Introduction
The primary health care system in New Zealand has undergone massive transformation over the years as the country struggles to offer a universal health care to all the New Zealanders irrespective of their social status. Rapoport, Jacobs, and Jonsson (2008, p. 78) define primary health care as “The professional health care provided in the community, usually from a general practitioner, practice nurse, pharmacist or other health professional working within a general practice.” A more detailed definition of primary health care is given by Carrin (2009, p. 65) who says, “It is essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community.” It covers a ranger of health services which include diagnosis, treatment, counselling, health education, and disease prevention (Papanicolas & Smith 2013, p. 67). With a population of about 4.5 million people, the country has been forced to find means of ensuring that its growing number of citizens has adequate access to affordable quality health care. The government has devolved the management of healthcare system to the 11 regional councils shown in the map in figure 1 below. In this study will conduct a detailed analysis of health systems organisation in New Zealand by looking at some of the health indicators such as population health status, citizen satisfaction, financial risk protection, efficiency, quality, and access to healthcare provision in this country
Current Overview of the Primary Healthcare System
The health care system in New Zealand has been transforming over the years as the government tries to ensure that all its citizens have access to affordable quality healthcare services. The performance of the primary health care system started improving in 1995 when the government lifted most of the restrictions to the investors into the healthcare sector. This led to massive growth of private hospitals in some of the major cities such as Auckland, Christchurch, and Wellington. This offered a challenge to the public sector healthcare facilities that had to adjust their care services in order to match the competition offered by the private sector hospitals. One of the main issues that this government has been trying to address is the inequality in healthcare provisions that existed in the country in the past. The creation of Primary Health Care Strategy in 2001 was a major effort from the government to ensure that the problem of inequality was solved.
The aim of this policy was to ensure that the poor members of the society can access quality health care without having to pay hefty medical fees. In order to ensure that this vision is achieved, the government launched primary health organisations to set a clear direction of what the public health institutions had to do in order to boost their operations. Hunter (2008, p. 97) observes that in 2009, the national government of New Zealand developed a Better Sooner More Convenient approach as a way of integrating health care services among the secondary and primary health providers. In order to ensure that the policy works properly, the ministry of health decentralised the strategy implementation to the district levels where the district health boards were put in charge to ensure that the primary and secondary health providers were integrated. Following the directives from the ministry of health through District Health Boards, most of the public health care providers have also started the Care Closer to Home program where healthcare professionals, especially the registered nurses, offer to work with the local communities as a way of bringing their services to the village level. This was specifically designed to help address the problem of a section of the New Zealanders who were not comfortable with the typical hospital setting.
Recent policy developments and reforms
The local health care professionals have also played a major role in promoting the performance of health care institutions in this country. These professionals have opted to form groups at the local level to help in addressing the local problems. The research by Gottret and Schieber (2006, p. 78) shows that one such successful group is Primary Health Care Nursing Advisory Committee in Wairarapa region that has been working closely with the local community. This region is sparsely populated, with most of its residents practicing large scale agriculture. It has the Europeans, Pacific Islanders, and the Maori. Designing local health care services has played a major role in boosting the performance of these institutions because in most of the cases, the services offered are individualised. This means that patients can express themselves freely to these professionals so that some of their fears can be addressed appropriately. The move has seen a rise in the number of the marginalized people visiting hospitals frequently than before, a sign that the strategy is a success. These committees have been receiving direct support from the government in order to finance their activities.
According to Perrot and Roodenbeke (2012, p. 78), although the Maoris have received special attention because it has was underserved, other regions within this country have also received enough attention from the organisations offering community-based healthcare services. The research by Spil and Schuring (2006, p. 57) reveals that the government established Primary Health Organisations across the country in the year 2002 to help in the provision of health care services to ethnic groups that were underserved. The government’s focus was on the this marginalized group, especially the Ngati Kahunguni tribe in Wairarapa district. They had shunned hospitals and the statistics were showing that they were the worst affected group by some of the manageable diseases that could be easily treated in hospitals. In 2013, the government started promoting people-centred primary care to boost the performance of conventional ambulatory medical care that has been common in the past (McMurray & Clendon 2011, p. 113). These services were not only offered to them, but also to other populations such as the Asians and Europeans who were in remote locations within the country. The table below shows a comparison of different communities in New Zealand approach to collaborative community healthcare provision.
It is important to determine the difference between these two types of health care systems. The table below helps in bringing out these differences.
Table 2: Comparing People Centred Health Care and Ambulatory Medical Care.
