The report looks at the readiness of New Zealand’s health system to cope with the changing needs of an ageing population.
“In many respects, New Zealand’s health care system is well placed to adapt to the challenge of chronic disease in an ageing population. Many of the developments in primary care and chronic disease management since the mid-1990s have the potential to position the system to respond efficiently and effectively. However, the changes needed to address chronic disease in an ageing population are complex, multi-faceted and need to take place at every level in the system.”
Leadership is needed as well as “concerted local action involving collaboration between managers and clinicians. They are also likely to require continuous evaluation, learning and adaptation.”
The report suggests that the issues it identifies have “…been acted on to some extent, but they have rarely been articulated in terms of their collective contribution to sustaining a largely free at the point of use, universal health care system in the face of an increase in people living with long term health conditions and an increasingly constrained budget. As a result, implementation has been incomplete and/or patchy.”
Most health professionals seem not to “…recognise the imperative for major change.”
The Ministry of Health has stated that “[i]ntegrated care is particularly valuable for frail, older people and those with long-term conditions – both populations are expected to present growing challenges for the health system.”
It has also decided to “…implement a work programme to improve the clinical integration of health services for the benefit of patients, avoiding the risks of fragmented delivery.” There is an emphasis on clinical and professional leadership, governance issues with good information and regional planning.
The report broadly supports these principles though notes a lack of detail.
“The key issue therefore will be whether the system progresses in the desired direction. To detect this, there is a pressing need for a much more systematic programme of monitoring and independent evaluation of the process and impact of the recent changes discussed above and any changes resulting from the Government’s new commitment to clinical integration.”
The report recommends a “…large-scale pilot that seeks to bring together the main elements of a new model of integrated care that seeks to tackle the issues outlined in this paper, including removing financial barriers to primary medical care, creating a regional entity that provides a full range of primary and secondary services, and is focused on innovative methods for managing chronic disease. Such an entity would be paid not to deliver episodes of care, but to keep people well and out of hospital.”
The key objectives should be to define the extent of the scope of the public system, to contain costs, to increase effectiveness and efficiency and to improve productivity. As the report says, the “full set of basic options for managing in this situation is simple to state and hard to implement in detail.”
PensionReforms agrees that health systems should be undergoing the same kind of self-examination and reform as retirement income systems. The report suggests that more cross-discipline care (less silo-oriented) seems needed to deal with the long-term needs of older citizens and their chronic conditions. A single ‘solution’ is most unlikely. Technology is likely to play a much larger part than now. (File size 1.3 MB; 76 pp) 682