Suffering poor health? Too bad for you

A rather disturbing report on Wellington’s health services shows that central government policies have led directly to people already in poor health getting even lower priority.

‘From Great to Good’, by professor Don Matheson, explains how – under pressure from central government targets – the Capital Coast District Health Board (C&CDHB) has increased spending on hospitals relative to GP and other basic health services.

The report, based on official information act requests, says that the health system already gives less to those at the bottom (despite what the public might think), even though they need more support.

Treasury figures show that an upper middle class household receives on average almost $11,000 of health services a year, whereas the households with the lowest income receive on average $6,000 of health services – despite their greater need.

The latest New Zealand Health Survey shows that one million New Zealanders had “unmet need” for primary health care in the last year – and this is worst among Maori, Pacific and low income groups.

Our health system is less equitable – that is, it does little to help those most in need – compared with those of Australia, Canada, Germany, the Netherlands and the United Kingdom. Only the USA has a more unfair health system.

The sad thing is that before 2008, Wellington’s health board was making progress in narrowing these health inequalities and helping those on the bottom. But since then, the report finds, the board has become focussed on meeting centrally imposed hospital targets.

While getting more operations done is important, it shouldn’t have come at the expense of funding frontline GP, maternity and other services – which have been cut by hundreds of thousands of dollars, and which most affect low-income households.

As the report puts it: “C&CDHB’s direction … decreased in scope and became increasingly focused on the Minister of Health’s targets.

“This narrowing of focus crowded out the previous focus the Board had on equity for the population that it serves. While previously it had led performance in addressing equity, it is now actively disinvesting in the providers that helped secure that leadership position … while at the same time push[ing] costs onto patients who could least afford to pay.”