As shown in the above table, the ambulatory medical care lacks the personal relationship between the care providers and the recipients. Hunter (2008, p. 31) says that in the current society, it may be necessary to have an individualistic attention given by a doctor to the patient in order to determine uniqueness of the problem of the patient. It is a fact that the population that the conventional medical care doctors and nurses have to deal with may not allow them to have an individualistic relationship with their patients. This weakness is perfectly addressed by the people-cantered primary health care facilities at the local levels.
System’s Performance
According to Johnson and Stoskopf (2010, p. 121), “New Zealand’s primary health care system has experienced dramatic changes since 2000, changes that government officials say have already improved access to its services for all the marginalized groups and the rest of the population.” This scholar notes that although the country is yet to achieve a universal healthcare provision for every citizen, it is rapidly moving towards this visions and with the current programs, and it will be achievable. The reviews of the work done by the health sector in this country to address health problems indicate that the performance of this sector has been impressive over the last few years (Beaglehole & Bonita, 2004). One major achievement has been the move by the health care professionals to move primary care closer to the people. With direct support from the government, these professionals have been able to penetrate the remote areas within this country that were previously ignored by the previous health care system.
Performance goals
As Figueras and McKee (2012) state, it is important to set clear, measurable, and achievable goals when developing a primary health care system. The following diagram shows a four-step approach that should be followed when developing performance objectives.
Setting Performance Goals
The model above should that the first step in setting of the goal should be the definition of what is to be achieved before setting a realistic objective. The next step would be to state the objectives in measurable terms. The team should then evaluate the measurements to determine if it is achievable. The last stage would be to manage the system in order to achieve the desired success. As opposed to other systems, all healthcare systems are very sensitive because they involve life. Any failure in the system may result into serious health complication or even loss of life. New Zealand’s primary health care system has specific performance goals that should be achieved after specific periods. When starting the initiative of Primary Health Organisations in New Zealand, the government was aiming at achieving a 100% enrolment of the local communities into the system. This was to ensure that the local communities are attended to within the shortest period possible without having to go to the referral hospitals.
It would also enable the patients to have their health problems diagnosed early so that they can be treated before its advanced stages. The 100% enrolment of the local communities into the system was to be achieved by the end of the year 2018. Currently, the country has achieved an average of 94% enrolment, a sign that it is moving towards the right direction. It was also expected that through this initiative, all the complex diseases such as cancer would be detected at the right stage so that patients would receive specialised care within the shortest period possible. To make this system more effective, the government planned to have an average of 2 local primary care institutions per every territorial authority. With a total of 67 territorial authorities, it would be expected that by 2017, there will be 134 primary health organisations spread across the country. Currently, there are 82 such institutions.
Performance measures
According to Johnson and Stoskopf (2010, p. 122), it is important to develop a quantifiable indicator that can be used to determine how well the system is moving towards achieving its set objectives. The performance indicator measures that were set for the system were based on the performance goals set by the government and other stakeholders that were involved in People Centred Primary Health Care Project. The performance measures in this community based healthcare provision project were in terms of the percentage of what was originally planned. The first performance goal stated above was achievement of 100% enrolment into the local primary health organisations by the local communities. The measure will be the percentage success of this goal by the end of the year. It is also expected that by the end of the year 2017, there will be 134 primary healthcare institutions in the country at the local levels. The following are some of the specific areas of performance measures that would be used to determine how successful the program is in achieving its objectives.
Population health status
The term population health is a relatively new term that is widely used in Canada. The definition of the term population health is still not universally accepted. Figueras and McKee (2012) say “The study of population health is focused on understanding health and disease in community, and on improving health and well-being through priority health approaches addressing the disparities in health status between social groups.” This statement clearly brings out fundamental issues about population health. When looking at population health status in New Zealand, some of the issues that will need to be analyzed are health disparities, disease management among the populace, and other health related facts among the study population. The People Centred Primary Health Care Project has played a major role in promoting the health status of many New Zealand citizens who have been directly involved in one way or the other in its implementation. The figure below shows some of the areas that have witnessed significant changes since the program were implemented.
The graph clearly indicates that people cantered collaborative approach to delivering health care had positive impact on patients suffering from chronic diseases. The programmes helped in enlightening them on how to handle themselves in various contexts. After going through the programmes, they were in better positions to handle their delicate conditions. The medical practitioners were also able to understand the needs of their patients. This strategy helped in improving the health status of the patients in the country.
