PHO Alliance outlines seven-step plan for a sustainable health system

The PHO Alliance has outlined seven policies that it believes need to be introduced to help New Zealand's health sector overcome the challenges it will increasingly face.

Three actions concern reprioritisation of funding and services, including a commitment to supporting IT systems that directly underpin patient-centred integrated care, and four are aimed at removing barriers to access and eliminating “perverse incentives”.

The PHO Alliance, which represents 21 primary health organisations, has presented its A time to act publication to the Minister for Health, Jonathan Coleman, saying the seven actions will help sustain the New Zealand health service for future generations.

PHO Alliance chairman John Ayling said the NZ health service was one of the best in the world, “but we have an ageing population living with more long-term conditions, increasing incidence of obesity, the challenge of technological advancement and rising public expectations, all of which are combining to place unsustainable pressures on hospitals, general practices and aged care providers.”

Manaia Health PHO chairman Andrew Miller said the actions asked some challenging questions.

“Whilst we have a great primary care system, we know we cannot meet rising demand using the same models of care and provision as we do now,” Dr Miller said.

“We need to address those areas of the current system which are failing to keep pace with demand and are failing to address the unacceptable inequalities being experienced by our most vulnerable and high-needs patients.”

The publication says a focus on health promotion, prevention and health literacy is critical to address the wider determinants of population health and a fundamental shift is urgently needed in the way healthcare is delivered.

“If we get the care right, it will be right for the patient as well as the system, then sustainability will follow,” it says.

The first action is to prioritise more services and funding to those most in need, especially Maori, Pacific Islanders and those New Zealanders living in the most deprived communities, by changing the capitation system and better targeting funding from the “myriad funding silos” that span Ministry of Health programs.

“The current system of universal capitation funding is failing those who need it most and the formula for allocating health dollars across both primary and secondary care services needs an overhaul to be targeted for best effect,” it says.

“The big advances in reducing inequalities come when bold decisions are made about funding priorities.”

It also wants the government to abandon health targets that have no evidence of improvements to patient outcomes, such as setting maximum waiting times for emergency departments and DHB targets for the number of patients receiving elective procedures. This, the PHO Alliance argues, does nothing for preventative health or for finding alternatives to secondary care.

It also wants to put integrated IT platforms in place, supporting the vision of the National Health IT Board but arguing more needs to be done to make it a reality.

“To achieve high quality healthcare and improve patient safety, New Zealanders need a core set of personal health information available electronically to them and their treatment providers regardless of the setting as they access health services,” it says.

“We need to find information solutions which allow patient-centred integrated care. These systems need to be interoperable, share data and be accessible to not only health providers but patients.

“For this to occur there has to be strong national and regional leadership to make unified decisions about how to progress towards the NHITB vision statement. This should be driven by the needs of patients and clinicians, not by IT vendors.”

Perverse incentives

In terms of removing the barriers to access and eliminating perverse incentives, it argues that all primary care consultations must be made more affordable.

“To allow patients to attend ED with its immediate access to diagnostics and its high-tech facilities with no co-payment, yet have financial barriers to see their GP, is perverse,” it says.

“The current Very Low Cost Access (VLCA) capitation funding formula is failing. There are 590,000 non-high needs patients receiving the benefit of VLCA funding. We need to have a funding formula that is targeted to the need of the individual patient.”

It also wants to improve multidisciplinary care by allowing patients direct access to allied health professionals and free up GP time for more complex patients.

“Once again, we believe removing the funding barriers and better co-ordinating access to all our primary care health professionals will not only improve outcomes but also save money as we optimise the skill mix for the primary care workload and reduce demand upon high cost secondary care services and ED.”

It wants to remove barriers to diagnostic services by allowing primary care teams to better use diagnostic services that are traditionally the domain of secondary care.

“Failure to provide access to the full suite of diagnostic services to our vital primary care workforce results in delays to diagnosis, anxiety for patients, duplication of costs through outpatient appointments and an overwhelming failure to provide the right care at the right time in the right place.”

The seventh action is to challenge what the PHO Alliance calls the “conflicted relationships” that DHBs have as both controllers of funds and managers of hospitals.

“In New Zealand, we feel investment in primary care has continually been eroded over recent years rather than increased,” it says.

“We believe this will not change whilst we have financial pressures at the same time that DHBs have the unenviable task of controlling those investment decisions locally and simultaneously being held robustly and publicly to account for the performance of secondary care acute hospitals.

“Very few directors or executives the world over could rationally increase the risk to their own bottom line by investing in another sector's growth and capacity.

“We need to look again at the purchaser/provider split without creating an industry of accountants and contract managers unwittingly diverting health funds away from real patient care.”

Mr Ayling said some of the proposed actions would require bravery to implement given that they confront an established way of thinking and established practice.

However, “improved patient outcomes must stand above existing arrangements and organisational barriers,” he said.

“Now is the time to act for those communities and families most at need.”

The publication (PDF) is available from the PHO Alliance website.

Posted in New Zealand eHealth

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