6. Hon TONY RYALL (National—Bay of Plenty) Link to this
to the Minister of Health
Are there any areas in the health system where he is not getting value for money; if so, where?
Hon PETE HODGSON (Minister of Health) Link to this
Yes, there are. Although the New Zealand health system is one of the most cost-effective in the Western world, seeking better value for money is a continuous process across the sector.
Why has the number of first specialist assessments and follow-up assessments provided by the public health system fallen by 28,000 in the past 6 years despite an extra $4 billion a year of health spending?
I would hope that that was the case. I suspect, actually, that it is not, but I hope that one day we can look forward to reduced hospital admissions and reduced first specialist assessments, because this Government is putting so much time, effort, and money into building a primary health care system. We are pretty proud of that, and I think it is the way of the future.
Lesley SoperCan the Minister justify his assertion that New Zealand has one of the most cost-effective systems in the Western World, and how does he measure cost-effectiveness?
The usual way to measure cost-effectiveness, or value for money, internationally is to compare life expectancy with the annual cost on health per person. For example, the United Kingdom spends more than New Zealand per person, but we in New Zealand live longer. The United States spends about three times per person on health each year than New Zealand does, yet we live longer than people in the United States.
Barbara StewartDoes the Minister consider that taxpayers are getting value for money for elective surgery when, in 2005-06, public hospitals performed 105,784 elective procedures against Southern Cross’s 126,300; and does the Government have any philosophical objections to making more use of private providers?
This is not a reflection on the member at all, but her public sector figure happens not to include surgery undertaken in an outpatient setting. But, none the less, the member is right to point out that the private sector provides a lot of surgery, both privately and publicly funded. When I increased funding for surgical services recently I made it clear again that district health boards could certainly contract the private sector to undertake that surgery if they wished.
Tariana TuriaTēnā koe, Madam Speaker. Tēnātātou katoa. Is the Minister aware that the dental health care of adults in rural Otago is an issue of particular concern, and what response would he give to a woman who sent an email to my office yesterday, advising me that adults, particularly Māori and those from lower or middle socio-economic groups, are not accessing dental care because: “The high cost of dental treatment and the increasing costs of travel are barriers for the marginalised groups.”?
The member is right to raise this matter. It is a matter of fact that adult dental care is not part of the public health system. It is just not part of it, and it never has been. This Government is preoccupied in the first instance with improving child and adolescent dental health. The member will be aware of that; she will be aware also that in the 1990s, we stopped training dental therapists—almost unbelievably, the previous National Government stopped training dental therapists. My predecessor, Annette King, opened two schools. We now have dental therapists again. We have money flowing into dental clinics. They have been put into community settings, not just in schools, so that in the future we can improve care for adolescents and maybe, as the costs allow, we can start looking afresh one day at whether this country can begin for the first time to look at providing adult dental care.
How can it be that after 6 years and $4 billion a year extra on health, 28,000 fewer people got an appointment with a hospital specialist last year, compared with 6 years ago, which was the first full calendar year that data was available?
The member continues to mine the hoards of data that are sent to him each week until he finds a figure that suits him. I just remind the member that since 1999 immunisation rates are up, infant mortality is down, 28 new or refurbished hospitals have been announced, breast screening is up, cervical screening is up, mental health services have improved very significantly, there are about 4,000 extra nurses in our system, there are over 1,000 extra doctors, doctors’ fees have come down, prescriptions that used to cost $15 now cost $3, and, interestingly, every year the life expectancy of a woman in New Zealand increases by almost 3 months and the life expectancy of a man in New Zealand increases by almost 4 months. That is the sort of response one gets when one invests in a health system, as we do.
Does it surprise the Minister that 14 of the country’s 21 district health boards provided their populations with fewer specialist appointments last year than 6 years ago, and is it acceptable for district health boards like Capital and Coast District Health Board and Whanganui District Health Board to provide 20 percent fewer specialist appointments than they did 6 years ago, despite the hundreds of millions of dollars he shovelled at the health system?
I will just say again that the member is well known for going through data until he can find two data points that give him an attack position. He has been doing that for the last year and a half. I would say to the member that if the health system is getting poorer, why is it that we have a thousand more doctors in our health system, why is it that we have a primary health care strategy that is now starting to get on top of issues before people need to go to a specialist, and why is it that New Zealanders are living longer if we are in so much difficulty? The member must look at the system as a whole. I invite him to try, for the first time, to do so.
Why is it that we have those thousand extra doctors in the hospital system but fewer people are getting appointments to see them, and does the Minister realise that to qualify for elective surgery, people need to get a specialist appointment; is it not the case that the Government is making it harder for sick people to get a specialist appointment, as one of the Minister’s sneaky ways of controlling the surgical waiting lists?
We have now moved into the realms of fantasy. The fact of the matter is that the amount of elective surgery in this country is going up, and that does not even include out-patients—it is going up. What is more, it will continue to go up. The member continues to rock up with figures that he chooses very carefully to show his point of view, and fails to look at the overall trend. He should start becoming a little more honest in the way that he phrases his questions.
Dr Jonathan Coleman Link to this
Would the Minister explain why in the 2006 calendar year there were 6,000 fewer first specialist assessments performed across the Auckland regional district health boards than in 2001, and should the public be concerned that that number represents a decrease of 8 percent over 5 years when the population of the region actually increased by 12 percent over the same period?
I just gently say again that my hope is that we reach a health system—and we have not yet, frankly—that is so good at the primary level that we can reduce the amount of first specialist assessments. That would be a good aim. The question is whether someone is not seeing a specialist when he or she should, and the member has not asked that question. As far as I am aware, generally speaking there is no particular difficulty across New Zealand, across all specialties, in people getting to see a specialist. Certainly, if anyone has an acute need to see a specialist, this health system is particularly good at delivering it.
I seek leave to table a table showing that there were 28,000 fewer specialist assessments in the last 6 years.
Madam SPEAKERI seek leave to table a table showing that fewer people received elective surgery last year than 6 years earlier.