Citizen satisfaction
It is important to determine the level of citizens satisfaction from the services they receive from New Zealand’s Health Care System. Sometimes the best way of determining the level of success is to assess citizen’s level of satisfaction with the services offered to them. They are the recipients of these services, and they will be in a better position to determine if the services meet their expectations. The research by OECD (2012, p. 89) shows that over 85% of the citizens of this country are comfortable with the services offered to them. Although this percentage may appear satisfactory, it is important for the relevant authority to determine why 15% of country’s populace is yet to be satisfied with the services. Coming up with measures that can address their issues may be the first step towards achieving 100% satisfaction level. The Ministry of Health, through the relevant boards, should make an effort to find out why 15% of the population is not satisfied, and the measures that can be taken to address this problem.
Financial risk protection
According to the research by Hefford, Crampton and Foley (2005, p. 21), it is clear that getting quality healthcare in this country comes with some financial risks that may not be favourable to the citizens who are economically challenged. Collaborative People Centred Primary Health Care Project helps in the protection of individuals from issues such as catastrophic financial loss. The research by Cumming and Mays (2009, p. 19) shows that a section of the citizens in New Zealand are unable to meet the rising cost of health in the country. They are forced to compromise on their health because they cannot afford to visit private hospitals that offer high quality healthcare services. This program is helpful to the economically challenged because it eliminates the financial barrier that may hinder a section of the society from accessing quality healthcare. The participating doctors are volunteers who feel that they have the responsibility to offer their services to the less fortunate members of the society. This means that the concerned individuals will be protected from catastrophic financial loss, especially when dealing with health problems that requires a lot of money to address.
Efficiency
The new approach taken by New Zealand Primary Health Care providers has focused on offering community based healthcare services as a way of reaching out to those who have been avoiding hospitals. According to the research by Smith and Janes (2008, p. 44) Wairarapa region is the biggest beneficiary of this new system and can attest to its efficiency. The efficiency of the new system is clearly demonstrates in the manner at which the healthcare providers have integrated with local population in addressing healthcare challenges of the locals. This efficiency has been demonstrated at Te Rangimaire clinic which has been a major source of medical help for the locals, especially the minority populations who were initially opposed to it. Through the initiative of the doctors and nurses in this region, they have come to appreciate that they can get medical help from these institutions. The efficiency has been promoted by the fact that doctors are able to understand the concerns of the local population better. The local people are also well informed about the relevance of the healthcare institutions, and the role they are supposed to play in order to improve the quality of services they receive from the healthcare providers. The figure below shows some changes that have taken place in the healthcare sector in this country.
Access
According to Howell and Cordery (2013, p. 33), it is very important to ensure that all the citizens of this country have access to quality healthcare services whenever they need it. The ministry of health, in conjunction with other private health care providers, have been struggling to ensure that there is quality healthcare provision to all the citizens of the country at affordable costs. The new system that has been embraced by the government has made health care services accessible to people in terms of their costs and geographic locations. Some of the mobile clinics serve people in very remote locations. The clinics established in various regions across the country are operating at costs that are subsidised by the government. The government has enrolled people from communities that are considered marginalized in order to enhance access to medical services. The table below shows the statistics of those who have received the subsidy in the recent past.
The table above shows number of people from the marginalized group who have been enrolled into government subsidy programmes that allows access to affordable healthcare services. The extra funding from other stakeholders, especially large companies operating locally, makes health care services even more accessible because of the low fees. The decision to move these facilities to the local level was meant to make them readily accessible to the people. It eliminated the need to travel to major cities such as Auckland or Christchurch when seeking medical attention.
Quality
It is important to note that although taking health care services close to the people was a noble move towards improving accessibility of the services, the strategy can only make sense if the services are of the right quality. According to Lee and North (2013, p. 318), any mistake made by a medical practitioner may have serious negative impact on the patient, and this means that the ministry of health, through the district boards, must ensure that the quality offered meets the international standards. In most of the clinics spread across the country, there are highly skilled physicians responsible for taking care of the patients who visit the facility for various medical problems. The bed capacity in most of the hospitals has also been on the rise for the past one decade, a sign that the ministry is keen on improving the quality of the health care services. It means that these hospitals are more equipped now than ever before, to offer quality medical services to both the inpatients and outpatients. The use of the modern assistive technologies for detection and treatment of diseases in these mobile centres have improved the quality of the services even further.
Organisation
The ministry of health of New Zealand has been responsible for the new programme that is focused on promoting primary healthcare through community-based approach. The figure below shows the organisational structure of the stakeholders who are involved in the policy formulation and implementation of the programme..
