Health Targets

The Government has poured a huge amount of extra money into Vote Health since 1999, yet health outcomes have only marginally improved, or in some cases even got worse.

A CIS report found:

•  Public health spending doubled in the last ten years, and has increased in real terms by 49% since 2000.
• Since 2000 the increase in life expectancy has slowed right down. From 2000 to 2004 (the latest available year) the average has only moved from 78.7 to 79.4 years.
• The rate of decrease in the infant mortality rate has slowed since 1997
• hospital efficiency would appear to have fallen by 7.7% over the last three years.’
• The number of elective surgery operations has actually declined since 2000, from 107,366 operations to 105,437 in 2006.
• Hospital readmission rates—a key indicator of the quality of care—are unchanged from 2000.
• Hospital mortality rates are unchanged from 2000.

Yesterday the Government finally, after eight years, announced a focus on outcomes rather than inputs or outputs.  This is a good thing as one can then judge the value of any extra spending.  The ten targets are:

1. To increase immunisation rates of two year olds from 77% to 95%
2. Increase from 54% to 85% the proportion of adolescents utilising oral health services
3. An undefined increase for each DHB in elective service discharges
4. Cancer patients to wait less than eight weeks for treatment to commence after assessment
5. Reduce the number of avoidable hospital admissions
6. Increase the percentage of diabates sufferers who have annual checks, and retinal screening
7. 90% of mental health patients have up-to-date  relapse prevention plans
8. Increase  proportion of infants breastfed to 74%, from 67%, at six weeks
9. Increase the proportion of “never smokers” in year ten students by 2% from 54% to 56%
10. Reduce the budget spent on the Ministry of Health from 1.85% to 1.65% by 2009/10

Now these are a good step forward.  However a few criticisms:

• Most have no date associated with them
• Three of them have no hard target for improvement
•  Some go for an easy outcome but not the best outcome such as targeting the rate of diabetes checking rather than actually aiming to lower the rate of diabates.
  Same also aiming to have more mental health plans in place rather than a more ambitious target of fewer occurrences of mental health problems
• The Ministry spending target is not very ambitious considering the total health spend is known to be budgeted to increase greatly by 2010 anyway.

It’s just a pity the Government has introduced these outcome targets at such a late stage we may never get to judge them on how well they do in implementing them.

Hopefully though future focus from the Government will be on these outcomes, not just on inputs and outputs as Pete Hodgsosn did in the very release announcing these where he claims:

• 150,000 New Zealand women get free mammograms each year
• an additional $2.2 billion has gone into primary healthcare
• an extra 4000 nurses and 1200 doctors have been employed

All true and maybe all good, but the point of health spending isn’t for money spent, more doctors and more nurses, or even more cancer checks.  It is to have a lower mortality rate from cancer, a healthier population, less illness etc etc.