear Consumer,
While public attention has been focused on the reform of hospital services, a second wave of health reforms has been quietly formulating behind the closed doors of New Zealand regional health authorities (RHAs). This involves the radical restructuring of primary health care. With the encouragement of the Health Minister, general practitioners are being steered towards an American-derived system called managed care, and a similar and equally contentious model from Britain called budget-holding or fund-holding.

In the forms they are being promulgated internationally, both fund-holding and managed care are new, untried and under-researched methods of delivering health care. The long term effects of the recently established British model are not known, but there are signs that the early savings made under fund-holding will not be sustained in the long-term. In the USA, managed care is rapidly evolving from a not-for profit health maintenance organisation model, to a for-profit one, with uncertain repercussions for the health and health care of enrollees.

But despite the newness of this development, in New Zealand it is being picked up by government agencies with considerable enthusiasm... Read More
 

Plunket's universal service threatened by health reforms

July 1997 Women's Health Watch

Have today's generation of caregivers changed so much that they require a reduced level of support? 'That was the question posed by Dianne Armstrong, outgoing president of Plunket at the society's 53rd national conference, held in Auckland in late April....In the last decade, said Mrs Armstrong, there had been debate about how many visits were needed, but in the past the front line professionals decided this based on their knowledge and contractual requirements. Currently the Well Child Tamariki Ora national schedule provides nine visits in the first five years of life, six in the first 18 months of a child's life. 'While support for the caregiver is eluded to, the primary focus is on the child's development and immunisation stage.' ... Read More

'Women and children last': the legacy of the New Right

July 1997 Women's Health Watch

Sandra Coney, director of Women's Health Action, was the keynote speaker at the opening session of the 53rd annual conference of the Royal New Zealand Plunket Society, held in Auckland in late April 1997. This is the text of her speech.

'Women and children first' is a motto we all know. In the last decade or so, it would be more true to say that women and children have come last. Women's interests, and those of their children, have come a poor second to those of the economy, business and the market.

Over the past ten or twelve years we have seen a progressive unravelling of many of the supports and benefits New Zealand women have had to enable them to raise healthy children.

Responsibility for children has almost entirely been thrown back onto parents to cope on their own. The policy of shrinking the state and providing only a safety net has been applied in relation to families as well as everything else... Read More

The Great Birthing Battle: Who is the Loser?

September 1996 Women's Health Watch

Report on Midwifery & medical attitudes to Section 51 scheme for maternity care

Doctors and midwives are split over the new joint RHA maternity scheme. A recent New Zealand Doctor survey showed that 36% of GPs would reduce their involvement in maternity care, while 97% would cease providing this care altogether.

However, the New Zealand College of Midwives support the scheme, although it is clear that many midwives have misgivings about it.

Many women have taken their lead about how to react to the scheme from midwives. Traditionally, what's good for midwives has been seen as also good for women. Women fought for the right of midwives to practice independently and formed groups such as Parents Centre and the Home Birth Association which lobbied for domiciliary midwifery. Since midwives support the new RHA scheme, many women believe it must be alright.

But this is an issue where midwives and women's interests are not identical... Read More

A Quick Guide to What's Wrong with the New Maternity Scheme

September 1996 Women's Health Watch

The new maternity scheme involves giving midwives and doctors a fixed sum or budget to look after a pregnant woman. no matter how much care and support she actually needs. The previous system paid doctors and midwives for the actual care they provided. .. Read More

 

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