As shown in the diagram above, the ministry of health is responsible for all the policy formulation and implementation through various organs. This collaborative community based primary healthcare provision involves various stakeholders, including corporate institutions. The tasks are implemented at the clinic levels. At each of the clinics, there will be project managers who will be responsible for the management activities at the centres. The project members will include the physicians, nurses, and other staff members who will participate in this programme.
Financing
Funding of the primary health care in New Zealand is a primary responsibility of the government of New Zealand. However, the collaborative community-based health care provision project has received massive support from corporate bodies in this country. Although corporate institutions have played a major role in funding similar projects in the past, it would be necessary to have direct support from the government. The New Zealand’s government, through the Ministry of Health, should increase its budget for the program. The diagram below shows the trends in expenditure of the New Zealand’s health sector as compared to other country’s health sectors as a cumulative percentage of the GDP of the country.
As shown in the above diagram, there was a consistent rise in the expenditure in health care sector from 1950 to 2010, not only in this country, but also in other countries around the world. According to Joumard (2010, p. 56), this expenditure has risen even further in the recent times given the increase in the number of people suffering from lifestyle diseases and other chronic illness. The increased funding of the ministry should be reflected in the allocations given to. This should not eliminate the extra funding that comes from the corporate institutions that have been supporting this course.
Purchasing
There has been a problem of procurement in this program, especially because of the existing confusion of the level at which some of the equipment and medical products should be bought. Centralised procurement will be inexpensive when purchasing these items because they will be bought in bulk. It also helps to eliminate the middlemen who may inflate the cost of these items. Expensive machines used in diagnosis and treatment of patients should be procured through this approach (Schneider 2011, p. 87). They can then be transported to various locations across the country. The second tear will involve decentralised procurement approach that will be done at the local clinics. This will involve purchase of non-involving items that are specific to particular regions. Such expenses will be authorised by the project managers at the clinics.
Regulatory policies
The ministry of health must understand the fact that regularity policies are needed in order to ensure that the public is not subjected to substandard healthcare services that may affect them negatively. Developing regulatory policies by the ministry of health to guide the implementation of the program is core to achieving success. Although individual clinics will be at liberty to individualise their services to meet local needs, it is necessary to have a common blueprint that should be followed by all the clinics for the purpose of uniformity. The regulatory task will be the responsibility of the ministry through the appointed projects’ coordinator. The projects’ coordinator will need to ensure that the performance of the system meets the expectations.
According to Johnson and Stoskopf (2010, p. 93), developing regulatory policies requires a sense of leadership. The individual people at the management unit must ensure that the policies developed will help in maintaining employee motivation. The nurses working at the village clinics are sacrificing the amenities found in the cities to ensure that people in these regions stay healthy. They need to be motivated. Using Transformational Leadership Theory may be the best method that can be used to maintain this motivated. The leaders must make the junior employees feel valued. This will help in creating a sense of responsibility among all the medical practitioners within the country, a fact the will improve their performance.
Conclusion
The discussion above reveals that primary health care system in New Zealand has undergone through massive transformation over the years following changes made to improve its service delivery. It has been redesigned to meet the local needs. This has brought various changes in the sector. According to the analysis above, it is clear that the performance of the New Zealand health system has been impressive in the recent years. Over 80% of the Maoris, most of the Asians and Pacific Islanders currently use services offered by the local medical clinics developed through this new program. In order to achieve the vision of the program, the following recommendations should be observed.
Policy recommendations
It is clear from the above analysis that the New Zealand primary health care system has improved massively over the past few years. The community based approach to delivering primary healthcare services to the local population has been considered to be the best approach that can be used to address health problems among financially challenged people. Based on the critical analysis done on the performance of New Zealand health system, the following recommendations should be observed.
- There have been complaints that the collaborative community-based primary care programmes are underfinanced. The government should increase funds for this sector in order to improve the quality of services they offer.
- The government should equip the clinics with modern tools and skilled medical practitioners. This may help in early detection and treatment of some chronic diseases.
- The government should ensure that all the clinics have all the relevant professionals in various fields to address a variety of problems.
- It is vital for the ministry of health to develop common policies and procedures for all the local clinics across the country, but they should be given room to make some decisions based on the local forces.
- The government should ensure that there is a clear communication system that will enable integration of different departments within the ministry.
- All the stakeholders, especially the medical staff, the local communities, and the sponsors should be integrated in the program in order to make them work as a unit. This promotes chances of achieving success.
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