New Zealand’s Health System Indicators
Written by Tom Varghese
The performance of New Zealand’s health system has always been measured. The focus of our attention has changed over time. In the 1990s, it was elective surgery access. By the 2000s, it became emergency department waiting.
Health targets were a set of national performance measures in place from 2007 to 2020, designed to improve the performance of health services. However, health targets have had their share of criticism of never being a reliable assessment of how well health services are performing.
These targets have now been replaced by the Health System Indicators (HSI). The HSI framework has been developed by the MoH and HQSC. It builds on the System Level Measures programme and include 12 indicators based on the Government’s six priorities for health: improving child wellbeing, improving mental wellbeing, improving wellbeing through preventative measures, creating a strong and equitable public health system, better primary healthcare and a financially sustainable health system.. It was found that the previous health targets have led to "perverse" outcomes as some hospitals were only driven to meet them without actually providing services that the people needed or wanted.
There are several conditions affecting New Zealanders’ health, including heart disease, strokes, diabetes and cancers, that are measured and monitored.
HSIs hope to perform a different function. They will tell us whether the health system overall is working to improve the health of all New Zealanders, and what we need to do to make it better. In contrast to the targets, the indicators don’t have a set percentage of compliance to aim for. But they will still report the actual performance, such as the percentage of two-year-olds who have been fully immunised.
These indicators are a mature improvement on the former targets. It is good that their scope is widened beyond what can be counted. Advocates claim that it is good to have indicators that will make the health sector look outside the hospital walls to see what changes can be made in the community that will make a true difference to New Zealand’s health outcomes. The emphasis is on continuous improvement at a local level, rather than focusing attention on achieving nationally set performance targets. The indicators will be publicly reported on every three months
But there are glaring omissions. The health system relies on people to keep it going and deliver timely and accessible healthcare. Yet, the acute workforce shortage faced by the sector has not been addressed, despite having a detrimental effect across the health system and fatiguing health professionals who are the prime driver of health system improvement. Workforce wellbeing as an indicator of sector performance has not been included.
Will HSI’s cut the mustard? Time will tell.
